Laparoscopic Video Research Articles

Intelligent viewpoint selection for efficient CT to video registration in laparoscopic liver surgery

PurposeMinimally invasive surgery offers advantages over open surgery due to a shorter recovery time, less pain and trauma for the patient. However, inherent challenges such as lack of tactile feedback and difficulty in controlling bleeding lower the percentage of suitable cases. Augmented reality can show a better visualisation of sub-surface structures and tumour locations by fusing pre-operative CT data with real-time laparoscopic video. Such augmented reality visualisation requires a fast and robust video to CT registration that minimises interruption to the surgical procedure.MethodsWe propose to use view planning for efficient rigid registration. Given the trocar position, a set of camera positions are sampled and scored based on the corresponding liver surface properties. We implement a simulation framework to validate the proof of concept using a segmented CT model from a human patient. Furthermore, we apply the proposed method on clinical data acquired during a human liver resection.ResultsThe first experiment motivates the viewpoint scoring strategy and investigates reliable liver regions for accurate registrations in an intuitive visualisation. The second experiment shows wider basins of convergence for higher scoring viewpoints. The third experiment shows that a comparable registration performance can be achieved by at least two merged high scoring views and four low scoring views. Hence, the focus could change from the acquisition of a large liver surface to a small number of distinctive patches, thereby giving a more explicit protocol for surface reconstruction. We discuss the application of the proposed method on clinical data and show initial results.ConclusionThe proposed simulation framework shows promising results to motivate more research into a comprehensive view planning method for efficient registration in laparoscopic liver surgery.

Training value of laparoscopic colorectal videos on the World Wide Web: a pilot study on the educational quality of laparoscopic right hemicolectomy videos.

Instructive laparoscopy videos with appropriate exposition could be ideal for initial training in laparoscopic surgery, but unfortunately there are no guidelines for annotating these videos or agreed methods to measure the educational content and the safety of the procedure presented. Aim of this study is to systematically search the World Wide Web to determine the availability of laparoscopic colorectal surgery videos and to objectively establish their potential training value. A search for laparoscopic right hemicolectomy videos was performed on the three most used English language web search engines Google.com, Bing.com, and Yahoo.com; moreover, a survey among 25 local trainees was performed to identify additional websites for inclusion. All laparoscopic right hemicolectomy videos with an English language title were included. Videos of open surgery, single incision laparoscopic surgery, robotic, and hand-assisted surgery were excluded. The safety of the demonstrated procedure was assessed with a validated competency assessment tool specifically designed for laparoscopic colorectal surgery and data on the educational content of the video were extracted. Thirty-one websites were identified and 182 surgical videos were included. One hundred and seventy-three videos (95%) detailed the year of publication; this demonstrated a significant increase in the number of videos published per year from 2009. Characteristics of the patient were rarely presented, only 10 videos (5.4%) reported operating time and only 6 videos (3.2%) reported 30-day morbidity; 34 videos (18.6%) underwent a peer-review process prior to publication. Formal case presentation, the presence of audio narration, the use of diagrams, and snapshots and a step-by-step approach are all characteristics of peer-reviewed videos but no significant difference was found in the safety of the procedure. Laparoscopic videos can be a useful adjunct to operative training. There is a large and increasing amount of material available for free on the internet, but this is currently unregulated.

Guided Laparoscopic Video Tutorials for Medical Student Instruction in Abdominal Anatomy.

As technological advances present new forms of media to anatomy educators involved in medical education, there is opportunity to expand on traditional dissection of embalmed cadavers. At the University of California, San Francisco School of Medicine, the surgery and anatomy departments collaborated to create guided video tutorials using laparoscopic surgical footage to teach the anatomy of the lesser sac and gastroesophageal junction. These tutorials are instructional adjuncts to a laparoscopy session on fresh cadavers with first-year medical students. Students view the videos on their own before attending the anatomy lab. The anatomy lab includes six 30-minute sessions, in which approximately 22 students at a time leave their cadaver lab to participate in this laparoscopy session taught by colorectal surgeons and general surgery residents. Learner interest and satisfaction was measured through a postsession survey. Nearly all respondents indicated that the videos helped them learn the anatomy of the gastroesophageal junction and lesser sac, and were a valuable addition to dissection of embalmed cadavers. A second session was conducted with first-year medical students in which a pretest and posttest were administered before and after a screening of the tutorial on the gastroesophageal junction. Learners' average scores on the test improved from 39% to 88% after watching the video. These data indicate that learners appreciate the incorporation of laparoscopy and video tutorials into anatomy education. These data further corroborate the measures of student enthusiasm, and support the value of the tutorials in short-term acquisition of anatomic knowledge.

