Department of Hepatobiliary Surgery, The Second Hospital of Hebei Medical University, 215 Heping West Road, Hebei, 050000, Shijiazhuang, China.
Hebei Medical University, Shijiazhuang, Hebei, China.
BMC Surg. 2022 Apr 11;22(1):139. doi: 10.1186/s12893-022-01585-0.
Laparoscopy is widely used in pancreatic surgeries nowadays. The efficient and correct judgment of the location of the anatomical structures is crucial for a safe laparoscopic pancreatic surgery. The technologies of 3-dimensional(3D) virtual model and image fusion are widely used for preoperative planning and intraoperative navigation in the medical field, but not in laparoscopic pancreatic surgery up to now. We aimed to develop an intraoperative navigation system with an accurate multi-modality fusion of 3D virtual model and laparoscopic real-time images for laparoscopic pancreatic surgery.
The software for the navigation system was developed ad hoc. The preclinical study included tests with the laparoscopic simulator and pilot cases. The 3D virtual models were built using preoperative Computed Tomography (CT) Digital Imaging and Communications in Medicine (DICOM) data. Manual and automatic real-time image fusions were tested. The practicality of the navigation system was evaluated by the operators using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) method.
The 3D virtual models were successfully built using the navigation system. The 3D model was correctly fused with the real-time laparoscopic images both manually and automatically optical orientation in the preclinical tests. The statistical comparative tests showed no statistically significant differences between the scores of the rigid model and those of the phantom model(P > 0.05). There was statistically significant difference between the total scores of automatic fusion function and those of manual fusion function (P = 0.026). In pilot cases, the 3D model was correctly fused with the real-time laparoscopic images manually. The Intraoperative navigation system was easy to use. The automatic fusion function brought more convenience to the user.
The intraoperative navigation system applied in laparoscopic pancreatic surgery clearly and correctly showed the covered anatomical structures. It has the potentiality of helping achieve a more safe and efficient laparoscopic pancreatic surgery.
腹腔镜技术目前已广泛应用于胰腺外科手术中。准确判断解剖结构的位置对于安全的腹腔镜胰腺手术至关重要。三维（3D）虚拟模型和图像融合技术广泛应用于术前规划和术中导航，但在腹腔镜胰腺手术中尚未应用。本研究旨在开发一种具有准确多模态融合的 3D 虚拟模型和腹腔镜实时图像的术中导航系统，用于腹腔镜胰腺手术。
专门开发了导航系统软件。该研究包括腹腔镜模拟器测试和初步临床案例。使用术前计算机断层扫描（CT）数字成像和通信医学数字成像和通信（DICOM）数据构建 3D 虚拟模型。测试手动和自动实时图像融合。操作人员使用美国国家航空航天局任务负荷指数（NASA-TLX）方法评估导航系统的实用性。
导航系统成功构建了 3D 虚拟模型。在预临床测试中，3D 模型通过手动和自动光学定向正确地与实时腹腔镜图像融合。统计比较测试显示，刚性模型和虚拟模型的评分之间没有统计学差异（P>0.05）。自动融合功能的总评分与手动融合功能的评分之间存在统计学差异（P=0.026）。在初步临床案例中，手动将 3D 模型与实时腹腔镜图像正确融合。术中导航系统易于使用。自动融合功能为用户带来了更多便利。
应用于腹腔镜胰腺手术的术中导航系统清晰、正确地显示了覆盖的解剖结构。它具有帮助实现更安全、更有效的腹腔镜胰腺手术的潜力。
