Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Mechanical Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA.
J Endourol. 2021 Mar;35(3):362-368. doi: 10.1089/end.2020.0363. Epub 2020 Nov 11.
Image-guided surgery (IGS) allows for accurate, real-time localization of subsurface critical structures during surgery. No prior IGS systems have described a feasible method of intraoperative reregistration after manipulation of the kidney during robotic partial nephrectomy (PN). We present a method for seamless reregistration during IGS and evaluate accuracy before and after tumor resection in two validated kidney phantoms. We performed robotic PN on two validated kidney phantoms-one with an endophytic tumor and one with an exophytic tumor-with our IGS system utilizing the da Vinci Xi robot. Intraoperatively, the kidney phantoms' surfaces were digitized with the da Vinci robotic manipulator via a touch-based method and registered to a three-dimensional segmented model created from cross-sectional CT imaging of the phantoms. Fiducial points were marked with a surgical marking pen and identified after the initial registration using the robotic manipulator. Segmented images were displayed via picture-in-picture in the surgeon console as tumor resection was performed. After resection, reregistration was performed by reidentifying the fiducial points. The accuracy of the initial registration and reregistration was compared. The root mean square (RMS) averages of target registration error (TRE) were 2.53 and 4.88 mm for the endophytic and exophytic phantoms, respectively. IGS enabled resection along preplanned contours. Specifically, the RMS averages of the normal TRE over the entire resection surface were 0.75 and 2.15 mm for the endophytic and exophytic phantoms, respectively. Both tumors were resected with grossly negative margins. Point-based reregistration enabled instantaneous reregistration with minimal impact on RMS TRE compared with the initial registration (from 1.34 to 1.70 mm preresection and from 1.60 to 2.10 mm postresection). We present a novel and accurate registration and reregistration framework for use during IGS for PN with the da Vinci Xi surgical system. The technology is easily integrated into the surgical workflow and does not require additional hardware.
图像引导手术（IGS）可实现手术过程中对亚表面关键结构的精确、实时定位。之前没有任何 IGS 系统描述过在机器人辅助部分肾切除术（PN）过程中肾脏操作后术中重新配准的可行方法。我们提出了一种在 IGS 期间进行无缝重新配准的方法，并在两个经过验证的肾脏模型中评估了肿瘤切除前后的准确性。我们使用达芬奇 Xi 机器人对两个经过验证的肾脏模型（一个有内生肿瘤，一个有外生肿瘤）进行了机器人辅助 PN。术中，通过基于触摸的方法，使用达芬奇机器人操纵器对肾脏模型的表面进行数字化处理，并将其与从模型的断层 CT 成像创建的三维分割模型进行配准。使用手术标记笔标记基准点，并在初始配准后使用机器人操纵器进行识别。在进行肿瘤切除时，通过画中画在外科医生控制台中显示分割图像。切除后，通过重新识别基准点进行重新配准。比较了初始配准和重新配准的准确性。内生和外生模型的靶标配准误差（TRE）的均方根（RMS）平均值分别为 2.53 和 4.88 毫米。IGS 使沿着预定轮廓进行切除成为可能。具体而言，内生和外生模型整个切除表面的正常 TRE 的 RMS 平均值分别为 0.75 和 2.15 毫米。两个肿瘤均被切除，切缘均为阴性。与初始配准相比，基于点的重新配准可以实现瞬时重新配准，对 RMS TRE 的影响最小（从 1.34 毫米到 1.70 毫米，术前；从 1.60 毫米到 2.10 毫米，术后）。我们提出了一种用于达芬奇 Xi 手术系统的 PN 期间 IGS 的新型、准确的配准和重新配准框架。该技术易于集成到手术工作流程中，不需要额外的硬件。