Use of augmented reality in laparoscopic gynecology to visualize myomas

To report the use of augmented reality (AR) in gynecology. AR is a surgical guidance technology that enables important hidden surface structures to be visualized in endoscopic images. AR has been used for other organs, but never in gynecology and never with a very mobile organ like the uterus. We have developed a new AR approach specifically for uterine surgery and demonstrated its use for myomectomy. Tertiary university hospital. Three patients with one, two, and multiple myomas, respectively. AR was used during laparoscopy to localize the myomas. Three-dimensional (3D) models of the patient's uterus and myomas were constructed before surgery from T2-weighted magnetic resonance imaging. The intraoperative 3D shape of the uterus was determined. These models were automatically aligned and "fused" with the laparoscopic video in real time. The live fused video made the uterus appear semitransparent, and the surgeon can see the location of the myoma in real time while moving the laparoscope and the uterus. With this information, the surgeon can easily and quickly decide on how best to access the myoma. We developed an AR system for gynecologic surgery and have used it to improve laparoscopic myomectomy. Technically, the software we developed is very different to approaches tried for other organs, and it can handle significant challenges, including image blur, fast motion, and partial views of the organ.

Intraoperative Archive of Right Colonic Vascular Variability Aids Central Vascular Ligation and Redefines Gastrocolic Trunk of Henle Variants.

Vascular supply to the right colon has become an issue because of high variability and subsequent impact on minimally invasive surgery. Past cadaveric or radiologic anatomic assessments are noncomprehensive. Intraoperative charting of right colonic arteriovenous anatomy was undertaken to determine the incidence and scope of vascular variations. Vascular anatomy variations were documented in snapshot images, captured during laparoscopic video recordings or through open surgical digital photography. Data were drawn from consecutive right hemicolectomies, routinely entailing complete mesocolic excision with central vascular ligation. Seventy patients (mean age, 62.7 years; 37 women (52.8%); 33 men (47.2%)), each with surgically treatable right-sided colon cancer, were prospectively studied. Both ileocolic and middle colic arteries were regularly identified (100%), with right colic artery present in 41.4% of patients. Ileocolic and middle colic veins consistently drained into the right colon. Although the ileocolic vein always emptied into the superior mesenteric vein, drainage of the middle colic vein was split (superior mesenteric vein, 94.3%; gastrocolic trunk of Henle, 5.3%), as was drainage of the right colic (superior mesenteric vein, 43.3%; gastrocolic trunk of Henle, 56.7%) and accessory middle colic veins (superior mesenteric vein, 54.5%; gastrocolic trunk of Henle, 45.5%), present in 42.9% and 15.7% of patients. Gastrocolic trunk of Henle was found in 88.6% of patients, usually draining into the superior mesenteric vein. No significant sex-related differences were present regarding the incidence and scope of variability displayed by the right colic artery, right colic vein, accessory middle colic vein, or gastrocolic trunk of Henle classification (p > 0.05). The inconsistency between cadaver and live surgery anatomy and the low BMI of the Asian population might be drawbacks of our study. Variations in right colonic arteriovenous channels, assessed intraoperatively, corroborate those established by cadaveric and radiologic means, prompting a new gastrocolic trunk of Henle classification.

Navigation of a robot-integrated fluorescence laparoscope in preoperative SPECT/CT and intraoperative freehand SPECT imaging data: a phantom study.

