Surgical navigation system for laparoscopic lateral pelvic lymph node dissection in rectal cancer surgery using laparosc
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Surgical navigation system for laparoscopic lateral pelvic lymph node dissection in rectal cancer surgery using laparoscopic‑vision‑tracked ultrasonic imaging Lei Ma1 · Junchen Wang2 · Hidemichi Kiyomatsu1 · Hiroyuki Tsukihara1 · Ichiro Sakuma1 · Etsuko Kobayashi1 Received: 25 June 2020 / Accepted: 4 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Laparoscopic lateral pelvic lymph node dissection (LPLND) in rectal cancer surgery requires considerable skill because the pelvic arteries, which need to be located to guide the dissection, are covered by other tissues and cannot be observed on laparoscopic views. Therefore, surgeons need to localize the pelvic arteries accurately before dissection, to prevent injury to these arteries. Methods This report proposes a surgical navigation system to facilitate artery localization in laparoscopic LPLND by combining ultrasonic imaging and laparoscopy. Specifically, free-hand laparoscopic ultrasound (LUS) is employed to capture the arteries intraoperatively in this approach, and a laparoscopic vision-based tracking system is utilized to track the LUS probe. To extract the artery contours from the two-dimensional ultrasound image sequences efficiently, an artery extraction framework based on local phase-based snakes was developed. After reconstructing the three-dimensional intraoperative artery model from ultrasound images, a high-resolution artery model segmented from preoperative computed tomography (CT) images was rigidly registered to the intraoperative artery model and overlaid onto the laparoscopic view to guide laparoscopic LPLND. Results Experiments were conducted to evaluate the performance of the vision-based tracking system, and the average reconstruction error of the proposed tracking system was found to be 2.4 mm. Then, the proposed navigation system was quantitatively evaluated on an artery phantom. The reconstruction time and average navigation error were 8 min and 2.3 mm, respectively. A navigation system was also successfully constructed to localize the pelvic arteries in laparoscopic and open surgeries of a swine. This demonstrated the feasibility of the proposed system in vivo. The construction times in the laparoscopic and open surgeries were 14 and 12 min, respectively. Conclusions The experimental results showed that the proposed navigation system can guide laparoscopic LPLND and requires a significantly shorter setting time than the state-of-the-art navigation systems do. Keywords Surgical navigation · Free-hand ultrasound · Vision-based tracking · Vessel segmentation In rectal cancer, a malignant tumor arises from the inner wall of the rectum. Approximately 50,000 people are diagnosed with rectal cancer in Japan every year [1]. Currently, surgery is the main treatment option for rectal cancer. In the surgical treatment of rectal cancer with possible lymphatic metastasis * Etsuko Kobayashi [email protected]‑tokyo.ac.jp 1
Graduate School of Engineering, The U
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