Image Navigation Research Articles

Automatic Labeling of Natural Landmarks for Wheelchair Motion Planning

Labeling landmarks for the mobile plan of the automatic electric wheelchair is essential, because it can assist disabled people. In particular, labeled landmark images will help the wheelchairs to locate landmarks and move more accurately and safely. Here, we propose an automatic detection of natural landmarks in RGBD images for navigation of mobile platforms in an indoor environment. This method can reduce the time for manually collecting and creating a dataset of landmarks. The wheelchair, equipped with a camera system, is allowed to move along corridors to detect and label natural landmarks automatically. These landmarks contain the camera and wheelchair positions with the 3D coordinates when storing the labeled landmark. The feature density method is comprised of Oriented FAST and Rotated BRIEF (ORB) feature extractors. Moreover, the central coordinates of the marked points in the obtained RGB images will be mapped to the images with the depth axis for determining the position of the RGB-D camera system in the spatial domain. An encoder and kinematics equations are applied to determine the position during movement. As expected, the system shows good results, such as a high IoU value of over 0.8 at a distance of less than 2 m and a fast time of 41.66 ms for object detection. This means that our technique is very effective for the automatic movement of the wheelchair.

Artificial intelligence meets medical robotics

Artificial intelligence (AI) applications in medical robots are bringing a new era to medicine. Advanced medical robots can perform diagnostic and surgical procedures, aid rehabilitation, and provide symbiotic prosthetics to replace limbs. The technology used in these devices, including computer vision, medical image analysis, haptics, navigation, precise manipulation, and machine learning (ML) , could allow autonomous robots to carry out diagnostic imaging, remote surgery, surgical subtasks, or even entire surgical procedures. Moreover, AI in rehabilitation devices and advanced prosthetics can provide individualized support, as well as improved functionality and mobility (see the figure). The combination of extraordinary advances in robotics, medicine, materials science, and computing could bring safer, more efficient, and more widely available patient care in the future. –Gemma K. Alderton

Correction: Echogenicity of Brain Structures in Huntington's Disease Patients Evaluated by Transcranial Sonography - Magnetic Resonance Fusion Imaging using Virtual Navigator and Digital Image Analysis.

Correction: Echogenicity of Brain Structures in Huntington's Disease Patients Evaluated by Transcranial Sonography - Magnetic Resonance Fusion Imaging using Virtual Navigator and Digital Image Analysis.

Microwave absorption-based magnetic liquid metal nano-missiles for thermodynamic/immunological cascade hepatoma therapy

Microwave ablation (MWA) therapy, as a local tumor hyperthermia technology, holds great promise for hepatoma treatment. However, the extensive clinical application of the MWA therapy is mired by incomplete ablation and nonspecific thermal injury. Herein, the microwave (MW) absorption-based magnetic liquid metal (MLM) nanohybrids are designed, serving as “precise strike nano-missiles for tumor” to enhance MWA technique for hepatoma therapy by MW thermodynamic synergistic priming immunomodulatory effects. The nano-missiles were prepared via encapsulating MLM into Alginate (ALG) microgels through a simple sonication process and further coating hyaluronic acid with layer-by-layer self-assembly technique (MLM@ALG-L NMs). It has excellent tumor targeting, and MRI function is introduced to offer imaging navigation for nano-missiles. MW electromagnetic energy can be absorbed by nano-missiles due to multiple loss mechanisms, showing enhanced thermal conversion efficiency to amplify thermodynamic therapy by producing abundant reactive oxygen species (ROS) and depleting glutathione (GSH). Interestingly, the MLM@ALG-L NMs-assisted MWA can activate immunomodulatory effects by increasing the presence of pro-inflammatory M1 macrophages and T lymphocytes in the tumor tissues. The strategy of thermodynamic/immunological cascade therapy shows excellent therapeutic advantages on mice-hepatoma models (enhanced therapeutic effects > 2 fold) over the traditional MWA treatment. This study establishes an innovative perspective to extend the future clinical application of MWA therapy.