Robot-assisted laparoscopic surgery is becoming an established technique for prostatectomy and is increasingly being explored for other types of cancer. Linking intraoperative imaging techniques, such as fluorescence guidance, with the three-dimensional insights provided by preoperative imaging remains a challenge. Navigation technologies may provide a solution, especially when directly linked to both the robotic setup and the fluorescence laparoscope. We evaluated the feasibility of such a setup. Preoperative single-photon emission computed tomography/X-ray computed tomography (SPECT/CT) or intraoperative freehand SPECT (fhSPECT) scans were used to navigate an optically tracked robot-integrated fluorescence laparoscope via an augmented reality overlay in the laparoscopic video feed. The navigation accuracy was evaluated in soft tissue phantoms, followed by studies in a human-like torso phantom. Navigation accuracies found for SPECT/CT-based navigation were 2.25 mm (coronal) and 2.08 mm (sagittal). For fhSPECT-based navigation, these were 1.92 mm (coronal) and 2.83 mm (sagittal). All errors remained below the <1-cm detection limit for fluorescence imaging, allowing refinement of the navigation process using fluorescence findings. The phantom experiments performed suggest that SPECT-based navigation of the robot-integrated fluorescence laparoscope is feasible and may aid fluorescence-guided surgery procedures.

EndoNet: A Deep Architecture for Recognition Tasks on Laparoscopic Videos.

Surgical workflow recognition has numerous potential medical applications, such as the automatic indexing of surgical video databases and the optimization of real-time operating room scheduling, among others. As a result, surgical phase recognition has been studied in the context of several kinds of surgeries, such as cataract, neurological, and laparoscopic surgeries. In the literature, two types of features are typically used to perform this task: visual features and tool usage signals. However, the used visual features are mostly handcrafted. Furthermore, the tool usage signals are usually collected via a manual annotation process or by using additional equipment. In this paper, we propose a novel method for phase recognition that uses a convolutional neural network (CNN) to automatically learn features from cholecystectomy videos and that relies uniquely on visual information. In previous studies, it has been shown that the tool usage signals can provide valuable information in performing the phase recognition task. Thus, we present a novel CNN architecture, called EndoNet, that is designed to carry out the phase recognition and tool presence detection tasks in a multi-task manner. To the best of our knowledge, this is the first work proposing to use a CNN for multiple recognition tasks on laparoscopic videos. Experimental comparisons to other methods show that EndoNet yields state-of-the-art results for both tasks.

Risk Factors for Cardiac Complications during Anesthesia for Laparoscopic Cholecystectomy Video

A prospective longitudinal cohort study was conducted in 470 patients undergoing surgery for gallstones by laparoscopic surgery provincial Hospital “Carlos Manuel de Cespedes in Bayamo, from the Cauto region during the period January 2012 to December 2014, with the aim to identify risk factors hypothetically related to the occurrence of intraoperative cardiorespiratory complications during anesthesia. The exposed cohort consisted of 147 patients who developed complications; Primary information was obtained from the medical records of operated patients. He also performed with each hypothetically influential factor, estimates of relative risk (RR) and confidence intervals 95% (95%) and hypothesis testing chi-square. Age, hypertension, ischemic heart disease were identified as the most important risk factors in the occurrence of cardiac complications in anesthesia for laparoscopic cholecystectomy video.

Risk Factors for Cardiac Complications during Anesthesia for Laparoscopic Cholecystectomy Video

Risk Factors for Cardiac Complications during Anesthesia for Laparoscopic Cholecystectomy Video

Transumbilical videolaparoscopic (single site) liver biopsy with laparoscopy equipment.

INTRODUCTION:Liver diseases have a high incidence in the whole world. In order to diagnose, stage and follow these diseases it is often necessary the execution of liver biopsy. There are many possible ways to perform the procedure and the rise of transumbilical endoscopic surgery (TUES) brings to the medical practice an additional good option.MATERIALS AND METHODS:The study is prospective, nonrandomised and cohort type. It involves 42 patients who underwent liver biopsy through TUES using conventional video laparoscopic material.RESULTS:Among the patients 18 (42.86%) underwent isolated liver biopsy and 24 (57.14%) to liver biopsy associated with umbilical hernia repair. Within those, 27 (64.28%) were male and 15 (35.71%) female. The average body mass index (BMI) was of 27.26 kg/m2, 10 were in the normal BMI range, 24 (57.14%) were in the overweight range, 6 (14.28%) had class I obesity and 2 (4.76%) had class II obesity. In none of the cases the procedure was converted to regular video laparoscopy, all the patients were discharged in the day after the procedure and reported a satisfactory aesthetic result.CONCLUSIONS:The study shows that liver biopsy using TUES has applicability and good results, including in obese patients that would have a contraindication to other methods.

