The accuracy of an electromagnetic navigation system in lateral skull base approaches.

PubMed

Komune, Noritaka; Matsushima, Ken; Matsuo, Satoshi; Safavi-Abbasi, Sam; Matsumoto, Nozomu; Rhoton, Albert L

2017-02-01

Image-guided optical tracking systems are being used with increased frequency in lateral skull base surgery. Recently, electromagnetic tracking systems have become available for use in this region. However, the clinical accuracy of the electromagnetic tracking system has not been examined in lateral skull base surgery. This study evaluates the accuracy of electromagnetic navigation in lateral skull base surgery. Cadaveric and radiographic study. Twenty cadaveric temporal bones were dissected in a surgical setting under a commercially available, electromagnetic surgical navigation system. The target registration error (TRE) was measured at 28 surgical landmarks during and after performing the standard translabyrinthine and middle cranial fossa surgical approaches to the internal acoustic canal. In addition, three demonstrative procedures that necessitate navigation with high accuracy were performed; that is, canalostomy of the superior semicircular canal from the middle cranial fossa, 1 cochleostomy from the middle cranial fossa, 2 and infralabyrinthine approach to the petrous apex. 3 RESULTS: Eleven of 17 (65%) of the targets in the translabyrinthine approach and five of 11 (45%) of the targets in the middle fossa approach could be identified in the navigation system with TRE of less than 0.5 mm. Three accuracy-dependent procedures were completed without anatomical injury of important anatomical structures. The electromagnetic navigation system had sufficient accuracy to be used in the surgical setting. It was possible to perform complex procedures in the lateral skull base under the guidance of the electromagnetically tracked navigation system. N/A. Laryngoscope, 2016 127:450-459, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Computer assisted positioning of the proximal segment after sagittal split osteotomy of the mandible: Preclinical investigation of a novel electromagnetic navigation system.

PubMed

Nova, Igor; Kallus, Sebastian; Berger, Moritz; Ristow, Oliver; Eisenmann, Urs; Freudlsperger, Christian; Hoffmann, Jürgen; Dickhaus, Hartmut

2017-05-01

Modifications of the temporomandibular joint position after mandible osteotomy are reluctantly accepted in orthognathic surgery. To tackle this problem, we developed a new navigation system using miniaturized electromagnetic sensors. Our imageless navigation approach is therefore optimized to avoid complications of previously proposed optical approaches such as the interference with established surgical procedures and the line of sight problem. High oblique sagittal split osteotomies were performed on 6 plastic skull mandibles in a laboratory under conditions comparable to the operating theatre. The subsequent condyle reposition was guided by an intuitive user interface and performed by electromagnetic navigation. To prove the suitability and accuracy of this novel approach for condyle navigation, the positions of 3 titanium marker screws placed on each of the proximal segments were compared using pre- and postoperative Cone Beam Computed Tomography (CBCT) imaging. Guided by the electromagnetic navigation system, positioning of the condyles was highly accurate in all dimensions. Translational discrepancies up to 0,65 mm and rotations up to 0,38° in mean could be measured postoperatively. There were no statistically significant differences between navigation results and CBCT measurements. The intuitive user interface provides a simple way to precisely restore the initial position and orientation of the proximal mandibular segments. Our electromagnetic navigation system therefore yields a promising approach for orthognathic surgery applications. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

The accuracy of image-guided navigation for maxillary positioning in bimaxillary surgery.

PubMed

Sun, Yi; Luebbers, Heinz-Theo; Agbaje, Jimoh Olubanwo; Lambrichts, Ivo; Politis, Constantinus

2014-05-01

The aim of our study was to evaluate the accuracy of image-guided maxillary positioning in sagittal, vertical, and mediolateral direction. Between May 2011 and July 2012, 17 patients (11 males, 6 females) underwent bimaxillary surgery with the use of intraoperative surgical navigation. During Le Fort I osteotomy, the Kolibri navigation system was used to measure movement of the maxilla at the edge of the upper central upper incisor in sagittal (buccal surface), vertical (incisor edge), and mediolateral (dental midline) direction. Six weeks after surgery, a postoperative CBCT scan was taken and registered to the preoperative cone-beam computed tomography scan to identify the actual surgical movement of the maxilla. Student 2-tailed paired t test was used to evaluate differences between the measured result from navigation system and actual surgical movement of the maxilla, which were 0.44 ± 0.35 mm (P = 0.82) in the sagittal, 0.50 ± 0.35 mm (P = 0.85) in the vertical, and 0.56 ± 0.36 mm (P = 0.81) in the mediolateral direction. Our finding demonstrates that intraoperative computer navigation is a promising tool for measuring the surgical change of the maxilla in bimaxillary surgery.

Preoperative magnetic resonance and intraoperative ultrasound fusion imaging for real-time neuronavigation in brain tumor surgery.

PubMed

Prada, F; Del Bene, M; Mattei, L; Lodigiani, L; DeBeni, S; Kolev, V; Vetrano, I; Solbiati, L; Sakas, G; DiMeco, F

2015-04-01

Brain shift and tissue deformation during surgery for intracranial lesions are the main actual limitations of neuro-navigation (NN), which currently relies mainly on preoperative imaging. Ultrasound (US), being a real-time imaging modality, is becoming progressively more widespread during neurosurgical procedures, but most neurosurgeons, trained on axial computed tomography (CT) and magnetic resonance imaging (MRI) slices, lack specific US training and have difficulties recognizing anatomic structures with the same confidence as in preoperative imaging. Therefore real-time intraoperative fusion imaging (FI) between preoperative imaging and intraoperative ultrasound (ioUS) for virtual navigation (VN) is highly desirable. We describe our procedure for real-time navigation during surgery for different cerebral lesions. We performed fusion imaging with virtual navigation for patients undergoing surgery for brain lesion removal using an ultrasound-based real-time neuro-navigation system that fuses intraoperative cerebral ultrasound with preoperative MRI and simultaneously displays an MRI slice coplanar to an ioUS image. 58 patients underwent surgery at our institution for intracranial lesion removal with image guidance using a US system equipped with fusion imaging for neuro-navigation. In all cases the initial (external) registration error obtained by the corresponding anatomical landmark procedure was below 2 mm and the craniotomy was correctly placed. The transdural window gave satisfactory US image quality and the lesion was always detectable and measurable on both axes. Brain shift/deformation correction has been successfully employed in 42 cases to restore the co-registration during surgery. The accuracy of ioUS/MRI fusion/overlapping was confirmed intraoperatively under direct visualization of anatomic landmarks and the error was < 3 mm in all cases (100 %). Neuro-navigation using intraoperative US integrated with preoperative MRI is reliable, accurate and user-friendly. Moreover, the adjustments are very helpful in correcting brain shift and tissue distortion. This integrated system allows true real-time feedback during surgery and is less expensive and time-consuming than other intraoperative imaging techniques, offering high precision and orientation. © Georg Thieme Verlag KG Stuttgart · New York.

The use of navigation (BrainLAB Vector vision(2)) and intraoperative 3D imaging system (Siemens Arcadis Orbic 3D) in the treatment of gunshot wounds of the maxillofacial region.

PubMed

Gröbe, Alexander; Weber, Christoph; Schmelzle, Rainer; Heiland, Max; Klatt, Jan; Pohlenz, Philipp

2009-09-01

Gunshot wounds are a rare occurrence during times of peace. The removal of projectiles is recommended; in some cases, however, this is a controversy. The reproduction of a projectile image can be difficult if it is not adjacent to an anatomical landmark. Therefore, navigation systems give the surgeon continuous real-time orientation intraoperatively. The aim of this study was to report our experiences for image-guided removal of projectiles and the resulting intra- and postoperative complications. We investigated 50 patients retrospectively; 32 had image-guided surgical removal of projectiles in the oral and maxillofacial region. Eighteen had surgical removal of projectiles without navigation assistance. There was a significant correlation (p = 0.0136) between the navigated surgery vs. not-navigated surgery and complication rate, including major bleeding (n = 4 vs. n = 1, 8% vs. 2%), soft tissue infections (n = 7 vs. n = 2, 14% vs. 4%), and nerval damage (n = 2 vs. n = 0, 4% vs. 0%; p = 0.038) and between the operating time and postoperative complications. A high tendency between operating time and navigated surgery (p = 0.1103) was shown. When using navigation system, we could reduce operating time. In conclusion, there is a significant correlation between reduced intra- and postoperative complications, including wound infections, nerval damage, and major bleeding, and the appropriate use of a navigation system. In all these cases, we could present reduced operating time. Cone-beam computed tomography plays an important role in detecting projectiles or metallic foreign bodies intraoperatively.

Real Time Navigation-Assisted Orbital Wall Reconstruction in Blowout Fractures.

PubMed

Shin, Ho Seong; Kim, Se Young; Cha, Han Gyu; Han, Ba Leun; Nam, Seung Min

2016-03-01

Limitation in performing restoration of orbital structures is the narrow, deep, and dark surgical field, which makes it difficult to view the operative site directly. To avoid perioperative complications from this limitation, the authors have evaluated the usefulness of computer-assisted navigation techniques in surgical treatment of blowout fracture. Total 37 patients (14 medial orbital wall fractures and 23 inferior orbital wall fractures) with facial deformities had surgical treatment under the guide of navigation system between September 2012 and January 2015. All 37 patients were treated successfully and safely with navigation-assisted surgery without any complications, including diplopia, retrobulbar hematoma, globe injury, implant migration, and blindness. Blowout fracture can be treated safely under guidance of a surgical navigation system. In orbital surgery, navigation-assisted technology could give rise to improvements in the functional and aesthetic outcome and checking the position of the instruments on the surgical site in real time, without injuring important anatomic structures.

Total Navigation in Spine Surgery; A Concise Guide to Eliminate Fluoroscopy Using a Portable Intraoperative Computed Tomography 3-Dimensional Navigation System.

PubMed

Navarro-Ramirez, Rodrigo; Lang, Gernot; Lian, Xiaofeng; Berlin, Connor; Janssen, Insa; Jada, Ajit; Alimi, Marjan; Härtl, Roger

2017-04-01

Portable intraoperative computed tomography (iCT) with integrated 3-dimensional navigation (NAV) offers new opportunities for more precise navigation in spinal surgery, eliminates radiation exposure for the surgical team, and accelerates surgical workflows. We present the concept of "total navigation" using iCT NAV in spinal surgery. Therefore, we propose a step-by-step guideline demonstrating how total navigation can eliminate fluoroscopy with time-efficient workflows integrating iCT NAV into daily practice. A prospective study was conducted on collected data from patients undergoing iCT NAV-guided spine surgery. Number of scans, radiation exposure, and workflow of iCT NAV (e.g., instrumentation, cage placement, localization) were documented. Finally, the accuracy of pedicle screws and time for instrumentation were determined. iCT NAV was successfully performed in 117 cases for various indications and in all regions of the spine. More than half (61%) of cases were performed in a minimally invasive manner. Navigation was used for skin incision, localization of index level, and verification of implant position. iCT NAV was used to evaluate neural decompression achieved in spinal fusion surgeries. Total navigation eliminates fluoroscopy in 75%, thus reducing staff radiation exposure entirely. The average times for iCT NAV setup and pedicle screw insertion were 12.1 and 3.1 minutes, respectively, achieving a pedicle screw accuracy of 99%. Total navigation makes spine surgery safer and more accurate, and it enhances efficient and reproducible workflows. Fluoroscopy and radiation exposure for the surgical staff can be eliminated in the majority of cases. Copyright © 2017 Elsevier Inc. All rights reserved.

Reliable Alignment in Total Knee Arthroplasty by the Use of an iPod-Based Navigation System

PubMed Central

Koenen, Paola; Schneider, Marco M.; Fröhlich, Matthias; Driessen, Arne; Bouillon, Bertil; Bäthis, Holger

2016-01-01

Axial alignment is one of the main objectives in total knee arthroplasty (TKA). Computer-assisted surgery (CAS) is more accurate regarding limb alignment reconstruction compared to the conventional technique. The aim of this study was to analyse the precision of the innovative navigation system DASH® by Brainlab and to evaluate the reliability of intraoperatively acquired data. A retrospective analysis of 40 patients was performed, who underwent CAS TKA using the iPod-based navigation system DASH. Pre- and postoperative axial alignment were measured on standardized radiographs by two independent observers. These data were compared with the navigation data. Furthermore, interobserver reliability was measured. The duration of surgery was monitored. The mean difference between the preoperative mechanical axis by X-ray and the first intraoperatively measured limb axis by the navigation system was 2.4°. The postoperative X-rays showed a mean difference of 1.3° compared to the final navigation measurement. According to radiographic measurements, 88% of arthroplasties had a postoperative limb axis within ±3°. The mean additional time needed for navigation was 5 minutes. We could prove very good precision for the DASH system, which is comparable to established navigation devices with only negligible expenditure of time compared to conventional TKA. PMID:27313898

Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

PubMed Central

Kim, Terrence T.; Johnson, J. Patrick; Pashman, Robert; Drazin, Doniel

2016-01-01

We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy. PMID:27213152

Cadaveric in-situ testing of optical coherence tomography system-based skull base surgery guidance

NASA Astrophysics Data System (ADS)

Sun, Cuiru; Khan, Osaama H.; Siegler, Peter; Jivraj, Jamil; Wong, Ronnie; Yang, Victor X. D.

2015-03-01

Optical Coherence Tomography (OCT) has extensive potential for producing clinical impact in the field of neurological diseases. A neurosurgical OCT hand-held forward viewing probe in Bayonet shape has been developed. In this study, we test the feasibility of integrating this imaging probe with modern navigation technology for guidance and monitoring of skull base surgery. Cadaver heads were used to simulate relevant surgical approaches for treatment of sellar, parasellar and skull base pathology. A high-resolution 3D CT scan was performed on the cadaver head to provide baseline data for navigation. The cadaver head was mounted on existing 3- or 4-point fixation systems. Tracking markers were attached to the OCT probe and the surgeon-probe-OCT interface was calibrated. 2D OCT images were shown in real time together with the optical tracking images to the surgeon during surgery. The intraoperative video and multimodality imaging data set, consisting of real time OCT images, OCT probe location registered to neurosurgical navigation were assessed. The integration of intraoperative OCT imaging with navigation technology provides the surgeon with updated image information, which is important to deal with tissue shifts and deformations during surgery. Preliminary results demonstrate that the clinical neurosurgical navigation system can provide the hand held OCT probe gross anatomical localization. The near-histological imaging resolution of intraoperative OCT can improve the identification of microstructural/morphology differences. The OCT imaging data, combined with the neurosurgical navigation tracking has the potential to improve image interpretation, precision and accuracy of the therapeutic procedure.