Robust Detection, Segmentation, and Metrology of High Bandwidth Memory 3D Scans Using an Improved Semi-Supervised Deep Learning Approach

Recent advancements in 3D deep learning have led to significant progress in improving accuracy and reducing processing time, with applications spanning various domains such as medical imaging, robotics, and autonomous vehicle navigation for identifying and segmenting different structures. In this study, we employ the latest developments in 3D semi-supervised learning to create cutting-edge models for the 3D object detection and segmentation of buried structures in high-resolution X-ray semiconductors scans. We illustrate our approach to locating the region of interest of the structures, their individual components, and their void defects. We showcase how semi-supervised learning is utilized to capitalize on the vast amounts of available unlabeled data to enhance both detection and segmentation performance. Additionally, we explore the benefit of contrastive learning in the data pre-selection step for our detection model and multi-scale Mean Teacher training paradigm in 3D semantic segmentation to achieve better performance compared with the state of the art. Our extensive experiments have shown that our method achieves competitive performance and is able to outperform by up to 16% on object detection and 7.8% on semantic segmentation. Additionally, our automated metrology package shows a mean error of less than 2 μm for key features such as Bond Line Thickness and pad misalignment.

Automatic Generation of 3D Indoor Navigation Networks from Building Information Modeling Data Using Image Thinning

Navigation networks are a common form of indoor map that provide the basis for a wide range of indoor location-based services, intelligent tasks for indoor robots, and three-dimensional (3D) geographic information systems. The majority of current indoor navigation networks are manually modeled, resulting in a laborious and fallible process. Building Information Modeling (BIM) captures design information, allowing for the automated generation of indoor maps. Most existing BIM-based navigation systems for floor-level wayfinding rely on well-defined spatial semantics, and do not adapt well to buildings with irregular 3D shapes, which can make cross-floor path generation difficult. This research introduces an innovative approach to generating 3D indoor navigation networks automatically from BIM data using image thinning, which is referred to as GINIT. Firstly, GINIT extracts grid-based maps for floors from BIM data using only two types of semantics, i.e., slabs and doors. Secondly, GINIT captures cross-floor paths from building components by projecting 3D forms onto a 2D image, thinning the 2D image to capture the 2D projection path, and crossing over the 2D routes with 3D routes to restore the 3D path. Finally, to demonstrate the effectiveness of GINIT, experiments were conducted on three real-world multi-floor buildings, evaluating its performance across eight types of cross-layer architectural component. GINIT overcomes the dependency of space definitions in current BIM-based navigation network generation schemes by introducing image thinning. Due to the adaptability of navigation image thinning to any binary image, GINIT is capable of generating navigation networks from building components with diverse 3D shapes. Moreover, the current studies on indoor navigation network extraction mainly use geometry theory, while this study is the first to generate 3D indoor navigation networks automatically using image thinning theory. The results of this study will offer a unique perspective and foster the exploration of imaging theory applications of BIM.

Echogenicity of Brain Structures in Huntington's Disease Patients Evaluated by Transcranial Sonography - Magnetic Resonance Fusion Imaging using Virtual Navigator and Digital Image Analysis.

Transcranial sonography (TCS) magnetic resonance (MR) fusion imaging and digital image analysis are useful tools for the evaluation of various brain pathologies. This study aimed to compare the echogenicity of predefined brain structures in Huntington's disease (HD) patients and healthy controls by TCS-MR fusion imaging using Virtual Navigator and digitized image analysis. The echogenicity of the caudate nucleus (CN), substantia nigra (SN), lentiform nucleus (LN), insula, and brainstem raphe (BR) evaluated by TCS-MR fusion imaging using digitized image analysis was compared between 21 HD patients and 23 healthy controls. The cutoff values of echogenicity indices for the CN, LN, insula, and BR with optimal sensitivity and specificity were calculated using receiver operating characteristic analysis. The mean echogenicity indices for the CN (67.0±22.6 vs. 37.9±7.6, p<0.0001), LN (110.7±23.6 vs. 59.7±11.1, p<0.0001), and insula (121.7±39.1 vs. 70.8±23.0, p<0.0001) were significantly higher in HD patients than in healthy controls. In contrast, BR echogenicity (24.8±5.3 vs. 30.1±5.3, p<0.001) was lower in HD patients than in healthy controls. The area under the curve was 90.9%, 95.5%, 84.1%, and 81.8% for the CN, LN, insula, and BR, respectively. The sensitivity and specificity were 86% and 96%, respectively, for the CN and 90% and 100%, respectively, for the LN. Increased CN, LN, and insula echogenicity and decreased BR echogenicity are typical findings in HD patients. The high sensitivity and specificity of the CN and LN hyperechogenicity in TCS-MR fusion imaging make them promising diagnostic markers for HD.