Toward real-time remote processing of laparoscopic video.

Laparoscopic surgery is a minimally invasive surgical technique where surgeons insert a small video camera into the patient's body to visualize internal organs and use small tools to perform surgical procedures. However, the benefit of small incisions has a drawback of limited visualization of subsurface tissues, which can lead to navigational challenges in the delivering of therapy. Image-guided surgery uses the images to map subsurface structures and can reduce the limitations of laparoscopic surgery. One particular laparoscopic camera system of interest is the vision system of the daVinci-Si robotic surgical system (Intuitive Surgical, Sunnyvale, California). The video streams generate approximately 360MB of data per second, demonstrating a trend toward increased data sizes in medicine, primarily due to higher-resolution video cameras and imaging equipment. Processing this data on a bedside PC has become challenging and a high-performance computing (HPC) environment may not always be available at the point of care. To process this data on remote HPC clusters at the typical 30 frames per second (fps) rate, it is required that each 11.9MB video frame be processed by a server and returned within 1/30th of a second. The ability to acquire, process, and visualize data in real time is essential for the performance of complex tasks as well as minimizing risk to the patient. As a result, utilizing high-speed networks to access computing clusters will lead to real-time medical image processing and improve surgical experiences by providing real-time augmented laparoscopic data. We have performed image processing algorithms on a high-definition head phantom video (1920 × 1080 pixels) and transferred the video using a message passing interface. The total transfer time is around 53ms or 19fps. We will optimize and parallelize these algorithms to reduce the total time to 30ms.

Неотложная эндовидеохирургия при острых заболеваниях органов брюшной полости

Summary. The basis of research included results of diagnostics and treatment by videoendoscopic interventions of 1812 patients with urgent surgical diseases of abdominal cavity and also the videolaparoscopy was done for patients with diagnostic purpose. During the carried-out researches it was established that the video laparoscopy is highly effective, safe, less traumatic way of surgical treatment. The quantity of the open laparotomies and their complications as eventration, postoperative hernias and suppurations of wounds was reduced.Key words:

Proximal segmentation of the dorsal mesogastrium reveals new anatomical implications for laparoscopic surgery.

Generally, the gold standard of radical surgery for gastrointestinal (GI) tumors is en bloc resection of primary lesions and their related tissues. For gastric cancer, the ideal surgical treatment should be D2 radical gastrectomy plus complete mesogastrium excision. Complete mesogastrium excision is rarely done or mentioned since little is known about the mesogastrium and its presence is still with controversy. Topographically, the “mesogastrium” refers to a peri-gastric structure composed of “fascia propria”, enveloping lymph nodes, blood vessels and adipose tissues, which by connecting to the stomach, suspends from the posterior abdominal wall. In this study, by employing video laparoscopy, a number of proximal segments of dorsal mesogastrium were found being extensively scattered around the pancreas. The structure of the mesogastrium was further identified intraoperatively and then confirmed both grossly and histologically after the operation. Our results demonstrated the existence of mesogastrium (gastric mesentery) and its architecture. We suggest for the first time a “Table model” to describe the relationship between the stomach and gastric mesenteries enveloped by fascia propria, which might provide an improvement in the surgical methods for excision of gastric cancer.

Near‐infrared fluorescence laparoscopy‐ technical description of PINPOINT® a novel and commercially available system

The PINPOINT Endoscopic Fluorescence Imaging System is a high-definition video laparoscopy system for conventional white light laparoscopic visualization and for near-infrared fluorescence imaging with indocyanine green (ICG). This manuscript describes it's technical characteristics and performance capabilities.