Development of a surgical navigation system based on 3D Slicer for intraoperative implant placement surgery

PubMed Central

Chen, Xiaojun; Xu, Lu; Wang, Huixiang; Wang, Fang; Wang, Qiugen; Kikinis, Ron

2017-01-01

Implant placement has been widely used in various kinds of surgery. However, accurate intraoperative drilling performance is essential to avoid injury to adjacent structures. Although some commercially-available surgical navigation systems have been approved for clinical applications, these systems are expensive and the source code is not available to researchers. 3D Slicer is a free, open source software platform for the research community of computer-aided surgery. In this study, a loadable module based on Slicer has been developed and validated to support surgical navigation. This research module allows reliable calibration of the surgical drill, point-based registration and surface matching registration, so that the position and orientation of the surgical drill can be tracked and displayed on the computer screen in real time, aiming at reducing risks. In accuracy verification experiments, the mean target registration error (TRE) for point-based and surface-based registration were 0.31±0.06mm and 1.01±0.06mm respectively, which should meet clinical requirements. Both phantom and cadaver experiments demonstrated the feasibility of our surgical navigation software module. PMID:28109564

Less is sometimes more: a comparison of distance-control and navigated-control concepts of image-guided navigation support for surgeons.

PubMed

Luz, Maria; Manzey, Dietrich; Modemann, Susanne; Strauss, Gero

2015-01-01

Image-guided navigation (IGN) systems provide automation support of intra-operative information analysis and decision-making for surgeons. Previous research showed that navigated-control (NC) systems which represent high levels of decision-support and directly intervene in surgeons' workflow provide benefits with respect to patient safety and surgeons' physiological stress but also involve several cost effects (e.g. prolonged surgery duration, reduced secondary-task performance). It was hypothesised that less automated distance-control (DC) systems would provide a better solution in terms of human performance consequences. N = 18 surgeons performed a simulated mastoidectomy with NC, DC and without IGN assistance. Effects on surgical performance, physiological effort, workload and situation awareness (SA) were compared. As expected, DC technology had the same benefits as the NC system but also led to less unwanted side effects on surgery duration, subjective workload and SA. This suggests that IGN systems just providing information analysis support are overall more beneficial than higher automated decision-support. This study investigates human performance consequences of different concepts of IGN support for surgeons. Less automated DC systems turned out to provide advantages for patient safety and surgeons' stress similar to higher automated NC systems with, at the same time, reduced negative consequences on surgery time and subjective workload.

The accuracy of a hand-held navigation system in total knee arthroplasty.

PubMed

Loh, Bryan; Chen, Jerry Yongqiang; Yew, Andy Khye Soon; Pang, Hee Nee; Tay, Darren Keng Jin; Chia, Shi-Lu; Lo, Ngai Nung; Yeo, Seng Jin

2017-03-01

This study aims to evaluate the effectiveness of a new hand-held navigation system. The authors of this study hypothesize that this navigation system will improve overall lower limb alignment and implant placement without causing a delay in surgery. Two hundred consecutive patients diagnosed with tricompartmental osteoarthritis and underwent total knee arthroplasty by a senior surgeon were included in this study. One hundred patients underwent TKA using the hand-held navigation system, while the other 100 patients underwent TKA using the conventional technique. The primary outcomes of this study were the overall alignment of the lower limb and the position of the components. This was determined radiologically using the: (1) Hip-Knee-Ankle angle (HKA) for lower limb alignment; (2) Coronal Femoral-Component angle (CFA); and (3) Coronal Tibia-Component angle (CTA) for component position. Normal alignment was taken as 180° ± 3° for the HKA and 90° ± 3° for both the CFA and CTA. For the CFA, the proportion of outliers was 7 and 17% in the hand-held navigation and conventional group, respectively (p = 0.030). For the HKA and CTA, there was no difference in the proportion of outliers between the two groups. The duration of surgery was 73 ± 9 min and 87 ± 15 min in the hand-held navigation and conventional group, respectively (p < 0.001). This hand-held navigation system is an effective intraoperative tool for reducing the proportion of outliers for femoral implant placement as well as the duration of surgery. The authors conclude that it can be considered for use to check femoral implant placement intra-operatively. III.

Assessment of the OsteoMark-Navigation System for Oral and Maxillofacial Surgery

PubMed Central

Peacock, Zachary S.; Magill, John C.; Tricomi, Brad J.; Murphy, Brian A.; Nikonovskiy, Vladimir; Hata, Nobuhiko; Chauvin, Laurent; Troulis, Maria J.

2015-01-01

Purpose To assess the accuracy of a novel navigation system for maxillofacial surgery using human cadavers and a live minipig model. Methods We describe and test an electromagnetic tracking system (OsteoMark Navigation) that uses simple sensors to determine position and orientation of a hand held pencil-like marking device. The device can translate 3-dimensional computed tomographic data intraoperatively to allow the surgeon to localize and draw a proposed osteotomy or the margins of a tumor on the bone. The accuracy of OsteoMark-Navigation in locating and marking osteotomies and screw positions in human cadaver heads was assessed. In Group 1 (n=3, 6 sides), Osteomark-Navigation marked osteotomies and screw positions were compared to virtual treatment plans In Group 2 (n=3, 6 sides), marked osteotomies and screw positions for distraction osteogenesis devices were compared to those carried out using fabricated guide-stents. Three metrics were used to document precision and accuracy. In Group 3 (n=1), the system was tested in a standard operating room environment. Results For Group 1, the mean error between points was 0.7mm (horizontal) and 1.7mm (vertical). When compared to the posterior and inferior mandibular border the mean error was 1.2 and 1.7mm, respectively. For Group 2, the mean discrepancy between points marked by Osteomark-Navigation and the surgical guides was 1.9 mm (range 0-4.1 mm). The system maintained accuracy on a live minipig in a standard operating room environment. Conclusion Based on this research OsteoMark-Navigation is potentially a powerful tool for clinical use in maxillofacial surgery. It has accuracy and precision comparable to existing clinical applications. PMID:25865717

Endoscopic intracranial surgery enhanced by electromagnetic-guided neuronavigation in children.

PubMed

Hermann, Elvis J; Esmaeilzadeh, Majid; Ertl, Philipp; Polemikos, Manolis; Raab, Peter; Krauss, Joachim K

2015-08-01

Navigated intracranial endoscopy with conventional technique usually requires sharp head fixation. In children, especially in those younger than 1 year of age and in older children with thin skulls due to chronic hydrocephalus, sharp head fixation is not possible. Here, we studied the feasibility, safety, and accuracy of electromagnetic (EM)-navigated endoscopy in a series of children, obviating the need of sharp head fixation. Seventeen children (ten boys, seven girls) between 12 days and 16.8 years (mean age 4.3 years; median 14 months) underwent EM-navigated intracranial endoscopic surgery based on 3D MR imaging of the head. Inclusion criteria for the study were intraventricular cysts, arachnoid cysts, aqueduct stenosis for endoscopic third ventriculostomy (ETV) with distorted ventricular anatomy, the need of biopsy in intraventricular tumors, and multiloculated hydrocephalus. A total of 22 endoscopic procedures were performed. Patients were registered for navigation by surface rendering in the supine position. After confirming accuracy, they were repositioned for endoscopic surgery with the head fixed slightly on a horseshoe headholder. EM navigation was performed using a flexible stylet introduced into the working channel of a rigid endoscope. Neuronavigation accuracy was checked for deviations measured in millimeters on screenshots after the referencing procedure and during surgery in the coronal (z = vertical), axial (x = mediolateral), and sagittal (y = anteroposterior) planes. EM-navigated endoscopy was feasible and safe. In all 17 patients, the aim of endoscopic surgery was achieved, except in one case in which a hemorrhage occurred, blurring visibility, and we proceeded with open surgery without complications for the patient. Navigation accuracy for extracranial markers such as the tragus, bregma, and nasion ranged between 1 and 2.5 mm. Accuracy for fixed anatomical structures like the optic nerve or the carotid artery varied between 2 and 4 mm, while there was a broader variance of accuracy at the target point of the cyst itself ranging between 2 and 9 mm. EM-navigated endoscopy in children is a safe and useful technique enhancing endoscopic intracranial surgery and obviating the need of sharp head fixation. It is a good alternative to the common opto-electric navigation system in this age group.

Image navigation as a means to expand the boundaries of fluorescence-guided surgery

NASA Astrophysics Data System (ADS)

Brouwer, Oscar R.; Buckle, Tessa; Bunschoten, Anton; Kuil, Joeri; Vahrmeijer, Alexander L.; Wendler, Thomas; Valdés-Olmos, Renato A.; van der Poel, Henk G.; van Leeuwen, Fijs W. B.

2012-05-01

Hybrid tracers that are both radioactive and fluorescent help extend the use of fluorescence-guided surgery to deeper structures. Such hybrid tracers facilitate preoperative surgical planning using (3D) scintigraphic images and enable synchronous intraoperative radio- and fluorescence guidance. Nevertheless, we previously found that improved orientation during laparoscopic surgery remains desirable. Here we illustrate how intraoperative navigation based on optical tracking of a fluorescence endoscope may help further improve the accuracy of hybrid surgical guidance. After feeding SPECT/CT images with an optical fiducial as a reference target to the navigation system, optical tracking could be used to position the tip of the fluorescence endoscope relative to the preoperative 3D imaging data. This hybrid navigation approach allowed us to accurately identify marker seeds in a phantom setup. The multispectral nature of the fluorescence endoscope enabled stepwise visualization of the two clinically approved fluorescent dyes, fluorescein and indocyanine green. In addition, the approach was used to navigate toward the prostate in a patient undergoing robot-assisted prostatectomy. Navigation of the tracked fluorescence endoscope toward the target identified on SPECT/CT resulted in real-time gradual visualization of the fluorescent signal in the prostate, thus providing an intraoperative confirmation of the navigation accuracy.

Measurement of electromagnetic tracking error in a navigated breast surgery setup

NASA Astrophysics Data System (ADS)

Harish, Vinyas; Baksh, Aidan; Ungi, Tamas; Lasso, Andras; Baum, Zachary; Gauvin, Gabrielle; Engel, Jay; Rudan, John; Fichtinger, Gabor

2016-03-01

PURPOSE: The measurement of tracking error is crucial to ensure the safety and feasibility of electromagnetically tracked, image-guided procedures. Measurement should occur in a clinical environment because electromagnetic field distortion depends on positioning relative to the field generator and metal objects. However, we could not find an accessible and open-source system for calibration, error measurement, and visualization. We developed such a system and tested it in a navigated breast surgery setup. METHODS: A pointer tool was designed for concurrent electromagnetic and optical tracking. Software modules were developed for automatic calibration of the measurement system, real-time error visualization, and analysis. The system was taken to an operating room to test for field distortion in a navigated breast surgery setup. Positional and rotational electromagnetic tracking errors were then calculated using optical tracking as a ground truth. RESULTS: Our system is quick to set up and can be rapidly deployed. The process from calibration to visualization also only takes a few minutes. Field distortion was measured in the presence of various surgical equipment. Positional and rotational error in a clean field was approximately 0.90 mm and 0.31°. The presence of a surgical table, an electrosurgical cautery, and anesthesia machine increased the error by up to a few tenths of a millimeter and tenth of a degree. CONCLUSION: In a navigated breast surgery setup, measurement and visualization of tracking error defines a safe working area in the presence of surgical equipment. Our system is available as an extension for the open-source 3D Slicer platform.

Interactive navigation-guided ophthalmic plastic surgery: the techniques and utility of 3-dimensional navigation.

PubMed

Ali, Mohammad Javed; Naik, Milind N; Kaliki, Swathi; Dave, Tarjani Vivek; Dendukuri, Gautam

2017-06-01

To demonstrate the techniques and utility of 3-dimensional reconstruction (3DR) of the target pathologies for subsequent navigation guidance in ophthalmic plastic surgery. Prospective interventional case series. Stereotactic surgeries using 3D reconstruction of target lesions as the intraoperative image-guiding tool were performed in 5 patients with varied etiopathologies. All the surgeries were performed using the intraoperative image-guided StealthStation system in the electromagnetic mode. 3DR was performed using StealthStation 3D model software. The utility of 3D reconstruction for extensive orbital mass lesions, large orbital fractures, intraconal foreign body, and delineation of perilesional intricate structures was studied. The intraoperative ease and usefulness for the navigation of a 3D lesion at crucial phases of the surgery were noted. Intraoperative geometric localization of the 3D lesions was found to be enhanced and precise. 3D reconstruction of the lesion along with the major vessels and nerves in the vicinity helped the surgeon to prevent potential injuries to these structures. The fracture defects could be navigated in a 3D plane and this helped in moderate customization of the implants intraoperatively. Foreign body located in difficult access positions could be accurately targeted for geometric localization before safe retrieval. Detailed preoperative 3D reconstruction by the surgeon was found to be beneficial for successful outcomes. Three-dimensional navigation is very useful in providing detailed anatomical delineation of the targets and enhances the precision in certain complex cases in ophthalmic plastic surgery. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis.

PubMed

van der List, Jelle P; Chawla, Harshvardhan; Joskowicz, Leo; Pearle, Andrew D

2016-11-01

Recently, there is a growing interest in surgical variables that are intraoperatively controlled by orthopaedic surgeons, including lower leg alignment, component positioning and soft tissues balancing. Since more tight control over these factors is associated with improved outcomes of unicompartmental knee arthroplasty and total knee arthroplasty (TKA), several computer navigation and robotic-assisted systems have been developed. Although mechanical axis accuracy and component positioning have been shown to improve with computer navigation, no superiority in functional outcomes has yet been shown. This could be explained by the fact that many differences exist between the number and type of surgical variables these systems control. Most systems control lower leg alignment and component positioning, while some in addition control soft tissue balancing. Finally, robotic-assisted systems have the additional advantage of improving surgical precision. A systematic search in PubMed, Embase and Cochrane Library resulted in 40 comparative studies and three registries on computer navigation reporting outcomes of 474,197 patients, and 21 basic science and clinical studies on robotic-assisted knee arthroplasty. Twenty-eight of these comparative computer navigation studies reported Knee Society Total scores in 3504 patients. Stratifying by type of surgical variables, no significant differences were noted in outcomes between surgery with computer-navigated TKA controlling for alignment and component positioning versus conventional TKA (p = 0.63). However, significantly better outcomes were noted following computer-navigated TKA that also controlled for soft tissue balancing versus conventional TKA (mean difference 4.84, 95 % Confidence Interval 1.61, 8.07, p = 0.003). A literature review of robotic systems showed that these systems can, similarly to computer navigation, reliably improve lower leg alignment, component positioning and soft tissues balancing. Furthermore, two studies comparing robotic-assisted with computer-navigated surgery reported superiority of robotic-assisted surgery in controlling these factors. Manually controlling all these surgical variables can be difficult for the orthopaedic surgeon. Findings in this study suggest that computer navigation or robotic assistance may help managing these multiple variables and could improve outcomes. Future studies assessing the role of soft tissue balancing in knee arthroplasty and long-term follow-up studies assessing the role of computer-navigated and robotic-assisted knee arthroplasty are needed.