Determination of sentinel lymph nodes in gynecological cancer using the radiopharmaceutical Sentiscan. A case series

Background. Lymphadenectomy in patients with malignant female genital neoplasms is a necessary step of surgical treatment, the implementation of which allows assessing the the metastatic involvement of the removed lymph nodes and determining indications for postoperative treatment. Sentinel lymph node (SLN) biopsy with ultrastaging method appears to be a good alternative to standard regional lymph node removal with similar long-term oncologic outcomes and significantly lower rates of postoperative complications.&#x0D; Aim. To present the possibility of using a domestic radiopharmaceutical labeled with technetium-99m (Sentiscan) in patients with gynecological cancer.&#x0D; Materials and methods. A series of clinical cases of the use of Sentiscan during SLN biopsy in three patients suffering from cancer of the uterus and vulva is presented.&#x0D; Results. 1824 hours before the operation, 0.4 ml of the prepared solution of radiopharmaceutical 99mTc-Sentiscan with a total activity of 150 MBq was injected into the cervix of the uterus with tumors of the uterine body and into the vulva. After 2 hours, SPECT/CT was performed on the Discovery 670 DR (GE) of the abdomen and pelvis, followed by 3D reconstruction of images for better intraoperative navigation. Intraoperatively, a portable gamma detector Rad Pointer Gamma (Medikor Pharma Ural) was used to identify sentinel lymph nodes. Sentinel lymph nodes were removed in all patients, followed by a control assessment of the gamma radiation level, histological and immunohistochemical studies using panCK, CK18 markers.&#x0D; Conclusion. Presented clinical cases demonstrated high efficacy of sentinel lymph node mapping using radiopharmaceutical Sentiscan. Further studies are necessary for wide implementation of this technology in clinical practice.

X-ray-to-visible light-field detection through pixelated colour conversion

Light-field detection measures both the intensity of light rays and their precise direction in free space. However, current light-field detection techniques either require complex microlens arrays or are limited to the ultraviolet–visible light wavelength ranges1–4. Here we present a robust, scalable method based on lithographically patterned perovskite nanocrystal arrays that can be used to determine radiation vectors from X-rays to visible light (0.002–550 nm). With these multicolour nanocrystal arrays, light rays from specific directions can be converted into pixelated colour outputs with an angular resolution of 0.0018°. We find that three-dimensional light-field detection and spatial positioning of light sources are possible by modifying nanocrystal arrays with specific orientations. We also demonstrate three-dimensional object imaging and visible light and X-ray phase-contrast imaging by combining pixelated nanocrystal arrays with a colour charge-coupled device. The ability to detect light direction beyond optical wavelengths through colour-contrast encoding could enable new applications, for example, in three-dimensional phase-contrast imaging, robotics, virtual reality, tomographic biological imaging and satellite autonomous navigation.

Needle Navigation; a New Era in the Interventional Pain Practice: A Narrative Review

Background: The hazardous effects of x-ray based technologies and shortcomings of other imaging systems like ultrasound have raised attention to create a new guiding system for interventional practice. After the introduction of virtual reality, the next challenge was how to implement it in the medical guiding systems. Medical engineering used registration aligned features of one imaging modality with real anatomical points and merged them into one single hybrid model. This augmented reality made the foundation and provided a level surface for the construction of every other new level. The next level was how to track a device in this augmented reality, which was accomplished with trackers and registration. To overcome the shortcomings of each imaging modality, the solution was fusion imaging, the combination of more than one modality to overcome the limitations of each. Nowadays, this fusion imaging plus needle tracking is the most sophisticated of navigational systems that interventionists work with. Despite clinical improvements in other medical fields like neurosurgery and urology, most of the work in the interventional pain practice has been done on phantom models and human cadavers, and there is still low experience in clinical studies about this new guiding system. Methods: The electronic search for this review included full text English article between 1990-2021 in PubMed and Google Scholar databases. The terms that have been searched are: “virtual reality”, “augmented reality”, “needle navigation”, “needle tracking”, and “fusion imaging”. Results: The navigation imaging guided system can be a practical, safe, efficient, reproducible, feasible guiding option for interventional pain procedure. Conclusions: The navigation based interventional injection is a new era in the interventional pain practice and can omit X-ray based hazardous.