A comparison of the endoscopic and laparoscopic view of the gastroesophageal junction in the use of transoral fundoplication

BackgroundEndoscopic fundoplication requires accurate evaluation of the gastroesophageal junction (GJ) to determine if hiatal hernia repair is necessary before fundoplication. We compared the endoscopic and laparoscopic evaluations of the GJ. MethodsA total of 53 patients with gastroesophageal reflux disease underwent a laparoscopic repair of a hiatal defect before endoscopic fundoplication. The video of the preoperative endoscopic evaluation was compared with the laparoscopic video (n = 44). Nine patients were excluded because both endoscopic and laparoscopic videos were not available. A 2-tailed paired t test was used to assess the difference between the 2 study groups. ResultsThe greatest transverse dimension of the hiatus assessed endoscopically was 3.30 cm ± 1.00 vs 3.88 cm ± 1.03 assessed laparoscopically, P < .001. In 22.8%, the average endoscopic Hill grade was lower than the estimated Hill grade when viewed laparoscopically. In 11.1% (range, 6% to 15%) of cases, the endoscopic view indicated a hiatal hernia repair was unnecessary when the matching laparoscopic view indicated hiatal repair would be needed. ConclusionsEndoscopic evaluation of the GJ may underestimate the radial size of the hiatal defect.

Artery to Cystic Duct: A Consistent Branch of Cystic Artery Seen in Laparoscopic Cholecystectomy.

Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is very important. Cystic artery is notoriously known to have a highly variable branching pattern. We reviewed the anatomy of the cystic artery and its branch to cystic duct as seen through the video laparoscope. A single artery to cystic duct with the classical “H-configuration” was demonstrated in 161 (91.47%) patients. This branch may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. Careful identification of artery to cystic duct is helpful in the proper dissection of Calot's triangle as it reduces the chances of hemorrhage and thus may also be helpful in prevention of extrahepatic biliary radical injuries.

Videolaparoscopia diagnóstica en ginecología

OBJETIVO: Establecer la patología ginecológica más frecuente diagnosticada mediante la videolaparoscopia. MATERIAL Y MÉTODOS: De las aproximadamente 253 videolaparoscopias diagnósticas realizadas en el Hospital "Félix Torrealva Gutiérrez", EsSalud, lca, entre marzo de 1996 y julio del 2004, se evaluó 236 casos. RESULTADOS: De las 236 intervenciones evaluadas, 125 (52,9%) fueron por infertilidad, 32 (13,6%) por dolor pélvico crónico, 31 (13,1%) por quiste de ovario, 31 (13,1%) para bloqueos tubáricos 5 (2.1%) por embarazo ectópico. Los hallazgos operatorios principalmente fueron: 42 (17,8%) casos de síndrome adherencial, 42 (17,8%) de poliquistosis ovárica, 41 (17,4%) de endometriosis, 40 (16,9%) por enfermedad pélvíca inflamatoria crónica, 32 (13,6%) de leiomiomatosis y oclusión tubárica, 32 (13,6%) de hidrosálpinx. El tipo de anestesia administrada fue la raquídea y la general inhalatoria mayoritariamente, la estancia hospitalaria promedio fue de 2 días; las complicaciones observadas fueron mínimas y referidas a 8 casos de cefalea posraquídea, 7 de infección de herida operatoria, 7 de infección de la vía urinaria; 6 casos fueron convertidos a laparotomía. Se hizo uso de antibióticos y analgésicos en forma profiláctica. CONCLUSIÓN: La patología ginecológica más frecuente encontrada por videolaparoscopia consistió en síndrome adherencial, poliquistosis ovárica, endometriosis y enfermedad pélvica inflamatoria crónica.