Radiological outcomes of pinless navigation in total knee arthroplasty: a randomized controlled trial.

PubMed

Chen, Jerry Yongqiang; Chin, Pak Lin; Li, Zongxian; Yew, Andy Khye Soon; Tay, Darren Keng Jin; Chia, Shi-Lu; Lo, Ngai Nung; Yeo, Seng Jin

2015-12-01

This study aimed to investigate the accuracy of pinless navigation (BrainLAB(®) VectorVision(®) Knee 2.5 Navigation System) as an intra-operative alignment guide in total knee arthroplasty (TKA). The authors hypothesized that pinless navigation would reduce the proportion of outliers in conventional TKA, without a significant increase in the duration of surgery. Between 2011 and 2012, 100 patients scheduled for a unilateral primary TKA were randomized into two groups: pinless navigation and conventional surgery. All TKAs were performed with the surgical aim of achieving neutral coronal alignment with a 180° mechanical axis. The primary outcomes of this study were post-operative radiographic assessment of lower limb alignment using hip-knee-ankle angle (HKA) and components placement using coronal femoral-component angle (CFA) and coronal tibia-component angle (CTA). There was a smaller proportion of outliers for HKA, CFA and CTA at 10, 2 and 2 % respectively, in the pinless navigation group, compared to 32, 16 and 16 %, respectively, in the conventional group (p = 0.013, p = 0.032 and p = 0.032, respectively). The mean CFA was also more accurate at 90° in the pinless navigation group compared to 91° in the conventional group (p = 0.002). There was no difference in the duration of surgery between the two groups (n.s.). Pinless navigation improves lower limb alignment and components placement without a significant increase in the duration of surgery. The authors recommend the use of pinless navigation to verify the coronal alignments of conventional cutting blocks in TKA before the bone cuts are made. I.

Image-guided navigation surgery for pelvic malignancies using electromagnetic tracking

NASA Astrophysics Data System (ADS)

Nijkamp, Jasper; Kuhlmann, Koert; Sonke, Jan-Jakob; Ruers, Theo

2016-03-01

The purpose of this study was to implement and evaluate a surgical navigation system for pelvic malignancies. For tracking an NDI Aurora tabletop field generator and in-house developed navigation software were used. For patient tracking three EM-sensor stickers were used, one on the back and two on the superior iliac spines. During surgery a trackable pointer was used. One day before surgery a CT scan was acquired with the stickers in-place and marked. From the CT scan the EM-sensors, tumor and normal structures were segmented. During surgery, accuracy was independently checked by pointing at the aorta bifurcation and the common iliac artery bifurcations. Subsequently, the system was used to localize the ureters and the tumor. Seven patients were included, three rectal tumors with lymph node-involvement, three lymph node recurrences, and one rectal recurrence. The average external marker registration accuracy was 0.75 cm RMSE (range 0.31-1.58 cm). The average distance between the pointer and the arterial bifurcations was 1.55 cm (1SD=0.63 cm). We were able to localize and confirm the location of all ureters. Twelve out of thirteen lymph nodes were localized and removed. All tumors were removed radically. In all cases the surgeons indicated that the system aided in better anatomical insight, and faster localization of malignant tissue and ureters. In 2/7 cases surgeons indicated that radical resection was only possible with navigation. The navigation accuracy was limited due to the use of skin markers. Nevertheless, preliminary results indicated potential clinical benefit due to better utilization of pre-treatment 3D imaging information.

Soft tissue navigation for laparoscopic prostatectomy: evaluation of camera pose estimation for enhanced visualization

NASA Astrophysics Data System (ADS)

Baumhauer, M.; Simpfendörfer, T.; Schwarz, R.; Seitel, M.; Müller-Stich, B. P.; Gutt, C. N.; Rassweiler, J.; Meinzer, H.-P.; Wolf, I.

2007-03-01

We introduce a novel navigation system to support minimally invasive prostate surgery. The system utilizes transrectal ultrasonography (TRUS) and needle-shaped navigation aids to visualize hidden structures via Augmented Reality. During the intervention, the navigation aids are segmented once from a 3D TRUS dataset and subsequently tracked by the endoscope camera. Camera Pose Estimation methods directly determine position and orientation of the camera in relation to the navigation aids. Accordingly, our system does not require any external tracking device for registration of endoscope camera and ultrasonography probe. In addition to a preoperative planning step in which the navigation targets are defined, the procedure consists of two main steps which are carried out during the intervention: First, the preoperatively prepared planning data is registered with an intraoperatively acquired 3D TRUS dataset and the segmented navigation aids. Second, the navigation aids are continuously tracked by the endoscope camera. The camera's pose can thereby be derived and relevant medical structures can be superimposed on the video image. This paper focuses on the latter step. We have implemented several promising real-time algorithms and incorporated them into the Open Source Toolkit MITK (www.mitk.org). Furthermore, we have evaluated them for minimally invasive surgery (MIS) navigation scenarios. For this purpose, a virtual evaluation environment has been developed, which allows for the simulation of navigation targets and navigation aids, including their measurement errors. Besides evaluating the accuracy of the computed pose, we have analyzed the impact of an inaccurate pose and the resulting displacement of navigation targets in Augmented Reality.

Experiments on robot-assisted navigated drilling and milling of bones for pedicle screw placement.

PubMed

Ortmaier, T; Weiss, H; Döbele, S; Schreiber, U

2006-12-01

This article presents experimental results for robot-assisted navigated drilling and milling for pedicle screw placement. The preliminary study was carried out in order to gain first insights into positioning accuracies and machining forces during hands-on robotic spine surgery. Additionally, the results formed the basis for the development of a new robot for surgery. A simplified anatomical model is used to derive the accuracy requirements. The experimental set-up consists of a navigation system and an impedance-controlled light-weight robot holding the surgical instrument. The navigation system is used to position the surgical instrument and to compensate for pose errors during machining. Holes are drilled in artificial bone and bovine spine. A quantitative comparison of the drill-hole diameters was achieved using a computer. The interaction forces and pose errors are discussed with respect to the chosen machining technology and control parameters. Within the technological boundaries of the experimental set-up, it is shown that the accuracy requirements can be met and that milling is superior to drilling. It is expected that robot assisted navigated surgery helps to improve the reliability of surgical procedures. Further experiments are necessary to take the whole workflow into account. Copyright 2006 John Wiley & Sons, Ltd.

The current status and future prospects of computer-assisted hip surgery.

PubMed

Inaba, Yutaka; Kobayashi, Naomi; Ike, Hiroyuki; Kubota, So; Saito, Tomoyuki

2016-03-01

The advances in computer assistance technology have allowed detailed three-dimensional preoperative planning and simulation of preoperative plans. The use of a navigation system as an intraoperative assistance tool allows more accurate execution of the preoperative plan, compared to manual operation without assistance of the navigation system. In total hip arthroplasty using CT-based navigation, three-dimensional preoperative planning with computer software allows the surgeon to determine the optimal angle of implant placement at which implant impingement is unlikely to occur in the range of hip joint motion necessary for daily activities of living, and to determine the amount of three-dimensional correction for leg length and offset. With the use of computer navigation for intraoperative assistance, the preoperative plan can be precisely executed. In hip osteotomy using CT-based navigation, the navigation allows three-dimensional preoperative planning, intraoperative confirmation of osteotomy sites, safe performance of osteotomy even under poor visual conditions, and a reduction in exposure doses from intraoperative fluoroscopy. Positions of the tips of chisels can be displayed on the computer monitor during surgery in real time, and staff other than the operator can also be aware of the progress of surgery. Thus, computer navigation also has an educational value. On the other hand, its limitations include the need for placement of trackers, increased radiation exposure from preoperative CT scans, and prolonged operative time. Moreover, because the position of a bone fragment cannot be traced after osteotomy, methods to find its precise position after its movement need to be developed. Despite the need to develop methods for the postoperative evaluation of accuracy for osteotomy, further application and development of these systems are expected in the future. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Patient-specific instrument can achieve same accuracy with less resection time than navigation assistance in periacetabular pelvic tumor surgery: a cadaveric study.

PubMed

Wong, Kwok-Chuen; Sze, Kwan-Yik; Wong, Irene Oi-Ling; Wong, Chung-Ming; Kumta, Shekhar-Madhukar

2016-02-01

Inaccurate resection in pelvic tumors can result in compromised margins with increase local recurrence. Navigation-assisted and patient-specific instrument (PSI) techniques have recently been reported in assisting pelvic tumor surgery with the tendency of improving surgical accuracy. We examined and compared the accuracy of transferring a virtual pelvic resection plan to actual surgery using navigation-assisted or PSI technique in a cadaver study. We performed CT scan in twelve cadaveric bodies including whole pelvic bones. Either supraacetabular or partial acetabular resection was virtually planned in a hemipelvis using engineering software. The virtual resection plan was transferred to a CT-based navigation system or was used for design and fabrication of PSI. Pelvic resections were performed using navigation assistance in six cadavers and PSI in another six. Post-resection images were co-registered with preoperative planning for comparative analysis of resection accuracy in the two techniques. The mean average deviation error from the planned resection was no different ([Formula: see text]) for the navigation and the PSI groups: 1.9 versus 1.4 mm, respectively. The mean time required for the bone resection was greater ([Formula: see text]) for the navigation group than for the PSI group: 16.2 versus 1.1 min, respectively. In simulated periacetabular pelvic tumor resections, PSI technique enabled surgeons to reproduce the virtual surgical plan with similar accuracy but with less bone resection time when compared with navigation assistance. Further studies are required to investigate the clinical benefits of PSI technique in pelvic tumor surgery.

A Low-Cost, Passive Navigation Training System for Image-Guided Spinal Intervention.

PubMed

Lorias-Espinoza, Daniel; Carranza, Vicente González; de León, Fernando Chico-Ponce; Escamirosa, Fernando Pérez; Martinez, Arturo Minor

2016-11-01

Navigation technology is used for training in various medical specialties, not least image-guided spinal interventions. Navigation practice is an important educational component that allows residents to understand how surgical instruments interact with complex anatomy and to learn basic surgical skills such as the tridimensional mental interpretation of bidimensional data. Inexpensive surgical simulators for spinal surgery, however, are lacking. We therefore designed a low-cost spinal surgery simulator (Spine MovDigSys 01) to allow 3-dimensional navigation via 2-dimensional images without altering or limiting the surgeon's natural movement. A training system was developed with an anatomical lumbar model and 2 webcams to passively digitize surgical instruments under MATLAB software control. A proof-of-concept recognition task (vertebral body cannulation) and a pilot test of the system with 12 neuro- and orthopedic surgeons were performed to obtain feedback on the system. Position, orientation, and kinematic variables were determined and the lateral, posteroanterior, and anteroposterior views obtained. The system was tested with a proof-of-concept experimental task. Operator metrics including time of execution (t), intracorporeal length (d), insertion angle (α), average speed (v¯), and acceleration (a) were obtained accurately. These metrics were converted into assessment metrics such as smoothness of operation and linearity of insertion. Results from initial testing are shown and the system advantages and disadvantages described. This low-cost spinal surgery training system digitized the position and orientation of the instruments and allowed image-guided navigation, the generation of metrics, and graphic recording of the instrumental route. Spine MovDigSys 01 is useful for development of basic, noninnate skills and allows the novice apprentice to quickly and economically move beyond the basics. Copyright © 2016 Elsevier Inc. All rights reserved.

The use of computer-assisted orthopedic surgery for total knee replacement in daily practice: a survey among ESSKA/SGO-SSO members.

PubMed

Friederich, N; Verdonk, R

2008-06-01

Computer-assisted orthopedic surgery (CAOS) for total knee arthroplasty is an emerging surgical tool, yet little is known about how it is being used in everyday orthopedic centers. We sought to better understand physicians' current practices and beliefs on this topic through performing a Web-based survey. Between December 2006 and January 2007, a 24-question survey was emailed to 3,330 members of the European Society of Sports Traumatology Knee Surgery and Arthroscopy (ESSKA) and the Swiss Orthopedic Society (SGO-SSO), with 389 (11.7%) agreeing to participate. Of this group, 202 (51.9%) reported that their center was equipped with a navigation system, which was an image-free based system for most (83.2%) and was primarily used for total knee arthroplasty (61.4%). In terms of the proportion of use, 50.5% of respondents used their navigation system in less than 25% of cases, 16.3% in 25-50% of cases, 7.4% in 51-75% of cases, and 25.7% in more than 75% of cases. The potential for improving the alignment of prosthesis was the most strongly cited reason for using a navigation system, while the potential for increasing operation times and the risk of infections were the most strongly cited reasons for not using a navigation system. Approximately half of respondents surveyed believed navigation systems were a real innovation contributing to the improvement of total knee implantation. However, heavy usage of computer-assisted navigation (> or =51% of cases) was observed in only 33.1% of respondents, with only a quarter using it at rates that could be considered frequent (>75% of cases). Forty-eight percent of respondents said they will use a navigation system in more cases and 39.1% that their usage will stay the same. These findings indicate that CAOS is being used only moderately in current practices, though respondents generally had a positive opinion of its potential benefits. Physicians may be awaiting more data before adopting the use of these systems, though survey responses also suggest a projected increase in their use in the coming years.

Workspace definition for navigated control functional endoscopic sinus surgery

NASA Astrophysics Data System (ADS)

Gessat, Michael; Hofer, Mathias; Audette, Michael; Dietz, Andreas; Meixensberger, Jürgen; Stauß, Gero; Burgert, Oliver

2007-03-01

For the pre-operative definition of a surgical workspace for Navigated Control ® Functional Endoscopic Sinus Surgery (FESS), we developed a semi-automatic image processing system. Based on observations of surgeons using a manual system, we implemented a workflow-based engineering process that led us to the development of a system reducing time and workload spent during the workspace definition. The system uses a feature based on local curvature to align vertices of a polygonal outline along the bone structures defining the cavities of the inner nose. An anisotropic morphologic operator was developed solve problems arising from artifacts from noise and partial volume effects. We used time measurements and NASA's TLX questionnaire to evaluate our system.

Evaluation of a navigation system for dental implantation as a tool to train novice dental practitioners.

