Efficiency, Accuracy and Clinical Applicability of a New Image-Guided Surgery System in 3D Laparoscopic Liver Surgery
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ORIGINAL ARTICLE
Efficiency, Accuracy and Clinical Applicability of a New Image-Guided Surgery System in 3D Laparoscopic Liver Surgery Gian Andrea Prevost 1 & Benjamin Eigl 2,3 & Iwan Paolucci 2 & Tobias Rudolph 3 & Matthias Peterhans 3 & Stefan Weber 2 & Guido Beldi 1 & Daniel Candinas 1 & Anja Lachenmayer 1 Received: 23 June 2019 / Accepted: 1 September 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Background To investigate efficiency, accuracy and clinical benefit of a new augmented reality system for 3D laparoscopic liver surgery. Methods All patients who received laparoscopic liver resection by a new image-guided surgery system with augmented 3Dimaging in a university hospital were included for analysis. Digitally processed preoperative cross-sectional imaging was merged with the laparoscopic image. Intraoperative efficiency of the procedure was measured as time needed to achieve sufficient registration accuracy. Technical accuracy was reported as fiducial registration error (FRE). Clinical benefit was assessed trough a questionnaire, reporting measures in a 5-point Likert scale format ranging from 1 (high) to 5 (low). Results From January to March 2018, ten laparoscopic liver resections of a total of 18 lesions were performed using the novel augmented reality system. Median time for registration was 8:50 min (range 1:31–23:56). The mean FRE was reduced from 14.0 mm (SD 5.0) in the first registration attempt to 9.2 mm (SD 2.8) in the last attempt. The questionnaire revealed the ease of use of the system (1.2, SD 0.4) and the benefit for resection of vanishing lesions (1.0, SD 0.0) as convincing positive aspects, whereas image registration accuracy for resection guidance was consistently judged as too inaccurate. Conclusions Augmented reality in 3D laparoscopic liver surgery with landmark-based registration technique is feasible with only little impact on the intraoperative workflow. The benefit for detecting particularly vanishing lesions is high. For an additional benefit during the resection process, registration accuracy has to be improved and non-rigid registration algorithms will be required to address intraoperative anatomical deformation. Keywords Augmented reality . 3D . Image-guided surgery . Laparoscopy . Liver
Introduction Laparoscopic liver resection is becoming more ubiquitous and high-volume centres could recently demonstrate a reduced complication rate and less perioperative morbidity even in The paper was presented at the annual meeting of the German Society for Surgeons in Munich (26.-29.03.2019). * Gian Andrea Prevost [email protected] 1
Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
2
ARTORG Center for Biomedical Engineering Research, University of Bern, 3010 Bern, Switzerland
3
CAScination AG, 3008 Bern, Switzerland
m ajor liver surge ry com pared to op en surge ry. 1 Nevertheless, major laparoscopic liver surgery is still scarce in smaller centres mainly because of a fl
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