Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan.
J Hepatobiliary Pancreat Sci. 2010 Sep;17(5):629-36. doi: 10.1007/s00534-009-0199-y. Epub 2009 Oct 2.
We applied a new concept of "image overlay surgery" consisting of the integration of virtual reality (VR) and augmented reality (AR) technology, in which dynamic 3D images were superimposed on the patient's actual body surface and evaluated as a reference for surgical navigation in gastrointestinal, hepatobiliary and pancreatic surgery.
We carried out seven surgeries, including three cholecystectomies, two gastrectomies and two colectomies. A Macintosh and a DICOM workstation OsiriX were used in the operating room for image analysis. Raw data of the preoperative patient information obtained via MDCT were reconstructed to volume rendering and projected onto the patient's body surface during the surgeries. For accurate registration, OsiriX was first set to reproduce the patient body surface, and the positional coordinates of the umbilicus, left and right nipples, and the inguinal region were fixed as physiological markers on the body surface to reduce the positional error.
The registration process was non-invasive and markerlesss, and was completed within 5 min. Image overlay navigation was helpful for 3D anatomical understanding of the surgical target in the gastrointestinal, hepatobiliary and pancreatic anatomies. The surgeon was able to minimize movement of the gaze and could utilize the image assistance without interfering with the forceps operation, reducing the gap from the VR. Unexpected organ injury could be avoided in all procedures. In biliary surgery, the projected virtual cholangiogram on the abdominal wall could advance safely with identification of the bile duct. For early gastric and colorectal cancer, the small tumors and blood vessels, which usually could not be found on the gastric serosa by laparoscopic view, were simultaneously detected on the body surface by carbon dioxide-enhanced MDCT. This provided accurate reconstructions of the tumor and involved lymph node, directly linked with optimization of the surgical procedures.
Our non-invasive markerless registration using physiological markers on the body surface reduced logistical efforts. The image overlay technique is a useful tool when highlighting hidden structures, giving more information.
我们应用了一种新的“图像叠加手术”概念，该概念包括虚拟现实（VR）和增强现实（AR）技术的整合，其中动态 3D 图像叠加在患者的实际身体表面上，并作为胃肠、肝胆胰手术导航的参考进行评估。
我们进行了七例手术，包括三例胆囊切除术、两例胃切除术和两例结肠切除术。在手术室中使用 Macintosh 和 DICOM 工作站 OsiriX 进行图像分析。通过 MDCT 获得的术前患者信息的原始数据被重建为体积渲染，并在手术期间投射到患者的身体表面上。为了进行准确的配准，首先在 OsiriX 中设置复制患者身体表面，并将脐、左右乳头和腹股沟区域的位置坐标固定为身体表面上的生理标记，以减少位置误差。
配准过程是非侵入性的，无需标记，且在 5 分钟内完成。图像叠加导航有助于胃肠道、肝胆胰解剖结构中手术目标的 3D 解剖理解。外科医生可以减少眼球的移动，并可以在不干扰钳子操作的情况下利用图像辅助，从而减少与 VR 的差距。所有手术均避免了意外的器官损伤。在胆道手术中，腹壁上投射的虚拟胆管造影可以安全推进，并识别胆管。对于早期胃和结直肠癌，通过腹腔镜观察通常无法在胃浆膜上发现的小肿瘤和血管，可以通过二氧化碳增强 MDCT 同时在身体表面上检测到。这提供了肿瘤和受累淋巴结的准确重建，直接与手术程序的优化相关。
我们使用身体表面上的生理标记进行的非侵入性无标记配准减少了物流工作。图像叠加技术是突出隐藏结构、提供更多信息的有用工具。