PubMed

Casap, Nardy; Nadel, Sahar; Tarazi, Eyal; Weiss, Ervin I

2011-10-01

This study evaluated the benefits of a virtual reality navigation system for teaching the surgical stage of dental implantation to final-year dental students. The study aimed to assess the students' performance in dental implantation assignments by comparing freehand protocols with virtual reality navigation. Forty final-year dentistry students without previous experience in dental implantation surgery were given an implantation assignment comprising 3 tasks. Marking, drilling, and widening of implant holes were executed by a freehand protocol on the 2 mandibular sides by 1 group and by virtual reality navigation on 1 side and contralaterally with the freehand protocol by the other group. Subjective and objective assessments of the students' performance were graded. Marking with the navigation system was more accurate than with the standard protocol. The 2 groups performed similarly in the 2-mm drilling on the 2 mandibular sides. Widening of the 2 mesial holes to 3 mm was significantly better with the second execution in the standard protocol group, but not in the navigation group. The navigation group's second-site freehand drilling of the molar was significantly worse than the first. The execution of all assignments was significantly faster in the freehand group than in the navigation group (60.75 vs 77.25 minutes, P = .02). Self-assessment only partly matched the objective measurements and was more realistic in the standard protocol group. Despite the improved performance with the navigation system, the added value of training in dental implantation surgery with virtual reality navigation was minimal. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

[Experience of Fusion image guided system in endonasal endoscopic surgery].

PubMed

Wen, Jingying; Zhen, Hongtao; Shi, Lili; Cao, Pingping; Cui, Yonghua

2015-08-01

To review endonasal endoscopic surgeries aided by Fusion image guided system, and to explore the application value of Fusion image guided system in endonasal endoscopic surgeries. Retrospective research. Sixty cases of endonasal endoscopic surgeries aided by Fusion image guided system were analysed including chronic rhinosinusitis with polyp (n = 10), fungus sinusitis (n = 5), endoscopic optic nerve decompression (n = 16), inverted papilloma of the paranasal sinus (n = 9), ossifying fibroma of sphenoid bone (n = 1), malignance of the paranasal sinus (n = 9), cerebrospinal fluid leak (n = 5), hemangioma of orbital apex (n = 2) and orbital reconstruction (n = 3). Sixty cases of endonasal endoscopic surgeries completed successfully without any complications. Fusion image guided system can help to identify the ostium of paranasal sinus, lamina papyracea and skull base. Fused CT-CTA images, or fused MR-MRA images can help to localize the optic nerve or internal carotid arteiy . Fused CT-MR images can help to detect the range of the tumor. It spent (7.13 ± 1.358) minutes for image guided system to do preoperative preparation and the surgical navigation accuracy reached less than 1mm after proficient. There was no device localization problem because of block or head set loosed. Fusion image guided system make endonasal endoscopic surgery to be a true microinvasive and exact surgery. It spends less preoperative preparation time, has high surgical navigation accuracy, improves the surgical safety and reduces the surgical complications.

[Surgical Correction of Scoliosis: Does Intraoperative CT Navigation Prolong Operative Time?

PubMed

Skála-Rosenbaum, J; Ježek, M; Džupa, V; Kadeřábek, R; Douša, P; Rusnák, R; Krbec, M

2016-01-01

PURPOSE OF THE STUDY The aim of the study was to compare the duration of corrective surgery for scoliosis in relation to the intra-operative use of either fluoroscopic or CT navigation. MATERIAL AND METHODS The indication for surgery was adolescent idiopathic scoliosis in younger patients and degenerative scoliosis in middleage or elderly patients. In a retrospective study, treatment outcomes in 43 consecutive patients operated on between April 2011 and April 2014 were compared. Only patients undergoing surgical correction of five or more spinal segments (fixation of six and more vertebrae) were included. RESULTS Transpedicular screw fixation of six to 13 vertebrae was performed under C-arm fluoroscopy guidance in 22 patients, and transpedicular screws were inserted in six to 14 vertebrae using the O-arm imaging system in 21 patients. A total of 246 screws were placed using the C-arm system and 340 screws were inserted using the O-arm system (p < 0.001). The procedures with use of the O-arm system were more complicated and required an average operative time longer by 48% (measured from the first skin incision to the completion of skin suture). However, the mean time needed for one screw placement (the sum of all surgical procedures with the use of a navigation technique divided by the number of screws placed using this technique) was the same in both techniques (19 min). DISCUSSION With good teamwork (surgeons, anaesthesiologists and a radiologist attending to the O-arm system), the time required to obtain one intra-operative CT scan is 3 to 5 minutes. The study showed that the mean time for placement of one screw was identical in both techniques although the average operative time was longer in surgery with O-arm navigation. The 19- minute interval was not the real placement time per screw. It was the sum of all operative times of surgical procedures (from first incision to suture completion including the whole approach within the range of planned stabilization) which used the same navigation technique divided by the number of all screws inserted during the procedures. The longer average operative time in procedures using O-arm navigation was not related to taking intra-operative O-arm scans. The authors consider surgery with an O-arm imaging system to be a safer procedure and use it currently in surgical correction of scoliosis. CONCLUSIONS The study focused on the length of surgery to correct scoliosis performed using either conventional fluoroscopy (C-arm) or intra-operative CT scanning (O-arm) showed that the mean placement time for one screw was identical in both imaging techniques when six or more vertebrae were stabilised. The use of intra-operative CT navigation did not make the surgery longer, and the higher number of inserted screws provides evidence that this technique is safer and allows us to achieve good stability of the correction procedure. Key words: virtual CT guidance, O-arm, scoliosis, transpedicular screw.

Current perspectives in the use of molecular imaging to target surgical treatments for genitourinary cancers.

PubMed

Greco, Francesco; Cadeddu, Jeffrey A; Gill, Inderbir S; Kaouk, Jihad H; Remzi, Mesut; Thompson, R Houston; van Leeuwen, Fijs W B; van der Poel, Henk G; Fornara, Paolo; Rassweiler, Jens

2014-05-01

Molecular imaging (MI) entails the visualisation, characterisation, and measurement of biologic processes at the molecular and cellular levels in humans and other living systems. Translating this technology to interventions in real-time enables interventional MI/image-guided surgery, for example, by providing better detection of tumours and their dimensions. To summarise and critically analyse the available evidence on image-guided surgery for genitourinary (GU) oncologic diseases. A comprehensive literature review was performed using PubMed and the Thomson Reuters Web of Science. In the free-text protocol, the following terms were applied: molecular imaging, genitourinary oncologic surgery, surgical navigation, image-guided surgery, and augmented reality. Review articles, editorials, commentaries, and letters to the editor were included if deemed to contain relevant information. We selected 79 articles according to the search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria and the IDEAL method. MI techniques included optical imaging and fluorescent techniques, the augmented reality (AR) navigation system, magnetic resonance imaging spectroscopy, positron emission tomography, and single-photon emission computed tomography. Experimental studies on the AR navigation system were restricted to the detection and therapy of adrenal and renal malignancies and in the relatively infrequent cases of prostate cancer, whereas fluorescence techniques and optical imaging presented a wide application of intraoperative GU oncologic surgery. In most cases, image-guided surgery was shown to improve the surgical resectability of tumours. Based on the evidence to date, image-guided surgery has promise in the near future for multiple GU malignancies. Further optimisation of targeted imaging agents, along with the integration of imaging modalities, is necessary to further enhance intraoperative GU oncologic surgery. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Electromagnetic navigated condylar positioning after high oblique sagittal split osteotomy of the mandible: a guided method to attain pristine temporomandibular joint conditions.

PubMed

Berger, Moritz; Nova, Igor; Kallus, Sebastian; Ristow, Oliver; Eisenmann, Urs; Dickhaus, Hartmut; Engel, Michael; Freudlsperger, Christian; Hoffmann, Jürgen; Seeberger, Robin

2018-05-01

Reproduction of the exact preoperative proximal-mandible position after osteotomy in orthognathic surgery is difficult to achieve. This clinical pilot study evaluated an electromagnetic (EM) navigation system for condylar positioning after high-oblique sagittal split osteotomy (HSSO). After HSSO as part of 2-jaw surgery, the position of 10 condyles was intraoperatively guided by an EM navigation system. As controls, 10 proximal segments were positioned by standard manual replacement. Accuracy was measured by pre- and postoperative cone beam computed tomography imaging. Overall, EM condyle repositioning was equally accurate compared with manual repositioning (P > .05). Subdivided into 3 axes, significant differences could be identified (P < .05). Nevertheless, no significantly and clinically relevant dislocations of the proximal segment of either the EM or the manual repositioning method could be shown (P > .05). This pilot study introduces a guided method for proximal segment positioning after HSSO by applying the intraoperative EM system. The data demonstrate the high accuracy of EM navigation, although manual replacement of the condyles could not be surpassed. However, EM navigation can avoid clinically hidden, severe malpositioning of the condyles. Copyright © 2017 Elsevier Inc. All rights reserved.

Sentinel lymph node navigation surgery for gastric cancer: Does it really benefit the patient?

PubMed

Tani, Tohru; Sonoda, Hiromichi; Tani, Masaji

2016-03-14

Sentinel lymph node (SLN) navigation surgery is accepted as a standard treatment procedure for malignant melanoma and breast cancer. However, the benefit of reduced lymphadenectomy based on SLN examination remains unclear in cases of gastric cancer. Here, we review previous studies to determine whether SLN navigation surgery is beneficial for gastric cancer patients. Recently, a large-scale prospective study from the Japanese Society of Sentinel Node Navigation Surgery reported that the endoscopic dual tracer method, using a dye and radioisotope for SLN biopsy, was safe and effective when applied to cases of superficial and relatively small gastric cancers. SLN mapping with SLN basin dissection was preferred for early gastric cancer since it is minimally invasive. However, previous studies reported that limited gastrectomy and lymphadenectomy may not improve the patient's postoperative quality of life (QOL). As a result, the benefit of SLN navigation surgery for gastric cancer patients, in terms of their QOL, is limited. Thus, endoscopic and laparoscopic limited gastrectomy combined with SLN navigation surgery has the potential to become the standard minimally invasive surgery in early gastric cancer.

Designing a wearable navigation system for image-guided cancer resection surgery

PubMed Central

Shao, Pengfei; Ding, Houzhu; Wang, Jinkun; Liu, Peng; Ling, Qiang; Chen, Jiayu; Xu, Junbin; Zhang, Shiwu; Xu, Ronald

2015-01-01

A wearable surgical navigation system is developed for intraoperative imaging of surgical margin in cancer resection surgery. The system consists of an excitation light source, a monochromatic CCD camera, a host computer, and a wearable headset unit in either of the following two modes: head-mounted display (HMD) and Google glass. In the HMD mode, a CMOS camera is installed on a personal cinema system to capture the surgical scene in real-time and transmit the image to the host computer through a USB port. In the Google glass mode, a wireless connection is established between the glass and the host computer for image acquisition and data transport tasks. A software program is written in Python to call OpenCV functions for image calibration, co-registration, fusion, and display with augmented reality. The imaging performance of the surgical navigation system is characterized in a tumor simulating phantom. Image-guided surgical resection is demonstrated in an ex vivo tissue model. Surgical margins identified by the wearable navigation system are co-incident with those acquired by a standard small animal imaging system, indicating the technical feasibility for intraoperative surgical margin detection. The proposed surgical navigation system combines the sensitivity and specificity of a fluorescence imaging system and the mobility of a wearable goggle. It can be potentially used by a surgeon to identify the residual tumor foci and reduce the risk of recurrent diseases without interfering with the regular resection procedure. PMID:24980159

Designing a wearable navigation system for image-guided cancer resection surgery.

PubMed

Shao, Pengfei; Ding, Houzhu; Wang, Jinkun; Liu, Peng; Ling, Qiang; Chen, Jiayu; Xu, Junbin; Zhang, Shiwu; Xu, Ronald

2014-11-01

A wearable surgical navigation system is developed for intraoperative imaging of surgical margin in cancer resection surgery. The system consists of an excitation light source, a monochromatic CCD camera, a host computer, and a wearable headset unit in either of the following two modes: head-mounted display (HMD) and Google glass. In the HMD mode, a CMOS camera is installed on a personal cinema system to capture the surgical scene in real-time and transmit the image to the host computer through a USB port. In the Google glass mode, a wireless connection is established between the glass and the host computer for image acquisition and data transport tasks. A software program is written in Python to call OpenCV functions for image calibration, co-registration, fusion, and display with augmented reality. The imaging performance of the surgical navigation system is characterized in a tumor simulating phantom. Image-guided surgical resection is demonstrated in an ex vivo tissue model. Surgical margins identified by the wearable navigation system are co-incident with those acquired by a standard small animal imaging system, indicating the technical feasibility for intraoperative surgical margin detection. The proposed surgical navigation system combines the sensitivity and specificity of a fluorescence imaging system and the mobility of a wearable goggle. It can be potentially used by a surgeon to identify the residual tumor foci and reduce the risk of recurrent diseases without interfering with the regular resection procedure.

Navigating surgical fluorescence cameras using near-infrared optical tracking.

PubMed

van Oosterom, Matthias; den Houting, David; van de Velde, Cornelis; van Leeuwen, Fijs

2018-05-01

Fluorescence guidance facilitates real-time intraoperative visualization of the tissue of interest. However, due to attenuation, the application of fluorescence guidance is restricted to superficial lesions. To overcome this shortcoming, we have previously applied three-dimensional surgical navigation to position the fluorescence camera in reach of the superficial fluorescent signal. Unfortunately, in open surgery, the near-infrared (NIR) optical tracking system (OTS) used for navigation also induced an interference during NIR fluorescence imaging. In an attempt to support future implementation of navigated fluorescence cameras, different aspects of this interference were characterized and solutions were sought after. Two commercial fluorescence cameras for open surgery were studied in (surgical) phantom and human tissue setups using two different NIR OTSs and one OTS simulating light-emitting diode setup. Following the outcome of these measurements, OTS settings were optimized. Measurements indicated the OTS interference was caused by: (1) spectral overlap between the OTS light and camera, (2) OTS light intensity, (3) OTS duty cycle, (4) OTS frequency, (5) fluorescence camera frequency, and (6) fluorescence camera sensitivity. By optimizing points 2 to 4, navigation of fluorescence cameras during open surgery could be facilitated. Optimization of the OTS and camera compatibility can be used to support navigated fluorescence guidance concepts. (2018) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE).

[The history and development of computer assisted orthopaedic surgery].

PubMed

Jenny, J-Y

2006-10-01

Computer assisted orthopaedic surgery (CAOS) was developed to improve the accuracy of surgical procedures. It has improved dramatically over the last years, being transformed from an experimental, laboratory procedure into a routine procedure theoretically available to every orthopaedic surgeon. The first field of application of computer assistance was neurosurgery. After the application of computer guided spinal surgery, the navigation of total hip and knee joints became available. Currently, several applications for computer assisted surgery are available. At the beginning of navigation, a preoperative CT-scan or several fluoroscopic images were necessary. The imageless systems allow the surgeon to digitize patient anatomy at the beginning of surgery without any preoperative imaging. The future of CAOS remains unknown, but there is no doubt that its importance will grow in the next 10 years, and that this technology will probably modify the conventional practice of orthopaedic surgery.

