Megali Giuseppe, Ferrari Vincenzo, Freschi Cinzia, Morabito Bruno, Cavallo Filippo, Turini Giuseppe, Troia Elena, Cappelli Carla, Pietrabissa Andrea, Tonet Oliver, Cuschieri Alfred, Dario Paolo, Mosca Franco
EndoCAS Center, Università di Pisa, Italy.
Int J Med Robot. 2008 Sep;4(3):242-51. doi: 10.1002/rcs.203.
Computer-assisted surgery (CAS) systems are currently used in only a few surgical specialties: ear, nose and throat (ENT), neurosurgery and orthopaedics. Almost all of these systems have been developed as dedicated platforms and work on rigid anatomical structures. The development of augmented reality systems for intra-abdominal organs remains problematic because of the anatomical complexity of the human peritoneal cavity and especially because of the deformability of its organs. The aim of the present work was to develop and implement a highly modular platform (targeted for minimally invasive laparoscopic surgery) generally suitable for CAS, and to produce a prototype for demonstration of its potential clinical application and use in laparoscopic surgery.
In this paper we outline details of a platform integrating several aspects of CAS and medical robotics into a modular open architecture: the EndoCAS navigator platform, which integrates all the functionalities necessary for provision of computer-based assistance to surgeons during all the management phases (diagnostic work-up, planning and intervention). A specific application for computer-assisted laparoscopic procedures has been developed on the basic modules of the platform. The system provides capabilities for three-dimensional (3D) surface model generation, 3D visualization, intra-operative registration, surgical guidance and robotic assistance during laparoscopic surgery. The description of specific modules and an account of the initial clinical experience with the system are reported.
We developed a common platform for computer assisted surgery and implemented a system for intraoperative laparoscopic navigation. The preliminary clinical trials and feedback from the surgeons on its use in laparoscopic surgery have been positive, although experience has been limited to date.
We have successfully developed a system for computer-assisted technologies for use in laparoscopic surgery and demonstrated, by early clinical trials, that the introduction of these technologies in operative laparoscopy, even though they are not yet sufficiently accurate (from an engineering viewpoint) for surgical treatment of intra-abdominal disease, brings added benefits to the execution of interventions by surgeons and hence represents concrete on-going progress in interventional technology.
计算机辅助手术（CAS）系统目前仅在少数外科专业中使用：耳鼻喉科（ENT）、神经外科和骨科。几乎所有这些系统都是作为专用平台开发的，并且适用于刚性解剖结构。由于人体腹膜腔的解剖复杂性，尤其是其器官的可变形性，用于腹腔内器官的增强现实系统的开发仍然存在问题。本研究的目的是开发并实施一个高度模块化的平台（针对微创腹腔镜手术），该平台一般适用于计算机辅助手术，并制作一个原型以展示其潜在的临床应用以及在腹腔镜手术中的使用。
在本文中，我们概述了一个将计算机辅助手术和医疗机器人技术的多个方面集成到模块化开放架构中的平台的详细信息：EndoCAS导航平台，该平台集成了在所有管理阶段（诊断检查、规划和干预）为外科医生提供基于计算机的辅助所需的所有功能。在该平台的基本模块上开发了一种用于计算机辅助腹腔镜手术的特定应用。该系统提供了三维（3D）表面模型生成、3D可视化、术中配准、手术引导以及腹腔镜手术期间的机器人辅助功能。报告了特定模块的描述以及该系统的初步临床经验。
我们开发了一个用于计算机辅助手术的通用平台，并实施了一个用于术中腹腔镜导航的系统。尽管迄今为止经验有限，但初步临床试验以及外科医生对其在腹腔镜手术中使用的反馈是积极的。
我们成功开发了一种用于腹腔镜手术的计算机辅助技术系统，并通过早期临床试验证明，在手术腹腔镜检查中引入这些技术，即使从工程角度来看它们对于腹腔内疾病的手术治疗还不够精确，但仍为外科医生执行干预带来了额外的益处，因此代表了介入技术方面切实的持续进展。
