Esther Wild1, Dogu Teber2, Daniel Schmid3,4, Tobias Simpfendörfer2, Michael Müller3,5, Ann-Christin Baranski6, Hannes Kenngott7, Klaus Kopka6, Lena Maier-Hein3. 1. Junior Group Computer-assisted Interventions, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. e.wild@dkfz-heidelberg.de. 2. Department of Urology, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany. 3. Junior Group Computer-assisted Interventions, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. 4. Faculty of Mechanics and Electronics, Heilbronn University, Heilbronn, Germany. 5. mbits imaging GmbH, Bergheimer Strasse 147, 69115, Heidelberg, Germany. 6. Division of Radiopharmaceutical Chemistry, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. 7. General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Abstract
PURPOSE: Laparoscopic interventions require the precise navigation of medical instruments through the patient's body, while taking critical structures into account. Although numerous concepts have been proposed for displaying subsurface anatomical detail using augmented reality, clinical translation of these methods has suffered from a lack of robustness as well as from cumbersome integration into the clinical workflow. The purpose of this study was to investigate the feasibility of a new approach to intra-operative registration based on fluorescent markers. METHODS: The proposed approach to augmented reality visualization relies on metabolizable fluorescent markers that are attached to the target organ to guide a 2D/3D intra-operative registration algorithm. In an ex vivo porcine study, marker tracking performance is evaluated in the presence of smoke, blood, and tissue in the field of view of the endoscope. RESULTS: In contrast to state-of-the-art needle-shaped fiducial markers, the fluorescent markers can be reliably tracked when occluded by smoke, blood or tissue. This makes the new 2D/3D intra-operative registration approach considerably more robust than state-of-the-art marker-based methods. CONCLUSION: As the concept can be smoothly integrated into the clinical workflow, its potential for application in clinical laparoscopy is high.
PURPOSE: Laparoscopic interventions require the precise navigation of medical instruments through the patient's body, while taking critical structures into account. Although numerous concepts have been proposed for displaying subsurface anatomical detail using augmented reality, clinical translation of these methods has suffered from a lack of robustness as well as from cumbersome integration into the clinical workflow. The purpose of this study was to investigate the feasibility of a new approach to intra-operative registration based on fluorescent markers. METHODS: The proposed approach to augmented reality visualization relies on metabolizable fluorescent markers that are attached to the target organ to guide a 2D/3D intra-operative registration algorithm. In an ex vivo porcine study, marker tracking performance is evaluated in the presence of smoke, blood, and tissue in the field of view of the endoscope. RESULTS: In contrast to state-of-the-art needle-shaped fiducial markers, the fluorescent markers can be reliably tracked when occluded by smoke, blood or tissue. This makes the new 2D/3D intra-operative registration approach considerably more robust than state-of-the-art marker-based methods. CONCLUSION: As the concept can be smoothly integrated into the clinical workflow, its potential for application in clinical laparoscopy is high.
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