3D point cloud analysis of structured light registration in computer-assisted navigation in spinal surgeries

NASA Astrophysics Data System (ADS)

Gupta, Shaurya; Guha, Daipayan; Jakubovic, Raphael; Yang, Victor X. D.

2017-02-01

Computer-assisted navigation is used by surgeons in spine procedures to guide pedicle screws to improve placement accuracy and in some cases, to better visualize patient's underlying anatomy. Intraoperative registration is performed to establish a correlation between patient's anatomy and the pre/intra-operative image. Current algorithms rely on seeding points obtained directly from the exposed spinal surface to achieve clinically acceptable registration accuracy. Registration of these three dimensional surface point-clouds are prone to various systematic errors. The goal of this study was to evaluate the robustness of surgical navigation systems by looking at the relationship between the optical density of an acquired 3D point-cloud and the corresponding surgical navigation error. A retrospective review of a total of 48 registrations performed using an experimental structured light navigation system developed within our lab was conducted. For each registration, the number of points in the acquired point cloud was evaluated relative to whether the registration was acceptable, the corresponding system reported error and target registration error. It was demonstrated that the number of points in the point cloud neither correlates with the acceptance/rejection of a registration or the system reported error. However, a negative correlation was observed between the number of the points in the point-cloud and the corresponding sagittal angular error. Thus, system reported total registration points and accuracy are insufficient to gauge the accuracy of a navigation system and the operating surgeon must verify and validate registration based on anatomical landmarks prior to commencing surgery.

Positioning accuracy in a registration-free CT-based navigation system

NASA Astrophysics Data System (ADS)

Brandenberger, D.; Birkfellner, W.; Baumann, B.; Messmer, P.; Huegli, R. W.; Regazzoni, P.; Jacob, A. L.

2007-12-01

In order to maintain overall navigation accuracy established by a calibration procedure in our CT-based registration-free navigation system, the CT scanner has to repeatedly generate identical volume images of a target at the same coordinates. We tested the positioning accuracy of the prototype of an advanced workplace for image-guided surgery (AWIGS) which features an operating table capable of direct patient transfer into a CT scanner. Volume images (N = 154) of a specialized phantom were analysed for translational shifting after various table translations. Variables included added weight and phantom position on the table. The navigation system's calibration accuracy was determined (bias 2.1 mm, precision ± 0.7 mm, N = 12). In repeated use, a bias of 3.0 mm and a precision of ± 0.9 mm (N = 10) were maintainable. Instances of translational image shifting were related to the table-to-CT scanner docking mechanism. A distance scaling error when altering the table's height was detected. Initial prototype problems visible in our study causing systematic errors were resolved by repeated system calibrations between interventions. We conclude that the accuracy achieved is sufficient for a wide range of clinical applications in surgery and interventional radiology.

Introduction of a standardized multimodality image protocol for navigation-guided surgery of suspected low-grade gliomas.

PubMed

Mert, Aygül; Kiesel, Barbara; Wöhrer, Adelheid; Martínez-Moreno, Mauricio; Minchev, Georgi; Furtner, Julia; Knosp, Engelbert; Wolfsberger, Stefan; Widhalm, Georg

2015-01-01

OBJECT Surgery of suspected low-grade gliomas (LGGs) poses a special challenge for neurosurgeons due to their diffusely infiltrative growth and histopathological heterogeneity. Consequently, neuronavigation with multimodality imaging data, such as structural and metabolic data, fiber tracking, and 3D brain visualization, has been proposed to optimize surgery. However, currently no standardized protocol has been established for multimodality imaging data in modern glioma surgery. The aim of this study was therefore to define a specific protocol for multimodality imaging and navigation for suspected LGG. METHODS Fifty-one patients who underwent surgery for a diffusely infiltrating glioma with nonsignificant contrast enhancement on MRI and available multimodality imaging data were included. In the first 40 patients with glioma, the authors retrospectively reviewed the imaging data, including structural MRI (contrast-enhanced T1-weighted, T2-weighted, and FLAIR sequences), metabolic images derived from PET, or MR spectroscopy chemical shift imaging, fiber tracking, and 3D brain surface/vessel visualization, to define standardized image settings and specific indications for each imaging modality. The feasibility and surgical relevance of this new protocol was subsequently prospectively investigated during surgery with the assistance of an advanced electromagnetic navigation system in the remaining 11 patients. Furthermore, specific surgical outcome parameters, including the extent of resection, histological analysis of the metabolic hotspot, presence of a new postoperative neurological deficit, and intraoperative accuracy of 3D brain visualization models, were assessed in each of these patients. RESULTS After reviewing these first 40 cases of glioma, the authors defined a specific protocol with standardized image settings and specific indications that allows for optimal and simultaneous visualization of structural and metabolic data, fiber tracking, and 3D brain visualization. This new protocol was feasible and was estimated to be surgically relevant during navigation-guided surgery in all 11 patients. According to the authors' predefined surgical outcome parameters, they observed a complete resection in all resectable gliomas (n = 5) by using contour visualization with T2-weighted or FLAIR images. Additionally, tumor tissue derived from the metabolic hotspot showed the presence of malignant tissue in all WHO Grade III or IV gliomas (n = 5). Moreover, no permanent postoperative neurological deficits occurred in any of these patients, and fiber tracking and/or intraoperative monitoring were applied during surgery in the vast majority of cases (n = 10). Furthermore, the authors found a significant intraoperative topographical correlation of 3D brain surface and vessel models with gyral anatomy and superficial vessels. Finally, real-time navigation with multimodality imaging data using the advanced electromagnetic navigation system was found to be useful for precise guidance to surgical targets, such as the tumor margin or the metabolic hotspot. CONCLUSIONS In this study, the authors defined a specific protocol for multimodality imaging data in suspected LGGs, and they propose the application of this new protocol for advanced navigation-guided procedures optimally in conjunction with continuous electromagnetic instrument tracking to optimize glioma surgery.

[Navigated control: a new concept in computer assisted ENT-surgery].

PubMed

Strauss, G; Koulechov, K; Richter, R; Dietz, A; Meixensberger, J; Trantakis, C; Lüth, T

2005-08-01

This work conceived and evaluates a mechatronical system for ORL-surgery by example of a Shaver for Functional Endoscopic Sinus Surgery controlled by navigation. The Shaver is automatically on/off-regulated depending on the current position in relation to the planned working space. This working space is defined on the basis of the individual CT data. Within this area the Shaver reacts to the signal of the surgeon (foot pedal). If the Shaver leaves the working space, an interruption of the drive regulation to the Shaver takes place. The evaluation of the planning software based on 32 patient CT-data sets. The registration accuracy in a anatomical model was examined on 451 measurements of endonasal attached titanium screws. The conversions of the working space were evaluated at 5 different technical models. The average time for segmenting the working space was found at 4.23 minutes per case. An average registration accuracy of the Shaver of 1.08 mm resulted. The pre-defined cavity was to be cleared away without restrictions. The preoperative determined work-space was converted by 3.1 mm over all levels. The study proves the feasibility of a mechatronical assistant system by the example of the navigate-controlled Shaver in paranasal sinus surgery. Contrary to conventional CAS solutions redundancy and cognitive discharge of the surgeon are considered in this conception. We see numerous applications according to the explained principle for power-control of instruments in ORL-surgery in the future such as drilling, high frequency surgery or laser.

"It was five years of hell": Parental experiences of navigating and processing the slow and arduous time to pediatric resective epilepsy surgery.

PubMed

Pieters, Huibrie C; Iwaki, Tomoko; Vickrey, Barbara G; Mathern, Gary W; Baca, Christine B

2016-09-01

Children with medically refractory epilepsy stand to benefit from surgery and live a life free of seizures. However, a large proportion of potentially eligible children do not receive a timely referral for a surgical evaluation. We aimed to describe experiences during the arduous time before the referral and the parent-reported facilitators that helped them move forward through this slow time. Individual semi-structured interviews with 37 parents of children who had previously undergone epilepsy surgery at UCLA (2006-2011) were recorded, transcribed, and systematically analyzed by two independent coders using thematic analysis. Clinical data were extracted from medical records. Parents, 41.3years of age on average, were mostly Caucasian, English-speaking, mothers, married, and employed. The mean age at surgery for children was 8.2years with a mean time from epilepsy onset to surgery of 5.4years. Parental decision-making was facilitated when parents eventually received a presurgical referral and navigated to a multidisciplinary team that they trusted to care for their child with medically refractory epilepsy. Four themes described the experiences that parents used to feel a sense of moving forward. The first theme, processing, involved working through feelings and was mostly done alone. The second theme, navigating the complex unknowns of the health-care system, was more active and purposeful. Processing co-occurred with navigating in a fluid intersection, the third theme, which was evidenced by deliberate actions. The fourth theme, facilitators, explained helpful ways of processing and navigating; parents utilized these mechanisms to turn vulnerable times following the distress of their child's diagnosis into an experience of productivity. To limit parental distress and remediate the slow and arduous journey to multidisciplinary care at a comprehensive epilepsy center for a surgical evaluation, we suggest multi-pronged interventions to modify barriers associated with parents, providers, and health-care systems. Based on the facilitators that moved parents of our sample forward, we provide practical suggestions such as increased peer support, developing the role of patient navigators and communication strategies with parents before, during, and after referral to a comprehensive epilepsy center and presurgical evaluation. Published by Elsevier Inc.

Use of an intraoperative navigation system for retrieving a broken dental instrument in the mandible: a case report.

PubMed

Sukegawa, Shintaro; Kanno, Takahiro; Shibata, Akane; Matsumoto, Kenichi; Sukegawa-Takahashi, Yuka; Sakaida, Kyosuke; Furuki, Yoshihiko

2017-01-15

A fracture of root canal instruments, with a fractured piece protruding beyond the apex, is a troublesome incident during an endodontic treatment. Locating and retrieving them represents a challenge to maxillofacial surgeons because it is difficult to access due to the proximity between the foreign body and vital structures. Although safe and accurate for surgery, radiographs and electromagnetic devices do not provide a precise three-dimensional position. In contrast, computer-aided navigation provides a correlation between preoperatively collected data and intraoperatively encountered anatomy. However, using a navigation system for mandible treatment is difficult as the mobile nature of the mandible complicates its synchronization with the preoperative imaging data during surgery. This report describes a case of a dental instrument breakage in the mandible during an endodontic treatment for a restorative dental procedure in a 65-year-old Japanese woman. The broken dental instrument was removed using a minimally invasive approach with a surgical navigation system and an interocclusal splint for a stable, identically repeatable positioning of the mandible. Using the three-dimensional position of the navigation probe, a location that best approximated the most anterior extent of the fragment was selected. A minimally invasive vestibular incision was made at this location, a subperiosteal reflection was performed, and the foreign body location was confirmed using a careful navigation system. The instrument was carefully visualized and extruded from the apical to the tooth crown side and was then removed using mosquito forceps through the medullary cavity of the crown side of the tooth. Follow-up was uneventful; her clinical course was good. The use of a surgical navigation system together with an interocclusal splint enabled the retrieval of a broken dental instrument in a safe and minimally invasive manner without damaging the surrounding vital structures.

Computer-assisted hip and knee arthroplasty. Navigation and active robotic systems: an evidence-based analysis.

PubMed

2004-01-01

The Medical Advisory Secretariat undertook a review of the evidence on the effectiveness and cost-effectiveness of computer assisted hip and knee arthroplasty. The two computer assisted arthroplasty systems that are the topics of this review are (1) navigation and (2) robotic-assisted hip and knee arthroplasty. Computer-assisted arthroplasty consists of navigation and robotic systems. Surgical navigation is a visualization system that provides positional information about surgical tools or implants relative to a target bone on a computer display. Most of the navigation-assisted arthroplasty devices that are the subject of this review are licensed by Health Canada. Robotic systems are active robots that mill bone according to information from a computer-assisted navigation system. The robotic-assisted arthroplasty devices that are the subject of this review are not currently licensed by Health Canada. The Cochrane and International Network of Agencies for Health Technology Assessment databases did not identify any health technology assessments on navigation or robotic-assisted hip or knee arthroplasty. The MEDLINE and EMBASE databases were searched for articles published between January 1, 1996 and November 30, 2003. This search produced 367 studies, of which 9 met the inclusion criteria. NAVIGATION-ASSISTED ARTHROPLASTY: Five studies were identified that examined navigation-assisted arthroplasty.A Level 1 evidence study from Germany found a statistically significant difference in alignment and angular deviation between navigation-assisted and free-hand total knee arthroplasty in favour of navigation-assisted surgery. However, the endpoints in this study were short-term. To date, the long-term effects (need for revision, implant longevity, pain, functional performance) are unknown.(1)A Level 2 evidence short-term study found that navigation-assisted total knee arthroplasty was significantly better than a non-navigated procedure for one of five postoperative measured angles.(2)A Level 2 evidence short-term study found no statistically significant difference in the variation of the abduction angle between navigation-assisted and conventional total hip arthroplasty.(3)Level 3 evidence observational studies of navigation-assisted total knee arthroplasty and unicompartmental knee arthroplasty have been conducted. Two studies reported that "the follow-up of the navigated prostheses is currently too short to know if clinical outcome or survival rates are improved. Longer follow-up is required to determine the respective advantages and disadvantages of both techniques."(4;5) ROBOTIC-ASSISTED ARTHROPLASTY: Four studies were identified that examined robotic-assisted arthroplasty.A Level 1 evidence study revealed that there was no statistically significant difference between functional hip scores at 24 months post implantation between patients who underwent robotic-assisted primary hip arthroplasty and those that were treated with manual implantation.(6)Robotic-assisted arthroplasty had advantages in terms of preoperative planning and the accuracy of the intraoperative procedure.(6)Patients who underwent robotic-assisted hip arthroplasty had a higher dislocation rate and more revisions.(6)Robotic-assisted arthroplasty may prove effective with certain prostheses (e.g., anatomic) because their use may result in less muscle detachment.(6)An observational study (Level 3 evidence) found that the incidence of severe embolic events during hip relocation was lower with robotic arthroplasty than with manual surgery.(7)An observational study (Level 3 evidence) found that there was no significant difference in gait analyses of patients who underwent robotic-assisted total hip arthroplasty using robotic surgery compared to patients who were treated with conventional cementless total hip arthroplasty.(8)An observational study (Level 3 evidence) compared outcomes of total knee arthroplasty between patients undergoing robotic surgery and patients who were historical controls. Brief, qualitative results suggested that there was much broader variation of angles after manual total knee arthroplasty compared to the robotic technique and that there was no difference in knee functional scores or implant position at the 3 and 6 month follow-up.(9).

