Magnetic tracking in the operation room using the da Vinci® telemanipulator is feasible

H G Kenngott,I Wegner,L Fischer,H P Meinzer,B P Müller-Stich,F Nickel,J Neuhaus,T Gehrig

doi:10.1007/s11701-012-0347-2

Abstract

In recent years, robotic assistance for surgical procedures has grown on a worldwide scale, particularly for use in more complex operations. Such operations usually require meticulous handling of tissue, involve a narrow working space and limit the surgeon’s sense of orientation in the human body. Improvement in both tissue handling and working within a narrow working space might be achieved through the use of robotic assistance. Soft tissue navigation might improve orientation by visualizing important target and risk structures intraoperatively, thereby possibly improving patient outcome. Prerequisites for navigation are its integration into the surgical workflow and accurate localization of both the instruments and patient. Magnetic tracking allows for good integration but is susceptible to distortion through metal or electro-magnetic interference, which may be caused by the operation table or a robotic system. We have investigated whether magnetic tracking can be used in combination with the da Vinci® (DV) telemanipulator in terms of stability and precision. We used a common magnetic tracking system (Aurora®, NDI Inc.) with the DV in a typical operation setup. Magnetic field distortion was evaluated using a measuring facility, with the following reference system: without any metal (R), operation table alone (T), DV in standby (D) and DV in motion (Dm). The maximum error of the entire tracking volume for R, T, D and Dm was 9.9, 32.8, 37.9 and 37.2 mm, respectively. Limiting the tracking volume to 190 mm (from cranial to caudal) resulted in a maximum error of 4.0, 8.3, 8.5 and 8.9 mm, respectively. When used in the operation room, magnetic tracking shows high errors, mainly due to the operation table. The target area should be limited to increase accuracy, which is possible for most surgical applications. The use of the da Vinci® telemanipulator only slightly aggravates the distortion and can thus be used in combination with magnetic tracking systems.

Highlights

The major beneWts of laparoscopy for the patient are a reduced need for analgesics, reduced surgical trauma, improved cosmesis and faster recovery [1]. This accounts for the worldwide acceptance of laparoscopy in the clinical setting, with its applications having expanded from simple ablative procedures to more complex operations, such as prostatectomy, gastric bypass and liver and rectal surgery [2,3,4,5]
Accuracy decreased at the periphery of the tracking volume, far from the Weld generator
This study has shown that an EMT can be reliably used with the da Vinci® surgical system (DV) within a real medical environment if the tracking volume is limited

Summary

Introduction

The major beneWts of laparoscopy for the patient are a reduced need for analgesics, reduced surgical trauma, improved cosmesis and faster recovery [1] This accounts for the worldwide acceptance of laparoscopy in the clinical setting, with its applications having expanded from simple ablative procedures to more complex operations, such as prostatectomy, gastric bypass and liver and rectal surgery [2,3,4,5]. Invasive robotic systems, such as the da Vinci® surgical system (DV) (Intuitive Surgical, Sunnyvale, CA), theoretically provide an ideal approach to address this challenge [6, 7]. Orientation in a narrow space, the identiWcation and attribution of structures and the estimation of the instrument’s position in relation to the position of risk and target structures remain diYcult [8].

Methods

Results

Conclusion