Clinical application of indocyanine green fluorescence imaging navigation for pediatric renal cancer.

Indocyanine Green (ICG) fluorescence imaging has been widely used in the surgical treatment of adult renal cancers, but its application in pediatric renal cancers has rarely been reported. This study aims to summarize the experience of ICG fluorescence imaging in pediatric renal cancers and explores its safety and feasibility. The clinical features, surgical information, ICG administration regimen, near infrared radiography data in vivo and ex vivo and pathological results of children with renal cancers using ICG navigation were analyzed and summarized. There were 7 cases of renal cancer, including 4 cases of Wilms tumor (WT), 1 case of malignant rhabdoid tumor of the kidney (MRTK) and 2 cases of renal cell carcinoma (RCC). By intraoperative intravenous injection of ICG from 2.5 to 5 mg (0.05-0.67 mg/kg), the tumors were visualized in 6 cases in vivo or ex vivo, and the tumor visualization failed in 1 case due to renal artery embolization before operation. By injecting 5 mg ICG into the normal renal tissue during the operation, 3 patients achieved fluorescent localization of sentinel lymph nodes. No ICG-related adverse reactions were found in any of the patients during or after operation. ICG fluorescence imaging is safe and feasible for renal cancers in children. Intraoperative administration can achieve tumor and sentinel lymph node visualization which will facilitate the development of nephron sparing surgery (NSS). However, the technique is affected by ICG dose, anatomical conditions around the tumor, and renal blood flow. A proper dose of ICG and the complete removal of perirenal fat are helpful for the fluorescence imaging of the tumor. It has potential in the operation of renal cancer in children.

Ten-kilohertz two-photon microscopy imaging of single-cell dendritic activity and hemodynamics in vivo.

The studying of rapid neuronal signaling across large spatial scales in intact, living brains requires both high temporal resolution and versatility of the measurement device. We introduce a high-speed two-photon microscope based on a custom-built acousto-optic deflector (AOD). This microscope has a maximum line scan frequency of 400kHz and a maximum frame rate of 10,000 frames per second (fps) at . For stepwise magnification from population view to subcellular view with high spatial and temporal resolution, we combined the AOD with resonance-galvo (RS) scanning. With this combinatorial device that supports both large-view navigation and small-view high-speed imaging, we measured dendritic calcium propagation velocity and the velocity of single red blood cells (RBCs). We measured dendritic calcium propagation velocity ( ) in OGB-1-labeled single cortical neurons in mice in vivo. To benchmark the spatial precision and detection sensitivity of measurement in vivo, we also visualized the trajectories of single RBCs and found that their movement speed follows Poiseuille's law of laminar flow. This proof-of-concept methodological development shows that the combination of AOD and RS scanning two-photon microscopy provides both versatility and precision for quantitative analysis of single neuronal activities and hemodynamics in vivo.

Optimized image registration algorithm at subpixel level for Geostationary Operational Environmental Satellite-R Advanced Baseline Imager navigation and registration performance assessment

The image navigation and registration (INR) performance assessment for the Geostationary Operational Environmental Satellite-R (GOES-R) Advanced Baseline Imager (ABI) is an image registration process at the subpixel level, which involves the registration of images from GOES-R ABI with corresponding images from Landsat at the same scene. We present an optimized image registration algorithm for GOES-R ABI INR performance assessment (GAIPA): a gradient descent algorithm with a Sobel edge-enhancement procedure and a normalized lookup table (NLUT) image transformation (GDSN), which is an area-based image registration approach with Pearson correlation as the similarity metric. Sobel edge enhancements increase the sensitivity of Pearson correlations that lead to much improved registration accuracy. NLUT transformations minimize radiance differences between GOES-R ABI images acquired at different times and Landsat reference images on image registration outcomes, which lead to improvements in correlation values and quality of image registration outputs. Evaluations of registration accuracy and quality metrics in GDSN show considerable improvements in computational efficiency, registration accuracy, and quality over the approach implemented on the image INR performance assessment tool set. Pearson correlations can be effective and robust similarity metrics in image registration at the subpixel level with implementing Sobel edge enhancement and NLUT transformation. The statistical analysis of the image registration outputs for GAIPA shows the new algorithm provides considerable improvements in reducing the uncertainties in the registration outputs.