Computer-Assisted Hip and Knee Arthroplasty. Navigation and Active Robotic Systems

PubMed Central

2004-01-01

Executive Summary Objective The Medical Advisory Secretariat undertook a review of the evidence on the effectiveness and cost-effectiveness of computer assisted hip and knee arthroplasty. The two computer assisted arthroplasty systems that are the topics of this review are (1) navigation and (2) robotic-assisted hip and knee arthroplasty. The Technology Computer-assisted arthroplasty consists of navigation and robotic systems. Surgical navigation is a visualization system that provides positional information about surgical tools or implants relative to a target bone on a computer display. Most of the navigation-assisted arthroplasty devices that are the subject of this review are licensed by Health Canada. Robotic systems are active robots that mill bone according to information from a computer-assisted navigation system. The robotic-assisted arthroplasty devices that are the subject of this review are not currently licensed by Health Canada. Review Strategy The Cochrane and International Network of Agencies for Health Technology Assessment databases did not identify any health technology assessments on navigation or robotic-assisted hip or knee arthroplasty. The MEDLINE and EMBASE databases were searched for articles published between January 1, 1996 and November 30, 2003. This search produced 367 studies, of which 9 met the inclusion criteria. Summary of Findings Navigation-Assisted Arthroplasty Five studies were identified that examined navigation-assisted arthroplasty. A Level 1 evidence study from Germany found a statistically significant difference in alignment and angular deviation between navigation-assisted and free-hand total knee arthroplasty in favour of navigation-assisted surgery. However, the endpoints in this study were short-term. To date, the long-term effects (need for revision, implant longevity, pain, functional performance) are unknown.(1) A Level 2 evidence short-term study found that navigation-assisted total knee arthroplasty was significantly better than a non-navigated procedure for one of five postoperative measured angles.(2) A Level 2 evidence short-term study found no statistically significant difference in the variation of the abduction angle between navigation-assisted and conventional total hip arthroplasty.(3) Level 3 evidence observational studies of navigation-assisted total knee arthroplasty and unicompartmental knee arthroplasty have been conducted. Two studies reported that “the follow-up of the navigated prostheses is currently too short to know if clinical outcome or survival rates are improved. Longer follow-up is required to determine the respective advantages and disadvantages of both techniques.”(4;5) Robotic-Assisted Arthroplasty Four studies were identified that examined robotic-assisted arthroplasty. A Level 1 evidence study revealed that there was no statistically significant difference between functional hip scores at 24 months post implantation between patients who underwent robotic-assisted primary hip arthroplasty and those that were treated with manual implantation.(6) Robotic-assisted arthroplasty had advantages in terms of preoperative planning and the accuracy of the intraoperative procedure.(6) Patients who underwent robotic-assisted hip arthroplasty had a higher dislocation rate and more revisions.(6) Robotic-assisted arthroplasty may prove effective with certain prostheses (e.g., anatomic) because their use may result in less muscle detachment.(6) An observational study (Level 3 evidence) found that the incidence of severe embolic events during hip relocation was lower with robotic arthroplasty than with manual surgery.(7) An observational study (Level 3 evidence) found that there was no significant difference in gait analyses of patients who underwent robotic-assisted total hip arthroplasty using robotic surgery compared to patients who were treated with conventional cementless total hip arthroplasty.(8) An observational study (Level 3 evidence) compared outcomes of total knee arthroplasty between patients undergoing robotic surgery and patients who were historical controls. Brief, qualitative results suggested that there was much broader variation of angles after manual total knee arthroplasty compared to the robotic technique and that there was no difference in knee functional scores or implant position at the 3 and 6 month follow-up.(9) PMID:23074452

Risk-benefit analysis of navigation techniques for vertebral transpedicular instrumentation: a prospective study.

PubMed

Noriega, David C; Hernández-Ramajo, Rubén; Rodríguez-Monsalve Milano, Fiona; Sanchez-Lite, Israel; Toribio, Borja; Ardura, Francisco; Torres, Ricardo; Corredera, Raul; Kruger, Antonio

2017-01-01

Pedicle screws in spinal surgery have allowed greater biomechanical stability and higher fusion rates. However, malposition is very common and may cause neurologic, vascular, and visceral injuries and compromise mechanical stability. The purpose of this study was to compare the malposition rate between intraoperative computed tomography (CT) scan assisted-navigation and free-hand fluoroscopy-guided techniques for placement of pedicle screw instrumentation. This is a prospective, randomized, observational study. A total of 114 patients were included: 58 in the assisted surgery group and 56 in the free-hand fluoroscopy-guided surgery group. Analysis of screw position was assessed using the Heary classification. Breach severity was defined according to the Gertzbein classification. Radiation doses were evaluated using thermoluminescent dosimeters, and estimates of effective and organ doses were made based on scan technical parameters. Consecutive patients with degenerative disease, who underwent surgical procedures using the free-hand, or intraoperative navigation technique for placement of transpedicular instrumentation, were included in the study. Forty-four out of 625 implanted screws were malpositioned: 11 (3.6%) in the navigated surgery group and 33 (10.3%) in the free-hand group (p<.001). Screw position according to the Heary scale was Grade II (4 navigated surgery, 6 fluoroscopy guided), Grade III (3 navigated surgery, 11 fluoroscopy guided), Grade IV (4 navigated surgery, 16 fluoroscopy guided), and Grade V (1 fluoroscopy guided). There was only one symptomatic case in the conventional surgery group. Breach severity was seven Grade A and four Grade B in the navigated surgery group, and eight Grade A, 24 Grade B, and one Grade C in free-hand fluoroscopy-guided surgery group. Radiation received per patient was 5.8 mSv (4.8-7.3). The median dose received in the free-hand fluoroscopy group was 1 mGy (0.8-1.1). There was no detectable radiation level in the navigation-assisted surgery group, whereas the effective dose was 10 µGy in the free-hand fluoroscopy-guided surgery group. Malposition rate, both symptomatic and asymptomatic, in spinal surgery is reduced when using CT-guided placement of transpedicular instrumentation compared with placement under fluoroscopic guidance, with radiation values within the safety limits for health. Larger studies are needed to determine risk-benefit in these patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Patient Navigation by Community Health Workers Increases Access to Surgical Care in Rural Haiti.

PubMed

Matousek, Alexi C; Addington, Stephen R; Kahan, Joseph; Sannon, Herriot; Luckner, Thelius; Exe, Chauvet; Jean Louis, Rodolphe R Eisenhower; Lipsitz, Stuart; Meara, John G; Riviello, Robert

2017-12-01

In the Hôpital Albert Schweitzer district in rural Haiti, patients from mountain areas receive fewer operations per capita than patients from the plains. Possible additional barriers for mountain patients include lower socioeconomic status, lack of awareness of financial support, illiteracy and unfamiliarity with the hospital system. We sought to increase the rate of elective surgery for a mountain population using a patient navigation program. Patient navigators were trained to guide subjects from a mountain population through the entire hospital process for elective surgery. We compared the rate of elective operations before and after the patient navigation intervention between three groups: a control group from a mountainous area, a control group from the plains and an intervention group from a mountainous area. The baseline elective operation rate differed significantly between the plains control group, the mountain control group and the mountain intervention group (361 vs. 57 vs. 68 operations per 100,000 population per year). The rate of elective surgery between the two mountain groups was not statistically different prior to the intervention. After the intervention, the elective operation rate in the mountain group that received patient navigation increased from 68 to 131 operations per 100,000 population per year (p = 0.017). Patient navigation doubled the elective operation rate for a mountain population in rural Haiti. While additional barriers to access remain for this vulnerable population, patient navigation is an essential augmentation to financial assistance programs to ensure that the poor gain access to surgical care.

Indocyanine Green Fluorescence Navigation Thoracoscopic Metastasectomy for Pulmonary Metastasis of Hepatocellular Carcinoma.

PubMed

Kawakita, Naoya; Takizawa, Hiromitsu; Kondo, Kazuya; Sakiyama, Shoji; Tangoku, Akira

2016-12-20

Indocyanine green can selectively accumulate in primary hepatocellular carcinoma (HCC) and extrahepatic metastases. We report a patient who underwent resection of pulmonary metastasis of HCC using a thoracoscopic near-infrared imaging system and fluorescent navigation surgery. A 66-year-old man with suspicion of pulmonary metastasis of HCC was referred to our hospital. Indocyanine green was injected intravenously at a dose of 0.5 mg/kg body weight, 20 h before thoracoscopic surgery. An endoscopic indocyanine green near-infrared fluorescence imaging system showed clear blue fluorescence, indicating pulmonary metastasis of HCC in a lingular segment. We performed wide wedge resection using the fluorescence image for navigation to confirm the surgical margins. The specimen was histologically confirmed as a pulmonary metastasis of HCC. In conclusion, thoracoscopic indocyanine green near-infrared fluorescence imaging for pulmonary metastases of HCC is useful in identifying tumor locations and ensuring resection margins.

Comparative examination of the accuracy of a mechanical and an optical system in CT and MRT based instrument navigation.

PubMed

Hassfeld, S; Mühling, J

2000-12-01

The aim of an intraoperative instrument navigation system is to support the surgeon in the localization of anatomical regions and to guide the use of surgical instruments. An overview of technical principles and literature reports on various navigation systems is provided here. The navigation accuracy (tested on a plastic phantom under simulated operating room conditions) of the mechanical Viewing Wand system and the optical SPOCS system amounts to 1 to 3 mm for computerized tomography (CT) data, with a significant inverse dependence on the layer thickness. The values for magnetic resonance tomography (MRT) data are significantly higher. In regard to the choice of registration points, a statistically inverse dependence exists between the number of points and the distance between the points. During the time period between autumn 1993 and mid-1999, more than 120 clinical applications were performed. The intraoperative accuracy was in the range of < or = 3 mm. Registering the patient position with preoperatively inserted screw markers achieved accuracy values of < or = 2 mm. The instrument navigation technique has proved to be very advantageous for the spatial orientation of the surgeons. The possibility of checking resection borders has opened up new perspectives in tumor surgery. A quality improvement and a reduction of the operational risks as well as a considerable decline in the stress placed on the patient can be expected in the near future due the techniques of computer-assisted surgery.

Improved accuracy of screw implantation could decrease the incidence of post-operative hydrothorax? O-arm navigation vs. free-hand in thoracic spinal deformity correction surgery.

PubMed

Zhao, Zhihui; Liu, Zhen; Hu, Zongshan; Tseng, Changchun; Li, Jie; Pan, Wei; Qiu, Yong; Zhu, Zezhang

2018-03-16

The purpose of this study was to analyze the occurrence of PE after intra-operative O-arm navigation-assisted surgery and determine whether the post-operative PE incidence could be decreased by using O-arm navigation as compared to conventional free-hand technique. A cohort of 27 patients with spinal deformity who were operated upon with an O-arm navigated system (group A) between 2013 and 2016 were enrolled in the study. A total of 27 curve-matched patients treated by conventional free-hand technique were included as the control group (group B). Whole spine posterior-anterior and lateral radiographs, and CT scans were taken pre and post-operation. Radiologic parameters and volume of PE were measured and compared between the two groups. There were no significant differences in age, Cobb angle, and sagittal contour between the two groups pre-operatively. The mean total volume of post-operative PE was significantly larger in the free-hand group (p < 0.001). In the O-arm group, 59 malpositioned screws were identified in 22 patients. In the free-hand group, 88 malpositioned screws were found among 26 patients. The screw perforation rate was higher in the free-hand group than in the O-arm group (p = 0.007). In the O-arm group, the mean volume of PE was significantly larger among patients with malpositioned screws than those without malpositioned screws (p < 0.001), as well as in the free-hand group. The volume of PE after correction surgery can be significantly decreased by application of O-arm navigation system as compared to conventional free-hand technique. We ascribed the improvement to the accuracy of screw implantation navigated by O-arm.

[Georg Schlöndorff-the father of computer-assisted surgery].

PubMed

Mösges, R

2016-09-01

Georg Schlöndorff (1931-2011) developed the idea of computer-assisted surgery (CAS) during his time as professor and chairman of the Department of Otorhinolaryngology at the Medical Faculty of the University of Aachen, Germany. In close cooperation with engineers and physicists, he succeeded in translating this concept into a functional prototype that was applied in live surgery in the operating theatre. The first intervention performed with this image-guided navigation system was a skull base surgical procedure 1987. During the following years, this concept was extended to orbital surgery, neurosurgery, mid-facial traumatology, and brachytherapy of solid tumors in the head and neck region. Further technical developments of this first prototype included touchless optical positioning and the computer vision concept with three orthogonal images, which is still common in contemporary navigation systems. During his time as emeritus professor from 1996, Georg Schlöndorff further pursued his concept of CAS by developing technical innovations such as computational fluid dynamics (CFD).

Minimally Invasive 2D Navigation-Assisted Treatment of Thoracolumbar Spinal Fractures in East Africa: A Case Report

PubMed Central

Njoku, Innocent; Wanin, Othman; Assey, Anthony; Shabani, Hamisi; Ngerageza, Japhet G; Berlin, Connor D

2016-01-01

Spinal surgery under Eastern-African circumstances is technically demanding and associated with significant complications, such as blood loss, infection, and wound breakdown. We report a spinal trauma case that was performed using minimally invasive surgery (MIS) and navigation, and hypothesize that these newer techniques may enable surgeons to perform effective spinal surgery with minimal complications and good outcomes.  During the 2014 First Hands-on Neurotrauma Course held in Dar es Salaam, Tanzania, we successfully performed three minimally invasive and two-dimensional (2D) navigated spinal surgeries to decompress and stabilize patients with complete and incomplete spinal injuries. In this report, we present a case of a paraplegic patient with a T12 burst fracture who tolerated MIS surgery with no intraoperative complications, and is doing well with no postoperative complications one year after surgery. Minimally invasive spinal surgery and 2D navigation may offer advantages in resource-poor countries. As part of the Weill Cornell Tanzania Neurosurgery project and in conjunction with the Foundation for International Education in Neurological Surgery (as well as other organizations), further experiences with 2D navigation and MIS surgery will be recorded in 2015. A neurotrauma registry has already been implemented to better understand the current management of neurotrauma in Eastern Africa. PMID:27026832

Noninvasive CT to Iso-C3D registration for improved intraoperative visualization in computer assisted orthopedic surgery

NASA Astrophysics Data System (ADS)

Rudolph, Tobias; Ebert, Lars; Kowal, Jens

2006-03-01

Supporting surgeons in performing minimally invasive surgeries can be considered as one of the major goals of computer assisted surgery. Excellent intraoperative visualization is a prerequisite to achieve this aim. The Siremobil Iso-C 3D has become a widely used imaging device, which, in combination with a navigation system, enables the surgeon to directly navigate within the acquired 3D image volume without any extra registration steps. However, the image quality is rather low compared to a CT scan and the volume size (approx. 12 cm 3) limits its application. A regularly used alternative in computer assisted orthopedic surgery is to use of a preoperatively acquired CT scan to visualize the operating field. But, the additional registration step, necessary in order to use CT stacks for navigation is quite invasive. Therefore the objective of this work is to develop a noninvasive registration technique. In this article a solution is being proposed that registers a preoperatively acquired CT scan to the intraoperatively acquired Iso-C 3D image volume, thereby registering the CT to the tracked anatomy. The procedure aligns both image volumes by maximizing the mutual information, an algorithm that has already been applied to similar registration problems and demonstrated good results. Furthermore the accuracy of such a registration method was investigated in a clinical setup, integrating a navigated Iso-C 3D in combination with an tracking system. Initial tests based on cadaveric animal bone resulted in an accuracy ranging from 0.63mm to 1.55mm mean error.

