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Comparison of manual and semi-automatic registration in augmented reality image-guided liver surgery: a clinical feasibility study
- Source :
- Surgical Endoscopy
- Publication Year :
- 2020
- Publisher :
- Springer Science and Business Media LLC, 2020.
-
Abstract
- Background The laparoscopic approach to liver resection may reduce morbidity and hospital stay. However, uptake has been slow due to concerns about patient safety and oncological radicality. Image guidance systems may improve patient safety by enabling 3D visualisation of critical intra- and extrahepatic structures. Current systems suffer from non-intuitive visualisation and a complicated setup process. A novel image guidance system (SmartLiver), offering augmented reality visualisation and semi-automatic registration has been developed to address these issues. A clinical feasibility study evaluated the performance and usability of SmartLiver with either manual or semi-automatic registration. Methods Intraoperative image guidance data were recorded and analysed in patients undergoing laparoscopic liver resection or cancer staging. Stereoscopic surface reconstruction and iterative closest point matching facilitated semi-automatic registration. The primary endpoint was defined as successful registration as determined by the operating surgeon. Secondary endpoints were system usability as assessed by a surgeon questionnaire and comparison of manual vs. semi-automatic registration accuracy. Since SmartLiver is still in development no attempt was made to evaluate its impact on perioperative outcomes. Results The primary endpoint was achieved in 16 out of 18 patients. Initially semi-automatic registration failed because the IGS could not distinguish the liver surface from surrounding structures. Implementation of a deep learning algorithm enabled the IGS to overcome this issue and facilitate semi-automatic registration. Mean registration accuracy was 10.9 ± 4.2 mm (manual) vs. 13.9 ± 4.4 mm (semi-automatic) (Mean difference − 3 mm; p = 0.158). Surgeon feedback was positive about IGS handling and improved intraoperative orientation but also highlighted the need for a simpler setup process and better integration with laparoscopic ultrasound. Conclusion The technical feasibility of using SmartLiver intraoperatively has been demonstrated. With further improvements semi-automatic registration may enhance user friendliness and workflow of SmartLiver. Manual and semi-automatic registration accuracy were comparable but evaluation on a larger patient cohort is required to confirm these findings.
- Subjects :
- Adult
Male
medicine.medical_specialty
Computer-assisted surgery
RESECTION
medicine.medical_treatment
03 medical and health sciences
Patient safety
0302 clinical medicine
Semi-automatic registration
Clinical endpoint
Image-guided surgery
Humans
Medicine
Medical physics
Aged
Aged, 80 and over
Science & Technology
Augmented Reality
GUIDANCE
business.industry
Orientation (computer vision)
Iterative closest point
1103 Clinical Sciences
Usability
Stereoscopic surface reconstruction
Middle Aged
New Technology
3. Good health
Liver
Surgery, Computer-Assisted
030220 oncology & carcinogenesis
Feasibility Studies
Female
030211 gastroenterology & hepatology
Surgery
Augmented reality
LEARNING-CURVE
business
Life Sciences & Biomedicine
Laparoscopic liver surgery
SYSTEM
Subjects
Details
- ISSN :
- 14322218 and 09302794
- Volume :
- 34
- Database :
- OpenAIRE
- Journal :
- Surgical Endoscopy
- Accession number :
- edsair.doi.dedup.....3e57624a29264bc3d6f17050bda2150c