Towards scarless surgery: An endoscopic ultrasound navigation system for transgastric access procedures

R. San Jose Estepar, Nicholas Stylopoulos, Randy Ellis, Eigil Samset, C.-F. Westin, Christopher Thompson, Kirby Vosburgh
Computer Aided Surgery
Volume 12, Number 6, Pages 311-324
Novermber, 2007

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Abstract

Objective: Scarless surgery is an innovative and promising technique that may herald a new era in surgical procedures. We have created a navigation system, named IRGUS, for endoscopic and transgastric access interventions and have validated it in in vivo pilot studies. Our hypothesis is that endoscopic ultrasound procedures will be performed more easily and efficiently if the operator is provided with approximately registered 3D and 2D processed CT images in real time that correspond to the probe position and ultrasound image. Materials and Methods: The system provides augmented visual feedback and additional contextual information to assist the operator. It establishes correspondence between the real-time endoscopic ultrasound image and a preoperative CT volume registered using electromagnetic tracking of the endoscopic ultrasound probe position. Based on this positional information, the CT volume is reformatted in approximately the same coordinate frame as the ultrasound image and displayed to the operator. Results: The system reduces the mental burden of probe navigation and enhances the operator's ability to interpret the ultrasound image. Using an initial rigid body registration, we measured the mis-registration error between the ultrasound image and the reformatted CT plane to be less than 5mm, which is sufficient to enable the performance of novice users of endoscopic systems to approach that of expert users. Conclusions: Our analysis shows that real-time display of data using rigid registration is sufficiently accurate to assist surgeons in performing endoscopic abdominal procedures. By using preoperative data to provide context and support for image interpretation and real-time imaging for targeting, it appears probable that both preoperative and intraoperative data may be used to improve operator performance.

Landmark points chosen for system registration error validation and corresponding examples of the Doppler US views for each landmark point. The branching interface is coded in the Doppler US as a change of color due to a change in blood flow direction.

Reference

San Jose Estepar R, Stylopoulos N, Ellis R, Samset E, Westin CF, Thompson C, Vosburgh K. Towards scarless surgery: An endoscopic ultrasound navigation system for transgastric access procedures. Computer Aided Surgery 2007;12(6):311-324.

Bibtex entry

@ARTICLE{sanjoseCAS07,
  author         = {Raul {San Jose Estepar} and Nicholas Stylopoulos and Randy 
                   Ellis and Eigil Samset and Carl-Fredrik Westin and          
                   Christopher Thompson and Kirby Vosburgh},                   
  title          = {Towards scarless surgery: An endoscopic ultrasound         
                   navigation system for transgastric access procedures},      
  journal        = {Computer Aided Surgery},                                   
  year           = {2007},                                                     
  volume         = {12},                                                       
  pages          = {311--324},                                                 
  number         = {6},                                                        
  month          = {Novermber}
}