Preliminary study on magnetic tracking-based planar shape sensing and navigation for flexible surgical robots in transoral surgery: methods and phantom experiments.

PubMed

Song, Shuang; Zhang, Changchun; Liu, Li; Meng, Max Q-H

2018-02-01

Flexible surgical robot can work in confined and complex environments, which makes it a good option for minimally invasive surgery. In order to utilize flexible manipulators in complicated and constrained surgical environments, it is of great significance to monitor the position and shape of the curvilinear manipulator in real time during the procedures. In this paper, we propose a magnetic tracking-based planar shape sensing and navigation system for flexible surgical robots in the transoral surgery. The system can provide the real-time tip position and shape information of the robot during the operation. We use wire-driven flexible robot to serve as the manipulator. It has three degrees of freedom. A permanent magnet is mounted at the distal end of the robot. Its magnetic field can be sensed with a magnetic sensor array. Therefore, position and orientation of the tip can be estimated utilizing a tracking method. A shape sensing algorithm is then carried out to estimate the real-time shape based on the tip pose. With the tip pose and shape display in the 3D reconstructed CT model, navigation can be achieved. Using the proposed system, we carried out planar navigation experiments on a skull phantom to touch three different target positions under the navigation of the skull display interface. During the experiments, the real-time shape has been well monitored and distance errors between the robot tip and the targets in the skull have been recorded. The mean navigation error is [Formula: see text] mm, while the maximum error is 3.2 mm. The proposed method provides the advantages that no sensors are needed to mount on the robot and no line-of-sight problem. Experimental results verified the feasibility of the proposed method.

A novel augmented reality system for displaying inferior alveolar nerve bundles in maxillofacial surgery

PubMed Central

Zhu, Ming; Liu, Fei; Chai, Gang; Pan, Jun J.; Jiang, Taoran; Lin, Li; Xin, Yu; Zhang, Yan; Li, Qingfeng

2017-01-01

Augmented reality systems can combine virtual images with a real environment to ensure accurate surgery with lower risk. This study aimed to develop a novel registration and tracking technique to establish a navigation system based on augmented reality for maxillofacial surgery. Specifically, a virtual image is reconstructed from CT data using 3D software. The real environment is tracked by the augmented reality (AR) software. The novel registration strategy that we created uses an occlusal splint compounded with a fiducial marker (OSM) to establish a relationship between the virtual image and the real object. After the fiducial marker is recognized, the virtual image is superimposed onto the real environment, forming the “integrated image” on semi-transparent glass. Via the registration process, the integral image, which combines the virtual image with the real scene, is successfully presented on the semi-transparent helmet. The position error of this navigation system is 0.96 ± 0.51 mm. This augmented reality system was applied in the clinic and good surgical outcomes were obtained. The augmented reality system that we established for maxillofacial surgery has the advantages of easy manipulation and high accuracy, which can improve surgical outcomes. Thus, this system exhibits significant potential in clinical applications. PMID:28198442

A novel augmented reality system for displaying inferior alveolar nerve bundles in maxillofacial surgery.

PubMed

Zhu, Ming; Liu, Fei; Chai, Gang; Pan, Jun J; Jiang, Taoran; Lin, Li; Xin, Yu; Zhang, Yan; Li, Qingfeng

2017-02-15

Augmented reality systems can combine virtual images with a real environment to ensure accurate surgery with lower risk. This study aimed to develop a novel registration and tracking technique to establish a navigation system based on augmented reality for maxillofacial surgery. Specifically, a virtual image is reconstructed from CT data using 3D software. The real environment is tracked by the augmented reality (AR) software. The novel registration strategy that we created uses an occlusal splint compounded with a fiducial marker (OSM) to establish a relationship between the virtual image and the real object. After the fiducial marker is recognized, the virtual image is superimposed onto the real environment, forming the "integrated image" on semi-transparent glass. Via the registration process, the integral image, which combines the virtual image with the real scene, is successfully presented on the semi-transparent helmet. The position error of this navigation system is 0.96 ± 0.51 mm. This augmented reality system was applied in the clinic and good surgical outcomes were obtained. The augmented reality system that we established for maxillofacial surgery has the advantages of easy manipulation and high accuracy, which can improve surgical outcomes. Thus, this system exhibits significant potential in clinical applications.

Accuracy of image-guided surgical navigation using near infrared (NIR) optical tracking

NASA Astrophysics Data System (ADS)

Jakubovic, Raphael; Farooq, Hamza; Alarcon, Joseph; Yang, Victor X. D.

2015-03-01

Spinal surgery is particularly challenging for surgeons, requiring a high level of expertise and precision without being able to see beyond the surface of the bone. Accurate insertion of pedicle screws is critical considering perforation of the pedicle can result in profound clinical consequences including spinal cord, nerve root, arterial injury, neurological deficits, chronic pain, and/or failed back syndrome. Various navigation systems have been designed to guide pedicle screw fixation. Computed tomography (CT)-based image guided navigation systems increase the accuracy of screw placement allowing for 3- dimensional visualization of the spinal anatomy. Current localization techniques require extensive preparation and introduce spatial deviations. Use of near infrared (NIR) optical tracking allows for realtime navigation of the surgery by utilizing spectral domain multiplexing of light, greatly enhancing the surgeon's situation awareness in the operating room. While the incidence of pedicle screw perforation and complications have been significantly reduced with the introduction of modern navigational technologies, some error exists. Several parameters have been suggested including fiducial localization and registration error, target registration error, and angular deviation. However, many of these techniques quantify error using the pre-operative CT and an intra-operative screenshot without assessing the true screw trajectory. In this study we quantified in-vivo error by comparing the true screw trajectory to the intra-operative trajectory. Pre- and post- operative CT as well as intra-operative screenshots were obtained for a cohort of patients undergoing spinal surgery. We quantified entry point error and angular deviation in the axial and sagittal planes.

Intraoperative 3-Dimensional Computed Tomography and Navigation in Foot and Ankle Surgery.

PubMed

Chowdhary, Ashwin; Drittenbass, Lisca; Dubois-Ferrière, Victor; Stern, Richard; Assal, Mathieu

2016-09-01

Computer-assisted orthopedic surgery has developed dramatically during the past 2 decades. This article describes the use of intraoperative 3-dimensional computed tomography and navigation in foot and ankle surgery. Traditional imaging based on serial radiography or C-arm-based fluoroscopy does not provide simultaneous real-time 3-dimensional imaging, and thus leads to suboptimal visualization and guidance. Three-dimensional computed tomography allows for accurate intraoperative visualization of the position of bones and/or navigation implants. Such imaging and navigation helps to further reduce intraoperative complications, leads to improved surgical outcomes, and may become the gold standard in foot and ankle surgery. [Orthopedics.2016; 39(5):e1005-e1010.]. Copyright 2016, SLACK Incorporated.

Neuronavigation Based on Track Density Image Extracted from Deterministic High-Definition Fiber Tractography.

PubMed

Wei, Peng-Hu; Cong, Fei; Chen, Ge; Li, Ming-Chu; Yu, Xin-Guang; Bao, Yu-Hai

2017-02-01

Diffusion tensor imaging-based navigation is unable to resolve crossing fibers or to determine with accuracy the fanning, origin, and termination of fibers. It is important to improve the accuracy of localizing white matter fibers for improved surgical approaches. We propose a solution to this problem using navigation based on track density imaging extracted from high-definition fiber tractography (HDFT). A 28-year-old asymptomatic female patient with a left-lateral ventricle meningioma was enrolled in the present study. Language and visual tests, magnetic resonance imaging findings, both preoperative and postoperative HDFT, and the intraoperative navigation and surgery process are presented. Track density images were extracted from tracts derived using full q-space (514 directions) diffusion spectrum imaging (DSI) and integrated into a neuronavigation system. Navigation accuracy was verified via intraoperative records and postoperative DSI tractography, as well as a functional examination. DSI successfully represented the shape and range of the Meyer loop and arcuate fasciculus. Extracted track density images from the DSI were successfully integrated into the navigation system. The relationship between the operation channel and surrounding tracts was consistent with the postoperative findings, and the patient was functionally intact after the surgery. DSI-based TDI navigation allows for the visualization of anatomic features such as fanning and angling and helps to identify the range of a given tract. Moreover, our results show that our HDFT navigation method is a promising technique that preserves neural function. Copyright © 2016 Elsevier Inc. All rights reserved.

Image-guided navigation: a cost effective practical introduction using the Image-Guided Surgery Toolkit (IGSTK).

PubMed

Güler, Özgür; Yaniv, Ziv

2012-01-01

Teaching the key technical aspects of image-guided interventions using a hands-on approach is a challenging task. This is primarily due to the high cost and lack of accessibility to imaging and tracking systems. We provide a software and data infrastructure which addresses both challenges. Our infrastructure allows students, patients, and clinicians to develop an understanding of the key technologies by using them, and possibly by developing additional components and integrating them into a simple navigation system which we provide. Our approach requires minimal hardware, LEGO blocks to construct a phantom for which we provide CT scans, and a webcam which when combined with our software provides the functionality of a tracking system. A premise of this approach is that tracking accuracy is sufficient for our purpose. We evaluate the accuracy provided by a consumer grade webcam and show that it is sufficient for educational use. We provide an open source implementation of all the components required for a basic image-guided navigation as part of the Image-Guided Surgery Toolkit (IGSTK). It has long been known that in education there is no substitute for hands-on experience, to quote Sophocles, "One must learn by doing the thing; for though you think you know it, you have no certainty, until you try.". Our work provides this missing capability in the context of image-guided navigation. Enabling a wide audience to learn and experience the use of a navigation system.

Marker-free registration for the accurate integration of CT images and the subject's anatomy during navigation surgery of the maxillary sinus

PubMed Central

Kang, S-H; Kim, M-K; Kim, J-H; Park, H-K; Park, W

2012-01-01

Objective This study compared three marker-free registration methods that are applicable to a navigation system that can be used for maxillary sinus surgery, and evaluated the associated errors, with the aim of determining which registration method is the most applicable for operations that require accurate navigation. Methods The CT digital imaging and communications in medicine (DICOM) data of ten maxillary models in DICOM files were converted into stereolithography file format. All of the ten maxillofacial models were scanned three dimensionally using a light-based three-dimensional scanner. The methods applied for registration of the maxillofacial models utilized the tooth cusp, bony landmarks and maxillary sinus anterior wall area. The errors during registration were compared between the groups. Results There were differences between the three registration methods in the zygoma, sinus posterior wall, molar alveolar, premolar alveolar, lateral nasal aperture and the infraorbital areas. The error was smallest using the overlay method for the anterior wall of the maxillary sinus, and the difference was statistically significant. Conclusion The navigation error can be minimized by conducting registration using the anterior wall of the maxillary sinus during image-guided surgery of the maxillary sinus. PMID:22499127

Direct endoscopic video registration for sinus surgery

NASA Astrophysics Data System (ADS)

Mirota, Daniel; Taylor, Russell H.; Ishii, Masaru; Hager, Gregory D.

2009-02-01

Advances in computer vision have made possible robust 3D reconstruction of monocular endoscopic video. These reconstructions accurately represent the visible anatomy and, once registered to pre-operative CT data, enable a navigation system to track directly through video eliminating the need for an external tracking system. Video registration provides the means for a direct interface between an endoscope and a navigation system and allows a shorter chain of rigid-body transformations to be used to solve the patient/navigation-system registration. To solve this registration step we propose a new 3D-3D registration algorithm based on Trimmed Iterative Closest Point (TrICP)1 and the z-buffer algorithm.2 The algorithm takes as input a 3D point cloud of relative scale with the origin at the camera center, an isosurface from the CT, and an initial guess of the scale and location. Our algorithm utilizes only the visible polygons of the isosurface from the current camera location during each iteration to minimize the search area of the target region and robustly reject outliers of the reconstruction. We present example registrations in the sinus passage applicable to both sinus surgery and transnasal surgery. To evaluate our algorithm's performance we compare it to registration via Optotrak and present closest distance point to surface error. We show our algorithm has a mean closest distance error of .2268mm.

[Principles of MR-guided interventions, surgery, navigation, and robotics].

PubMed

Melzer, A

2010-08-01

The application of magnetic resonance imaging (MRI) as an imaging technique in interventional and surgical techniques provides a new dimension of soft tissue-oriented precise procedures without exposure to ionizing radiation and nephrotoxic allergenic, iodine-containing contrast agents. The technical capabilities of MRI in combination with interventional devices and systems, navigation, and robotics are discussed.

Navigation and Robotics in Spinal Surgery: Where Are We Now?

PubMed

Overley, Samuel C; Cho, Samuel K; Mehta, Ankit I; Arnold, Paul M

2017-03-01

Spine surgery has experienced much technological innovation over the past several decades. The field has seen advancements in operative techniques, implants and biologics, and equipment such as computer-assisted navigation and surgical robotics. With the arrival of real-time image guidance and navigation capabilities along with the computing ability to process and reconstruct these data into an interactive three-dimensional spinal "map", so too have the applications of surgical robotic technology. While spinal robotics and navigation represent promising potential for improving modern spinal surgery, it remains paramount to demonstrate its superiority as compared to traditional techniques prior to assimilation of its use amongst surgeons.The applications for intraoperative navigation and image-guided robotics have expanded to surgical resection of spinal column and intradural tumors, revision procedures on arthrodesed spines, and deformity cases with distorted anatomy. Additionally, these platforms may mitigate much of the harmful radiation exposure in minimally invasive surgery to which the patient, surgeon, and ancillary operating room staff are subjected.Spine surgery relies upon meticulous fine motor skills to manipulate neural elements and a steady hand while doing so, often exploiting small working corridors utilizing exposures that minimize collateral damage. Additionally, the procedures may be long and arduous, predisposing the surgeon to both mental and physical fatigue. In light of these characteristics, spine surgery may actually be an ideal candidate for the integration of navigation and robotic-assisted procedures.With this paper, we aim to critically evaluate the current literature and explore the options available for intraoperative navigation and robotic-assisted spine surgery. Copyright © 2016 by the Congress of Neurological Surgeons.

