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Real-time Computed Tomography-based Augmented Reality for Natural Orifice Transluminal Endoscopic Surgery Navigation

Institution:
1Minimally Invasive and Bariatric Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
2Department of Surgery Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
3Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
4Center for Integration of Medicine and Innovative Technology Image Guidance Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Publisher:
John Wiley & Sons, Inc.
Publication Date:
Sep-2012
Journal:
Br J Surg
Volume Number:
99
Issue Number:
9
Pages:
1246-53
Citation:
Br J Surg. 2012 Sep;99(9):1246-53.
PubMed ID:
22864885
PMCID:
PMC3677565
Appears in Collections:
NCIGT, SLICER
Sponsors:
K25 HL104085/HL/NHLBI NIH HHS/United States
P41 EB015898/EB/NIBIB NIH HHS/United States
P41 RR019703/RR/NCRR NIH HHS/United States
R25 CA089017/CA/NCI NIH HHS/United States
Generated Citation:
Azagury D.E., Ryou M., Shaikh S.N., San Jose Estepar R., Lengyel B.I., Jayender J., Vosburgh K.G., Thompson C.C. Real-time Computed Tomography-based Augmented Reality for Natural Orifice Transluminal Endoscopic Surgery Navigation. Br J Surg. 2012 Sep;99(9):1246-53. PMID: 22864885. PMCID: PMC3677565.
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BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) is technically challenging owing to endoscopic short-sighted visualization, excessive scope flexibility and lack of adequate instrumentation. Augmented reality may overcome these difficulties. This study tested whether an image registration system for NOTES procedures (IR-NOTES) can facilitate navigation. METHODS: In three human cadavers 15 intra-abdominal organs were targeted endoscopically with and without IR-NOTES via both transgastric and transcolonic routes, by three endoscopists with different levels of expertise. Ease of navigation was evaluated objectively by kinematic analysis, and navigation complexity was determined by creating an organ access complexity score based on the same data. RESULTS: Without IR-NOTES, 21 (11·7 per cent) of 180 targets were not reached (expert endoscopist 3, advanced 7, intermediate 11), compared with one (1 per cent) of 90 with IR-NOTES (intermediate endoscopist) (P = 0·002). Endoscope movements were significantly less complex in eight of the 15 listed organs when using IR-NOTES. The most complex areas to access were the pelvis and left upper quadrant, independently of the access route. The most difficult organs to access were the spleen (5 failed attempts; 3 of 7 kinematic variables significantly improved) and rectum (4 failed attempts; 5 of 7 kinematic variables significantly improved). The time needed to access the rectum through a transgastric approach was 206·3 s without and 54·9 s with IR-NOTES (P = 0·027). CONCLUSION: The IR-NOTES system enhanced both navigation efficacy and ease of intra-abdominal NOTES exploration for operators of all levels. The system rendered some organs accessible to non-expert operators, thereby reducing one impediment to NOTES procedures.

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