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首页> 外文期刊>European urology >Augmented reality: a new tool to improve surgical accuracy during laparoscopic partial nephrectomy? Preliminary in vitro and in vivo results.
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Augmented reality: a new tool to improve surgical accuracy during laparoscopic partial nephrectomy? Preliminary in vitro and in vivo results.

机译：增强现实：在腹腔镜部分肾切除术中提高手术准确性的新工具？初步的体外和体内结果。

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摘要

BACKGROUND: Use of an augmented reality (AR)-based soft tissue navigation system in urologic laparoscopic surgery is an evolving technique. OBJECTIVE: To evaluate a novel soft tissue navigation system developed to enhance the surgeon's perception and to provide decision-making guidance directly before initiation of kidney resection for laparoscopic partial nephrectomy (LPN). DESIGN, SETTING, AND PARTICIPANTS: Custom-designed navigation aids, a mobile C-arm capable of cone-beam imaging, and a standard personal computer were used. The feasibility and reproducibility of inside-out tracking principles were evaluated in a porcine model with an artificially created intraparenchymal tumor in vitro. The same algorithm was then incorporated into clinical practice during LPN. INTERVENTIONS: Evaluation of a fully automated inside-out tracking system was repeated in exactly the same way for 10 different porcine renal units. Additionally, 10 patients underwent retroperitoneal LPNs under manual AR guidance by one surgeon. MEASUREMENTS: The navigation errors and image-acquisition times were determined in vitro. The mean operative time, time to locate the tumor, and positive surgical margin were assessed in vivo. RESULTS AND LIMITATIONS: The system was able to navigate and superpose the virtually created images and real-time images with an error margin of only 0.5 mm, and fully automated initial image acquisition took 40 ms. The mean operative time was 165 min (range: 135-195 min), and mean time to locate the tumor was 20 min (range: 13-27 min). None of the cases required conversion to open surgery. Definitive histology revealed tumor-free margins in all 10 cases. CONCLUSIONS: This novel AR tracking system proved to be functional with a reasonable margin of error and image-to-image registration time. Mounting the pre- or intraoperative imaging properties on real-time videoendoscopic images in a real-time manner will simplify and increase the precision of laparoscopic procedures.
机译：背景：在泌尿外科腹腔镜手术中使用基于增强现实（AR）的软组织导航系统是一项不断发展的技术。目的：评估一种新颖的软组织导航系统，以增强外科医生的知觉并在腹腔镜部分肾切除术（LPN）肾切除术开始之前直接提供决策指导。设计，设置和参与者：使用了定制设计的导航辅助设备，能够进行锥形束成像的移动C型臂和一台标准个人计算机。在具有人工创建的实质内肿瘤的猪模型中评估了由内而外追踪原理的可行性和可重复性。然后在LPN期间将相同的算法纳入临床实践。干预措施：以完全相同的方式对10个不同的猪肾单位重复了一个由内而外的全自动跟踪系统的评估。此外，有10位患者在一名外科医生的手动AR指导下接受了腹膜后LPN。测量：导航误差和图像获取时间是在体外确定的。在体内评估平均手术时间，定位肿瘤的时间和手术切缘阳性。结果与局限性：该系统能够导航和叠加虚拟创建的图像和实时图像，误差范围仅为0.5毫米，全自动初始图像采集需要40毫秒。平均手术时间为165分钟（范围：135-195分钟），定位肿瘤的平均时间为20分钟（范围：13-27分钟）。没有一个病例需要转换为开放手术。明确的组织学检查显示所有10例患者均无肿瘤。结论：这种新颖的AR跟踪系统被证明可以正常工作，并具有合理的误差范围和图像到图像的配准时间。以实时方式将术前或术中成像特性安装在实时视频内窥镜图像上将简化并提高腹腔镜手术的精度。

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