Classification approach for automatic laparoscopic video database organization

One of the advantages of minimally invasive surgery (MIS) is that the underlying digitization provides invaluable information regarding the execution of procedures in various patient-specific conditions. However, such information can only be obtained conveniently if the laparoscopic video database comes with semantic annotations, which are typically provided manually by experts. Considering the growing popularity of MIS, manual annotation becomes a laborious and costly task. In this paper, we tackle the problem of laparoscopic video classification, which consists of automatically identifying the type of abdominal surgery performed in a video. In addition to performing classifications on the full recordings of the procedures, we also carry out sub-video and video clip classifications. These classifications are carried out to investigate how many frames from a video are needed to get a good classification performance and which parts of the procedures contain more discriminative features. Our classification pipeline is as follows. First, we reject the irrelevant frames from the videos using the color properties of the video frames. Second, we extract visual features from the relevant frames. Third, we quantize the features using several feature encoding methods, i.e., vector quantization, sparse coding (SC), and Fisher encoding. Fourth, we carry out the classification using support vector machines. While the sub-video classification is carried out by uniformly downsampling the video frames, the video clip classification is carried out by taking three parts of the videos (i.e., beginning, middle, and end) and running the classification pipeline separately for every video part. Ultimately, we build our final classification model by combining the features using a multiple kernel learning (MKL) approach. To carry out the experiments, we use a dataset containing 208 videos of eight different surgeries performed by 10 different surgeons. The results show that SC with K-singular value decomposition (K-SVD) yields the best classification accuracy. The results also demonstrate that the classification accuracy only decreases by 3 % when solely 60 % of the video frames are utilized. Furthermore, it is also shown that the end part of the procedures is the most discriminative part of the surgery. Specifically, by using only the last 20 % of the video frames, a classification accuracy greater than 70 % can be achieved. Finally, the combination of all features yields the best performance of 90.38 % accuracy. The SC with K-SVD provides the best representation of our videos, yielding the best accuracies for all features. In terms of information, the end part of the laparoscopic videos is the most discriminative compared to the other parts of the videos. In addition to their good performance individually, the features yield even better classification results when all of them are combined using the MKL approach.

The NifTK software platform for image-guided interventions: platform overview and NiftyLink messaging.

PurposeTo perform research in image-guided interventions, researchers need a wide variety of software components, and assembling these components into a flexible and reliable system can be a challenging task. In this paper, the NifTK software platform is presented. A key focus has been high-performance streaming of stereo laparoscopic video data, ultrasound data and tracking data simultaneously.MethodsA new messaging library called NiftyLink is introduced that uses the OpenIGTLink protocol and provides the user with easy-to-use asynchronous two-way messaging, high reliability and comprehensive error reporting. A small suite of applications called NiftyGuide has been developed, containing lightweight applications for grabbing data, currently from position trackers and ultrasound scanners. These applications use NiftyLink to stream data into NiftyIGI, which is a workstation-based application, built on top of MITK, for visualisation and user interaction. Design decisions, performance characteristics and initial applications are described in detail. NiftyLink was tested for latency when transmitting images, tracking data, and interleaved imaging and tracking data.ResultsNiftyLink can transmit tracking data at 1,024 frames per second (fps) with latency of 0.31 milliseconds, and 512 KB images with latency of 6.06 milliseconds at 32 fps. NiftyIGI was tested, receiving stereo high-definition laparoscopic video at 30 fps, tracking data from 4 rigid bodies at 20–30 fps and ultrasound data at 20 fps with rendering refresh rates between 2 and 20 Hz with no loss of user interaction.ConclusionThese packages form part of the NifTK platform and have proven to be successful in a variety of image-guided surgery projects. Code and documentation for the NifTK platform are available from http://www.niftk.org. NiftyLink is provided open-source under a BSD license and available from http://github.com/NifTK/NiftyLink. The code for this paper is tagged IJCARS-2014.

The role of staging laparoscopy in treatment of locally advanced gastric cancer.

The aim of this study was to evaluate the role of videolaparoscopy (VLP) in gastric cancer staging, particularly for the detection of peritoneal cancer, to verify its impact in changing the therapeutic conduct, as well as defining the characteristics of the group that can benefit from VLP as staging method. A prospective cohort study was conducted from May 2011 to March 2013. Thirty-two patients with gastric adenocarcinoma underwent conventional staging together with VLP staging. VLP identified peritoneal disease in 22.6% of patients. Sensitivity was 86%, and specificity was 100%. In the group with non-Borrmann IV, <8 cm tumors, and without evidence of lymphadenomegaly, VLP identified peritoneal implants in 23.1% of cases. VLP is a safe procedure capable of improving the accuracy of gastric cancer staging. There is no justification for failing to perform laparoscopy in patients with <8 cm, non-Borrmann type IV tumors and without evidence of lymphadenomegaly on preoperative examinations.