Preclinical Evaluation of CD36-Targeting Antiangiogenic Peptide ABT-510 for Near-Infrared Fluorescence Molecular Imaging of Colorectal Cancer.

Surgical resection constitutes the first choice of treatment for colorectal cancer (CRC). Despite advancements in intraoperative navigation, there remains a considerable lack of effective targeting probes for the imaging-guided surgical navigation of CRC owing to their high heterogeneity. Hence, developing a suitable fluorescent probe to detect the specific types of CRC populations is crucial. Herein, we labeled ABT-510, a small, CD36-targeting thrombospondin-1-mimetic peptide overexpressed in various cancer types, with fluorescein isothiocyanate or near-infrared dye MPA. We found that fluorescence-conjugated ABT-510 exhibited excellent selectivity and specificity toward cells or tissues with high CD36 expression. The tumor-to-colorectal signal ratios were 11.28 ± 0.61 (95% confidence interval) and 10.74 ± 0.07 (95% confidence interval) in subcutaneous HCT-116 and HT-29 tumor-bearing nude mice, respectively. Moreover, high signal contrast was observed in the orthotopic and liver metastatic CRC xenograft mouse models. Furthermore, MPA-PEG4-r-ABT-510 exhibited an antiangiogenic effect via tube information assay with human umbilical vein endothelial cells. Overall, MPA-PEG4-r-ABT-510 presents rapid and precise tumor delineation characteristics, thereby making it a desirable tool for CRC imaging and surgical navigation.

Prospective Analysis of Versatility and User Satisfaction with a Novel Single-Use Cystoscope with Working Channel

Introduction: In the present study, a prospective systematic assessment of the clinical utility of the Ambu^® aScopeTM 4 Cysto Reverse Deflection with regard to image quality, maneuverability, and navigation in an outpatient and inpatient setting was performed. Materials and Methods: A prospective multicenter study was performed for evaluation of the instrument during routine cystoscopy. We evaluated the clinical performance of the instruments using a standardized user questionnaire in different categories including image quality, treatment success, imaging of all areas of the urinary bladder, quality of navigation, flexibility of the endoscope, and satisfaction with the device. Statistical analyses were performed by SPSS using the Kruskal-Wallis and Wilcoxon-Mann-Whitney tests. A p value of p ≤ 0.05 was defined as statistically significant. Results: A total of 200 cystoscopies were performed, and the questionnaire response rate was 100%. The image quality was rated as very good in 65.5% (n = 131), good in 30.5% (n = 61), and neutral in 4% (n = 8) of cases. The criteria for poor or very poor were not mentioned. The characteristic “treatment success based on image quality” was also evaluated as very good in 49% (n = 98) and good in 50.5% (n = 101). The analysis revealed a very good or good overall impression of the examiners in all cases. Replacement of the cystoscope was not necessary during any of the examinations. However, in 3 cases, technical difficulties were documented. Further analysis of the data showed that physicians with less professional experience rated the visualization of the urinary bladder (p = 0.007) and the treatment success with regard to image quality significantly worse (p = 0.007). Conclusion: The Ambu^® aScope™ 4 Cysto Reverse Deflection shows high satisfaction values among users in clinical routine. In analogy to other studies with flexible endoscopes, urologists with more professional experience show higher satisfaction values than examiners with less training in flexible endoscopy.

Abstract 3163: Ontology guided navigation of somatic variants, mutational signatures, gene expression and histology images for pediatric cancer

