Abstract
Conventional surgical navigation systems rely on preoperative imaging to provide guidance. In laparoscopic liver surgery, insufflation of the abdomen (pneumoperitoneum) can cause deformations on the liver, introducing inaccuracies in the correspondence between the preoperative images and the intraoperative reality. This study evaluates the improvements provided by intraoperative imaging for laparoscopic liver surgical navigation, when displayed as augmented reality (AR). Significant differences were found in terms of accuracy of the AR, in favor of intraoperative imaging. In addition, results showed an effect of user-induced error: image-to-patient registration based on annotations performed by clinicians caused 33% more inaccuracy as compared to image-to-patient registration algorithms that do not depend on user annotations. Hence, to achieve accurate surgical navigation for laparoscopic liver surgery, intraoperative imaging is recommendable to compensate for deformation. Moreover, user annotation errors may lead to inaccuracies in registration processes.
Highlights
Conventional surgical navigation systems rely on preoperative imaging to provide guidance
Through in vivo assessment of augmented reality (AR) accuracy attained with state-of-the art algorithms for image-guided surgery (IGS), this study aims to test if intraoperative imaging is necessary for accurate surgical navigation for Laparoscopic Liver Resection (LLR)
AR is more accurate with intraoperative imaging
Summary
Conventional surgical navigation systems rely on preoperative imaging to provide guidance. This study evaluates the improvements provided by intraoperative imaging for laparoscopic liver surgical navigation, when displayed as augmented reality (AR). LLR is a minimally invasive procedure performed through small abdominal incisions, through which laparoscopes and extended surgical tools are inserted after inflation of the patient’s abdomen with carbon dioxide gas This process separates peritoneal layers and is commonly referred to as pneumoperitoneum. LLR are performed using laparoscopic ultrasound (US) intraoperatively to guide the surgery Preoperative images, such as computed tomography (CT) and magnetic resonance imaging (MRI), are used for decision making as well as for surgical planning[9]. Through segmentation and reconstruction processes, these images can show relevant anatomical structures in 3D Deformations such as pneumoperitoneum complicate the anatomical correlation with the CT and MRI scans that the surgeons perform during the surgery.
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