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.
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.
Authors: Raúl San José Estépar; Nicholas Stylopoulos; Randy Ellis; Eigil Samset; Carl-Fredrik Westin; Christopher Thompson; Kirby Vosburgh Journal: Comput Aided Surg Date: 2007-11
Authors: Kirby G Vosburgh; Nicholas Stylopoulos; Raul San Jose Estepar; Randy E Ellis; Eigil Samset; Christopher C Thompson Journal: Gastrointest Endosc Date: 2007-05 Impact factor: 9.427
Authors: Mikael H Sodergren; Felipe Orihuela-Espina; Peter Mountney; James Clark; Julian Teare; Ara Darzi; Guang-Zhong Yang Journal: Ann Surg Date: 2011-08 Impact factor: 12.969
Authors: Peter Nau; Joel Anderson; Benjamin Yuh; Peter Muscarella; E Christopher Ellison; Lynn Happel; Vimal K Narula; W Scott Melvin; Jeffrey W Hazey Journal: Surg Endosc Date: 2010-01-07 Impact factor: 4.584
Authors: Rogier P Voermans; Brett Sheppard; Mark I van Berge Henegouwen; Paul Fockens; Douglas O Faigel Journal: Ann Surg Date: 2009-08 Impact factor: 12.969
Authors: Jeffrey W Hazey; Vimal K Narula; David B Renton; Kevin M Reavis; Christopher M Paul; Kristen E Hinshaw; Peter Muscarella; E Christopher Ellison; W Scott Melvin Journal: Surg Endosc Date: 2007-08-14 Impact factor: 4.584
Authors: Justin Sutherland; Jason Belec; Adnan Sheikh; Leonid Chepelev; Waleed Althobaity; Benjamin J W Chow; Dimitrios Mitsouras; Andy Christensen; Frank J Rybicki; Daniel J La Russa Journal: J Digit Imaging Date: 2019-02 Impact factor: 4.056