Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Translational Surgical Oncology, National Center for Tumor Diseases - Partner Site Dresden, Dresden, Germany.
Surg Endosc. 2018 Sep;32(9):4052-4061. doi: 10.1007/s00464-018-6135-y. Epub 2018 Mar 5.
This study aimed at developing and evaluating a tool for computer-assisted 3D bowel length measurement (BMS) to improve objective measurement in minimally invasive surgery. Standardization and quality of surgery as well as its documentation are currently limited by lack of objective intraoperative measurements. To solve this problem, we developed BMS as a clinical application of Quantitative Laparoscopy (QL).
BMS processes images from a conventional 3D laparoscope. Computer vision algorithms are used to measure the distance between laparoscopic instruments along a 3D reconstruction of the bowel surface. Preclinical evaluation was performed in phantom, ex vivo porcine, and in vivo porcine models. A bowel length of 70 cm was measured with BMS and compared to a manually obtained ground truth. Afterwards 70 cm of bowel (ground truth) was measured and compared to BMS.
Ground truth was 66.1 ± 2.7 cm (relative error + 5.8%) in phantom, 65.8 ± 2.5 cm (relative error + 6.4%) in ex vivo, and 67.5 ± 6.6 cm (relative error + 3.7%) in in vivo porcine evaluation when 70 cm was measured with BMS. Using 70 cm of bowel, BMS measured 75.0 ± 2.9 cm (relative error + 7.2%) in phantom and 74.4 ± 2.8 cm (relative error + 6.3%) in ex vivo porcine evaluation. After thorough preclinical evaluation, BMS was successfully used in a patient undergoing laparoscopic Roux-en-Y gastric bypass for morbid obesity.
QL using BMS was shown to be feasible and was successfully translated from studies on phantom, ex vivo, and in vivo porcine bowel to a clinical feasibility study.
本研究旨在开发和评估一种用于计算机辅助 3D 肠长测量（BMS）的工具，以改善微创手术中的客观测量。由于缺乏客观的术中测量，目前手术的标准化和质量及其记录受到限制。为了解决这个问题，我们开发了 BMS，作为定量腹腔镜（QL）的临床应用。
BMS 处理来自常规 3D 腹腔镜的图像。计算机视觉算法用于测量腹腔镜器械在肠表面 3D 重建上的距离。在体模、离体猪和活体猪模型中进行了临床前评估。使用 BMS 测量 70cm 的肠长，并与手动获得的真实值进行比较。然后测量 70cm 的肠（真实值）并与 BMS 进行比较。
当使用 BMS 测量 70cm 时，体模中的真实值为 66.1±2.7cm（相对误差+5.8%），离体猪中为 65.8±2.5cm（相对误差+6.4%），活体猪中为 67.5±6.6cm（相对误差+3.7%）。使用 70cm 的肠，BMS 在体模中测量的长度为 75.0±2.9cm（相对误差+7.2%），离体猪中为 74.4±2.8cm（相对误差+6.3%）。经过彻底的临床前评估，BMS 成功应用于一名接受腹腔镜 Roux-en-Y 胃旁路术治疗病态肥胖的患者。
使用 BMS 的 QL 被证明是可行的，并已成功从体模、离体猪和活体猪肠的研究转化为临床可行性研究。
