Abstract
By intervening during the early stage of gestation, fetal surgeons aim to correct or minimize the effects of congenital disorders. As compared to postnatal treatment of these disorders, such early interventions can often actually save the life of the fetus and also improve the quality of life of the newborn. However, fetal surgery is considered one of the most challenging disciplines within Minimally Invasive Surgery (MIS), owing to factors such as the fragility of the anatomic features, poor visibility, limited manoeuvrability, and extreme requirements in terms of instrument handling with precise positioning. This work is centered on a fetal laser surgery procedure treating placental disorders. It proposes the use of haptic guidance to enhance the overall safety of this procedure and to simplify instrument handling. A method is described that provides effective guidance by installing a forbidden region virtual fixture over the placenta, thereby safeguarding adequate clearance between the instrument tip and the placenta. With a novel application of all-optical ultrasound distance sensing in which transmission and reception are performed with fibre optics, this method can be used with a sole reliance on intraoperatively acquired data. The added value of the guidance approach, in terms of safety and performance, is demonstrated in a series of experiments with a robotic platform.
Highlights
Instruments for Minimally Invasive Surgery (MIS) are typically long and slender, to provide access to tissues deep within the body, with access typically performed through small incisions
This paper develops a haptic guidance scheme that aims at increasing the safety and the interventional outcome for laser-based coagulation tasks in to-twin transfusion syndrome (TTTS) procedures
In order to not interfere with the normal workflow, rather than imposing a predefined rich motion pattern to acquire information on n, we propose to use an Extended Kalman Filter (EKF)
Summary
Instruments for Minimally Invasive Surgery (MIS) are typically long and slender, to provide access to tissues deep within the body, with access typically performed through small incisions. With MIS, there tend to be shorter hospital stays, faster recoveries, and cosmetic benefits, as compared to open surgeries [1]. When an open surgical approach is taken, a rather large uterine incision is made, which is believed to lead to an increased likelihood of preterm birth [2]. A recent study from Petersen et al indicated that increases in access diameter might lead to increases in the likelihood of premature delivery before 28 weeks [3]. Fetoscopic interventions, where the placenta and fetus are accessed through small incisions in the amniotic sac, are the preferred approach
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
