Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
Tech Coloproctol. 2022 Sep;26(9):735-743. doi: 10.1007/s10151-022-02643-8. Epub 2022 Jun 8.
We carried out robot-assisted lateral pelvic lymph node dissection (LPLND) for rectal cancer with a stereotactic navigation system. The purpose of this study was to evaluate the accuracy and feasibility of the system.
We constructed a navigation system based on the Polaris Spectra optical tracking device (Northern Digital Inc., Canada) and the open-source software 3D Slicer (version 3.8.1; http://www.slicer.org ). We used the landmark-based registration method for patient-to-image registration. Body surface landmarks and intra-abdominal landmarks were used. We evaluated the time required for registration and target registration error (TRE; the distance between corresponding points after registration) for the root of the superior gluteal artery the root of the obturator or superior vesical artery, and the obturator foramen during minimally invasive LPLND for rectal cancer. Five patients who had LPLND for rectal cancer at the University of Tokyo Hospital between September 2020 and May 2021 were enrolled.
The mean time required for registration was 49 s with the body surface landmarks and 88 s with the intra-abdominal landmarks. The mean TRE improved markedly when the registration was performed using intra-abdominal landmarks. The mean TRE of the root of the superior gluteal artery, the root of the obturator or superior vesical artery, and the obturator foramen were 55.8 mm, 53.4 mm, and 55.2 mm with the body surface landmarks and 11.8 mm, 10.0 mm, and 12.6 mm with the intra-abdominal landmarks, respectively. There were no adverse events related to the registration process.
When stereotactic navigation systems are used for minimally invasive LPLND, the use of intra-abdominal landmarks for registration is feasible and may allow simpler and more accurate navigation than the use of body surface landmarks.
我们使用立体定向导航系统为直肠癌患者实施机器人辅助侧盆淋巴结清扫术（LPLND）。本研究旨在评估该系统的准确性和可行性。
我们基于北极星光谱光学跟踪设备（加拿大 Northern Digital Inc.）和开源软件 3D Slicer（版本 3.8.1；http://www.slicer.org）构建了导航系统。我们采用基于标志点的患者-图像配准方法。使用体表标志点和腹腔内标志点。我们评估了直肠癌微创 LPLND 中用于 Superior gluteal artery 根部、Obturator 或 Superior vesical artery 根部和闭孔的体表标志点和腹腔内标志点的配准时间和目标配准误差（TRE；配准后对应点之间的距离）。2020 年 9 月至 2021 年 5 月，东京大学医院有 5 例直肠癌患者接受了 LPLND。
使用体表标志点的平均配准时间为 49 秒，使用腹腔内标志点的平均配准时间为 88 秒。使用腹腔内标志点进行配准时，TRE 明显改善。Superior gluteal artery 根部、Obturator 或 Superior vesical artery 根部和闭孔的 TRE 平均值分别为体表标志点时的 55.8mm、53.4mm 和 55.2mm，腹腔内标志点时的 11.8mm、10.0mm 和 12.6mm。无与注册过程相关的不良事件。
当立体定向导航系统用于微创 LPLND 时，使用腹腔内标志点进行配准是可行的，与使用体表标志点相比，可能使导航更简单、更准确。