Abstract PeCan Knowledgebase on St. Jude Cloud (pecan.stjude.cloud), initially developed as a resource of curated genomic variants of pediatric cancer (PeCan), is now significantly expanded to comprise a hub of interconnected data facets for over 9,000 hematologic (heme), CNS, and non-CNS solid (solid) tumor patient samples from around the world. The new data facets, which include gene expression, mutational signatures, and histology, can be explored alongside our existing variants data facet inspiring new hypothesis generation. Variants shows a genomic landscape view (i.e. oncoprint view) and gene- or genome-level view (i.e. ProteinPaint view). Expression data, generated from normalized RNA-seq of ~2,500 samples, can be explored via interactive 2-dimensional maps, revealing distinct subtypes relevant for patient stratification for precision therapy. Mutational signatures, identified from ~2,000 WGS samples, are presented as a heatmap across subtypes, in addition to a summary view for a user-defined cohort or individual sample for which we also display a mutation profile frequency plot together and identified signatures. Histology enables review of histological slide images and associated clinical notes for ~3,000 solid tumors via a searchable interface. As all samples on PeCan have been mapped to a WHO pediatric cancer classification based ontology, the user can customize the view of each data facet presented in PeCan by selecting a specific cancer subtype. Integrative analysis between the data facets has enabled new insights into pediatric cancer biology as demonstrated in the following two examples. First is the discovery of two potential subtypes of adamantinomatous craniopharyngioma. These were initially identified via expression analysis which revealed two distinct groups that were confirmed by examination of associated histology slide data which revealed delineation by brain invasion. Second is an analysis that links germline and somatic alterations in genes involved in DNA Damage Response with mutational signatures associated with homologous recombination deficiency (HRD). This provided new insights on the applicability of therapies targeting HRD in the pediatric cancer population. These examples demonstrate the potential value of PeCan in advancing clinical diagnosis classifications of pediatric cancer and exploration of new therapeutic opportunities. PeCan is an evolving knowledgebase, as we are continuously expanding the platform and adding data over time to foster scientific discovery for the global research community, with the goal of improving treatments for pediatric cancer. Citation Format: Alexander M. Gout, Stephanie Sandor, Delaram Rahbarinia, Jobin Sunny, James Madson, Lucian Vacaroiu, Wentao Yang, Ben Lansdell, Michael Macias, Samuel W. Brady, David Finkelstein, Victor Pastor, Kevin Benton, Andrew Frantz, Mark R. Wilkinson, Cynthia Cline, Brent A. Orr, Abbas Shirinifard, Elizabeth Stewart, Michael Rusch, Xin Zhou, Michael Dyer, David A. Wheeler, Clay McLeod, Jinghui Zhang. Ontology guided navigation of somatic variants, mutational signatures, gene expression and histology images for pediatric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3163.

In situ orderly self-assembly strategy affording NIR-II-J-aggregates for in vivo imaging and surgical navigation

J-aggregation, an effective strategy to extend wavelength, has been considered as a promising method for constructing NIR-II fluorophores. However, due to weak intermolecular interactions, conventional J-aggregates are easily decomposed into monomers in the biological environment. Although adding external carriers could help conventional J-aggregates stabilize, such methods still suffer from high-concentration dependence and are unsuitable for activatable probes design. Besides, these carriers-assisted nanoparticles are risky of disassembly in lipophilic environment. Herein, by fusing the precipitated dye (HPQ) which has orderly self-assembly structure, onto simple hemi-cyanine conjugated system, we construct a series of activatable, high-stability NIR-II-J-aggregates which overcome conventional J-aggregates carrier’s dependence and could in situ self-assembly in vivo. Further, we employ the NIR-II-J-aggregates probe HPQ-Zzh-B to achieve the long-term in situ imaging of tumor and precise tumor resection by NIR-II imaging navigation for reducing lung metastasis. We believe this strategy will advance the development of controllable NIR-II-J-aggregates and precise bioimaging in vivo.

493 One and Two-Level Robotic MIS TLIF With Expandable Implants Demonstrates a Favorable Safety Profile and Improved Alignment Parameters

INTRODUCTION: Minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF) is an established technique, but continues to evolve with the development of expandable titanium cages and robotic screw insertion. METHODS: This retrospective case series assessed clinical data, complications, and radiographic outcomes at short term follow-up. Screw placement was performed using intraoperative 3D imaging and robotic navigation, and TLIFs were performed via complete facetectomy from a unilateral trajectory in line with pedicle screws using titanium expandable cages. RESULTS: 22 patients, 32 levels, and 108 inserted screws were analyzed. Implants included curved cages in 14 levels, 2 straight cages (diverging “V” pattern) in 12 levels, and a single straight cage in 6 levels. 21/22 patients (95%) had decreased pain. 4/22 patients (18%) experienced complications including deep infection causing screw pullout (requiring revision), painful radiculopathy, contact dermatitis (glue), and UTI. 108/108 screws (100%) showed excellent position. Increases were observed in average segmental lordosis (4.3 ± 4.9°), anterior disc height (6.6 ± 3.5 mm), posterior disc height (4.1 ± 2.1 mm), and foraminal height (5.0 ± 3.1 mm). Improved alignment was observed in 3/3 patients (100%) with SVA &gt; 50 mm (78.3 ± 13.3 mm to 41.7 ±14.3 mm), 3/4 (75%) with pelvic tilt &gt;=25° (30.3 ± 1.5° to 22.7 ± 4.0°), 5/5 (100%) with lumbopelvic mismatch &gt; 10° (PI – LL: 21.4 ± 2.1° to 9.8 ± 8.5°), 13/13 (100%) with anterolisthesis (6.5 ± 2.3 mm to 1.8 ± 1.9 mm), and 4/4 (100%) with segmental coronal imbalance &gt;5° (8.0 ± 3.2° to 2.8 ± 1.3°). CONCLUSIONS: Robotic MIS TLIF with expandable cages has a favorable safety profile, successful short-term clinical results, and is effective at correcting mild spinal malalignment.

