Autonomous Ultrasound-Guided Tissue Dissection
Intraoperative ultrasound imaging can act as a valuable guide during minimally invasive tumour resection. However, contemporaneous bimanual manipulation of the transducer and cutting instrument presents significant challenges for the surgeon. Both cannot
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Abstract. Intraoperative ultrasound imaging can act as a valuable guide during minimally invasive tumour resection. However, contemporaneous bimanual manipulation of the transducer and cutting instrument presents significant challenges for the surgeon. Both cannot occupy the same physical location, and so a carefully coordinated relative motion is required. Using robotic partial nephrectomy as an index procedure, and employing PVA cryogel tissue phantoms in a reduced dimensionality setting, this study sets out to achieve autonomous tissue dissection with a high velocity waterjet under ultrasound guidance. The open-source da Vinci Research Kit (DVRK) provides the foundation for a novel multimodal visual servoing approach, based on the simultaneous processing and analysis of endoscopic and ultrasound images. Following an accurate and robust Jacobian estimation procedure, dissections are performed with specified theoretical tumour margin distances. The resulting margins, with a mean difference of 0.77mm, indicate that the overall system performs accurately, and that future generalisation to 3D tumour and organ surface morphologies is warranted.
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Introduction
Many contemporary minimally invasive surgical procedures stand to benefit from intraoperative ultrasound guidance as a means of overcoming the haptic deficit imposed by having restricted access. In the context of cancerous tumour resection, the modality can provide excellent views of the interface between healthy and diseased tissues. One such case is robotic partial nephrectomy, adopted by this study as a clinical exemplar, through which the nephron-sparing approach offers the best long-term patient prognoses. However, experience tells us that the ideal paradigm of simultaneous guidance and dissection is very difficult to achieve in practice, even when registration [1] is used to co-locate endoscopic and ultrasound images. Nonetheless, rapid progress in the field of autonomous robotic surgical systems [2] points toward novel solutions to this problem. It can only be a matter of time before tumour resection requires the surgeon only in a supervisory role. © Springer International Publishing Switzerland 2015 N. Navab et al. (Eds.): MICCAI 2015, Part I, LNCS 9349, pp. 249–257, 2015. DOI: 10.1007/978-3-319-24553-9_31
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Notable examples of such systems include the Probot [3], an early computercontrolled robot capable of performing transurethral resection of the prostate (TURP), successfully translated through to human clinical trials. Preoperative transrectal ultrasound, combined with a curve-fitting procedure, was used to build 3D models of the target resection volume. Recently, the open-source da Vinci Research Kit (DVRK) [4] has facilitated a ‘robotic ultrasound surgical assistant’ [5], whereby the imaging plane of a ‘pick-up’ transducer automatically follows the tips of other instruments engaged in resection tasks. These distal coordinate frames are related to each other through an initial registration of the robot arm base frames. The cu
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