V06-09 ROBOT-ASSISTED NEPHRON-SPARING MANAGEMENT OF URETERAL TUMORS: PATIENT-TAILORED APPROACH WITH DEMONSTRATION OF FOUR DIFFERENT TECHNIQUES

You have accessJournal of UrologyCME1 Apr 2023V06-09 ROBOT-ASSISTED NEPHRON-SPARING MANAGEMENT OF URETERAL TUMORS: PATIENT-TAILORED APPROACH WITH DEMONSTRATION OF FOUR DIFFERENT TECHNIQUES Sumit Saini, Timothy O'Rourke, and Ashok Hemal Sumit SainiSumit Saini More articles by this author , Timothy O'RourkeTimothy O'Rourke More articles by this author , and Ashok HemalAshok Hemal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Need for renal function preservation may influence the decision to take a nephron sparing approach of segmental ureterectomy for localized ureteral tumors, as an alternative to radical nephroureterectomy. In this video we demonstrate four different individualized surgical techniques tailored according to patient’s disease. METHODS: All the surgeries were performed by single surgeon (AKH) using da Vinci (Si/Xi) robotic surgical system. For distal ureteral tumors, distal ureterectomy with bladder cuff excision/partial cystectomy with pelvic lymph node dissection (PLND) and uretero-neo-cystostomy was performed in 11 patients. Proximal ureteral tumors were addressed with segmental ureterectomy and uretero-ureterostomy in 5 patients and another patient underwent augmented anastomotic ureteroplasty using free circumferential ileal patch. Regardless of the surgical approach adopted, complete preoperative evaluation was carried out with cross sectional imaging and other investigations (renogram, retrograde pyelogram & nephrostogram) as indicated. These procedures were considered in carefully selected patients with unifocal disease associated with medical co-morbidities, advancing age, and compromised renal function. Intraoperative fluoroscopy guided navigation and/or molecular imaging using indocyanine green (intraluminal or intravascular) are also helpful. RESULTS: In this video, we have demonstrated four such techniques, including our novel approach of augmented anastomotic ureteroplasty with free circumferential ileal patch to bridge a significant defect following segmental ureterectomy. We have also highlighted our novel technique of intra-corporeal JJ stent placement. No intra or post operative complications were noted, and all the surgical margins were negative. JJ Stents was removed in about 4 weeks post-operatively. CONCLUSIONS: Robot-assisted patient-tailored approach for ureteral tumors may be effectively employed in appropriately selected patients of ureteral tumors with excision and end to end anastomosis, augmented anastomosis or uretero-neo-cystotomy with psoas hitch as an alternative to radical nephroureterectomy to salvage the ipsilateral kidney. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e511 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sumit Saini More articles by this author Timothy O'Rourke More articles by this author Ashok Hemal More articles by this author Expand All Advertisement PDF downloadLoading ...

Application of augmented reality navigation in laparoscopic and robot-assisted liver surgery

In recent years, laparoscopic surgery and robotic surgery have been widely used, and various intraoperative image navigation systems have also developed rapidly. However, the liver itself has a complex vessel and duct system, which increase the difficulty of liver surgery. The augmented reality image navigation system combines the three-dimensional reconstructed image of the liver with the real liver anatomy, which presents the specific relationship between the tumor location and the surrounding vessels for the surgeon. Compared with other intraoperative image navigation methods, augmented reality has its unique advantages. This paper provides an overview of current advances in registration technology in augmented reality image navigation system, and focuses on its applications in liver surgery, including laparoscopic surgery and robotic surgery. Finally, the technological problems and difficulties still faced at present are summarized, and future directions worth studying in this field are proposed.