A full 3D-navigation system in a suitcase.

PubMed

Freysinger, W; Truppe, M J; Gunkel, A R; Thumfart, W F

2001-01-01

To reduce the impact of contemporary 3D-navigation systems on the environment of typical otorhinolaryngologic operating rooms, we demonstrate that a transfer of navigation software to modern high-power notebook computers is feasible and results in a practicable way to provide positional information to a surgeon intraoperatively. The ARTMA Virtual Patient System has been implemented on a Macintosh PowerBook G3 and, in connection with the Polhemus FASTRAK digitizer, provides intraoperative positional information during endoscopic endonasal surgery. Satisfactory intraoperative navigation has been realized in two- and three-dimensional medical image data sets (i.e., X-ray, ultrasound images, CT, and MR) and live video. This proof-of-concept study demonstrates that acceptable ergonomics and excellent performance of the system can be achieved with contemporary high-end notebook computers. Copyright 2001 Wiley-Liss, Inc.

Development of a surgical navigation system based on augmented reality using an optical see-through head-mounted display.

PubMed

Chen, Xiaojun; Xu, Lu; Wang, Yiping; Wang, Huixiang; Wang, Fang; Zeng, Xiangsen; Wang, Qiugen; Egger, Jan

2015-06-01

The surgical navigation system has experienced tremendous development over the past decades for minimizing the risks and improving the precision of the surgery. Nowadays, Augmented Reality (AR)-based surgical navigation is a promising technology for clinical applications. In the AR system, virtual and actual reality are mixed, offering real-time, high-quality visualization of an extensive variety of information to the users (Moussa et al., 2012) [1]. For example, virtual anatomical structures such as soft tissues, blood vessels and nerves can be integrated with the real-world scenario in real time. In this study, an AR-based surgical navigation system (AR-SNS) is developed using an optical see-through HMD (head-mounted display), aiming at improving the safety and reliability of the surgery. With the use of this system, including the calibration of instruments, registration, and the calibration of HMD, the 3D virtual critical anatomical structures in the head-mounted display are aligned with the actual structures of patient in real-world scenario during the intra-operative motion tracking process. The accuracy verification experiment demonstrated that the mean distance and angular errors were respectively 0.809±0.05mm and 1.038°±0.05°, which was sufficient to meet the clinical requirements. Copyright © 2015 Elsevier Inc. All rights reserved.

A navigated mechatronic system with haptic features to assist in surgical interventions.

PubMed

Pieck, S; Gross, I; Knappe, P; Kuenzler, S; Kerschbaumer, F; Wahrburg, J

2003-01-01

In orthopaedic surgery, the development of new computer-based technologies such as navigation systems and robotics will facilitate more precise, reproducible results in surgical interventions. There are already commercial systems available for clinical use, though these still have some limitations and drawbacks. This paper presents an alternative approach to a universal modular surgical assistant system for supporting less or minimally invasive surgery. The position of a mechatronic arm, which is part of the system, is controlled by a navigation system so that small patient movements are automatically detected and compensated for in real time. Thus, the optimal tool position can be constantly maintained without the need for rigid bone or patient fixation. Furthermore, a force control mode of the mechatronic assistant system, based on a force-torque sensor, not only increases safety during surgical interventions but also facilitates hand-driven direct positioning of the arm. A prototype has been successfully tested in clinical applications at the Orthopadische Universitätsklinik Frankfurt. For the first time worldwide, implantation of the cup prosthesis in total hip replacement surgery has been carried out with the assistance of a mechatronic arm. According to measurements by the digitizing system, operating tool angle deviation remained below 0.5 degrees, relative to the preoperative planning. The presented approach to a new kind of surgical mechatronic assistance system supports the surgeon as needed by optimal positioning of the surgical instruments. Due to its modular design, it is applicable to a wide range of tasks in surgical interventions, e.g., endoscope guidance, bone preparation, etc.

Comparing conventional and computer-assisted surgery baseplate and screw placement in reverse shoulder arthroplasty.

PubMed

Venne, Gabriel; Rasquinha, Brian J; Pichora, David; Ellis, Randy E; Bicknell, Ryan

2015-07-01

Preoperative planning and intraoperative navigation technologies have each been shown separately to be beneficial for optimizing screw and baseplate positioning in reverse shoulder arthroplasty (RSA) but to date have not been combined. This study describes development of a system for performing computer-assisted RSA glenoid baseplate and screw placement, including preoperative planning, intraoperative navigation, and postoperative evaluation, and compares this system with a conventional approach. We used a custom-designed system allowing computed tomography (CT)-based preoperative planning, intraoperative navigation, and postoperative evaluation. Five orthopedic surgeons defined common preoperative plans on 3-dimensional CT reconstructed cadaveric shoulders. Each surgeon performed 3 computer-assisted and 3 conventional simulated procedures. The 3-dimensional CT reconstructed postoperative units were digitally matched to the preoperative model for evaluation of entry points, end points, and angulations of screws and baseplate. Values were used to find accuracy and precision of the 2 groups with respect to the defined placement. Statistical analysis was performed by t tests (α = .05). Comparison of the groups revealed no difference in accuracy or precision of screws or baseplate entry points (P > .05). Accuracy and precision were improved with use of navigation for end points and angulations of 3 screws (P < .05). Accuracy of the inferior screw showed a trend of improvement with navigation (P > .05). Navigated baseplate end point precision was improved (P < .05), with a trend toward improved accuracy (P > .05). We conclude that CT-based preoperative planning and intraoperative navigation allow improved accuracy and precision for screw placement and precision for baseplate positioning with respect to a predefined placement compared with conventional techniques in RSA. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Diagnostic and therapeutic aspects in the treatment of gunshot wounds of the viscerocranium.

PubMed

Gröbe, A; Klatt, J; Heiland, M; Schmelzle, R; Pohlenz, P

2011-02-01

Gunshot wounds of the viscerocranium are a rare occurrence during times of peace in Europe. The removal of projectiles is recommended; in some cases, however, this is controversial. The material properties of projectiles and destruction of anatomical landmarks make it difficult to determine their precise location. Therefore, navigation systems and cone-beam computed tomography (CT) provide the surgeon with continuous intraoperative orientation in real-time. The aim of this study was to report our experiences for image-guided removal of projectiles, the use of cone-beam computed tomography and the resulting intra- and postoperative complications. We investigated 50 patients with gunshot wounds of the facial skeleton retrospectively, 32 had image-guided surgical removal of projectiles in the oral and maxillofacial region, 18 had surgical removal of projectiles without navigation assistance and in 28 cases we used cone-beam CT in the case of dislocated projectiles and fractured bones. There was a significant correlation (p = 0.0136) between the navigated versus not navigated surgery and complication rate (8 vs. 32%, p = 0.0132) including major bleeding, soft tissue infections and nerve damage. Furthermore, we could reduce operating time while using a navigation system and cone-beam CT (p = 0.038). A high tendency between operating time and navigated surgery (p = 0.1103) was found. In conclusion, there is a significant correlation between reduced intra- and postoperative complications including wound infections, nerve damage and major bleeding and the appropriate use of a navigation system. In all these cases we were able to present reduced operating time. Cone-beam CT plays a key role as a useful diagnostic tool in detecting projectiles or metallic foreign bodies intraoperatively.

Efficacy of a novel IGS system in atrial septal defect repair

NASA Astrophysics Data System (ADS)

Mefleh, Fuad N.; Baker, G. Hamilton; Kwartowitz, David M.

2013-03-01

Congenital heart disease occurs in 107.6 out of 10,000 live births, with Atrial Septal Defects (ASD) accounting for 10% of these conditions. Historically, ASDs were treated with open heart surgery using cardiopulmonary bypass, allowing a patch to be sewn over the defect. In 1976, King et al. demonstrated use of a transcatheter occlusion procedure, thus reducing the invasiveness of ASD repair. Localization during these catheter based procedures traditionally has relied on bi-plane fluoroscopy; more recently trans-esophageal echocardiography (TEE) and intra-cardiac echocardiography (ICE) have been used to navigate these procedures. Although there is a high success rate using the transcatheter occlusion procedure, fluoroscopy poses radiation dose risk to both patient and clinician. The impact of this dose to the patients is important as many of those undergoing this procedure are children, who have an increased risk associated with radiation exposure. Their longer life expectancy than adults provides a larger window of opportunity for expressing the damaging effects of ionizing radiation. In addition, epidemiologic studies of exposed populations have demonstrated that children are considerably more sensitive to the carcinogenic effects radiation. Image-guided surgery (IGS) uses pre-operative and intra-operative images to guide surgery or an interventional procedure. Central to every IGS system is a software application capable of processing and displaying patient images, registration between multiple coordinate systems, and interfacing with a tool tracking system. We have developed a novel image-guided surgery framework called Kit for Navigation by Image Focused Exploration (KNIFE). In this work we assess the efficacy of this image-guided navigation system for ASD repair using a series of mock clinical experiments designed to simulate ASD repair device deployment.

Videoexoscopic real-time intraoperative navigation for spinal neurosurgery: a novel co-adaptation of two existing technology platforms, technical note.

PubMed

Huang, Meng; Barber, Sean Michael; Steele, William James; Boghani, Zain; Desai, Viren Rajendrakumar; Britz, Gavin Wayne; West, George Alexander; Trask, Todd Wilson; Holman, Paul Joseph

2018-06-01

Image-guided approaches to spinal instrumentation and interbody fusion have been widely popularized in the last decade [1-5]. Navigated pedicle screws are significantly less likely to breach [2, 3, 5, 6]. Navigation otherwise remains a point reference tool because the projection is off-axis to the surgeon's inline loupe or microscope view. The Synaptive robotic brightmatter drive videoexoscope monitor system represents a new paradigm for off-axis high-definition (HD) surgical visualization. It has many advantages over the traditional microscope and loupes, which have already been demonstrated in a cadaveric study [7]. An auxiliary, but powerful capability of this system is projection of a second, modifiable image in a split-screen configuration. We hypothesized that integration of both Medtronic and Synaptive platforms could permit the visualization of reconstructed navigation and surgical field images simultaneously. By utilizing navigated instruments, this configuration has the ability to support live image-guided surgery or real-time navigation (RTN). Medtronic O-arm/Stealth S7 navigation, MetRx, NavLock, and SureTrak spinal systems were implemented on a prone cadaveric specimen with a stream output to the Synaptive Display. Surgical visualization was provided using a Storz Image S1 platform and camera mounted to the Synaptive robotic brightmatter drive. We were able to successfully technically co-adapt both platforms. A minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) and an open pedicle subtraction osteotomy (PSO) were performed using a navigated high-speed drill under RTN. Disc Shaver and Trials under RTN were implemented on the MIS TLIF. The synergy of Synaptive HD videoexoscope robotic drive and Medtronic Stealth platforms allow for live image-guided surgery or real-time navigation (RTN). Off-axis projection also allows upright neutral cervical spine operative ergonomics for the surgeons and improved surgical team visualization and education compared to traditional means. This technique has the potential to augment existing minimally invasive and open approaches, but will require long-term outcome measurements for efficacy.

Navigating laparoscopic surgery into the next decade in developing countries - a personal perspective.

PubMed

Udwadia, Tehemton E

2007-01-01

Over 500 years ago, Vasco de Gama navigated from west to east, from Lisbon in Portugal to Calicut in India, in an epic voyage that lasted over 1 year (Fig. 1). This voyage was perhaps the greatest historic and, certainly, the greatest navigational achievement of the last millennium. For better or for worse, it catalysed a series of events that forever changed not only the history, but also the geography of the world. In our plans to navigate endoscopic surgery into the next decade in developing countries, we too should endeavour to change both the history and the geography of surgery. This talk traces a journey over 34 years of effort to spread laparoscopic surgery into developing countries.

Technological advances in robotic-assisted laparoscopic surgery.

PubMed

Tan, Gerald Y; Goel, Raj K; Kaouk, Jihad H; Tewari, Ashutosh K

2009-05-01

In this article, the authors describe the evolution of urologic robotic systems and the current state-of-the-art features and existing limitations of the da Vinci S HD System (Intuitive Surgical, Inc.). They then review promising innovations in scaling down the footprint of robotic platforms, the early experience with mobile miniaturized in vivo robots, advances in endoscopic navigation systems using augmented reality technologies and tracking devices, the emergence of technologies for robotic natural orifice transluminal endoscopic surgery and single-port surgery, advances in flexible robotics and haptics, the development of new virtual reality simulator training platforms compatible with the existing da Vinci system, and recent experiences with remote robotic surgery and telestration.

Knee stability before and after total and unicondylar knee replacement: in vivo kinematic evaluation utilizing navigation.

PubMed

Casino, Daniela; Martelli, Sandra; Zaffagnini, Stefano; Lopomo, Nicola; Iacono, Francesco; Bignozzi, Simone; Visani, Andrea; Marcacci, Maurilio

2009-02-01

Surgical navigation systems are currently used to guide the surgeon in the correct alignment of the implant. The aim of this study was to expand the use of navigation systems by proposing a surgical protocol for intraoperative kinematics evaluations during knee arthroplasty. The protocol was evaluated on 20 patients, half undergoing unicondylar knee arthroplasty (UKA) and half undergoing posterior-substituting, rotating-platform total knee arthroplasty (TKA). The protocol includes a simple acquisition procedure and an original elaboration methodology. Kinematic tests were performed before and after surgery and included varus/valgus stress at 0 and 30 degrees and passive range of motion. Both UKA and TKA improved varus/valgus stability in extension and preserved the total magnitude of screw-home motion during flexion. Moreover, compared to preoperative conditions, values assumed by tibial axial rotation during flexion in TKA knees were more similar to the rotating patterns of UKA knees. The analysis of the anteroposterior displacement of the knee compartments confirmed that the two prostheses did not produce medial pivoting, but achieved a postoperative normal behavior. These results demonstrated that proposed intraoperative kinematics evaluations by a navigation system provided new information on the functional outcome of the reconstruction useful to restore knee kinematics during surgery.

A near-infrared fluorescence-based surgical navigation system imaging software for sentinel lymph node detection

NASA Astrophysics Data System (ADS)

Ye, Jinzuo; Chi, Chongwei; Zhang, Shuang; Ma, Xibo; Tian, Jie

2014-02-01

Sentinel lymph node (SLN) in vivo detection is vital in breast cancer surgery. A new near-infrared fluorescence-based surgical navigation system (SNS) imaging software, which has been developed by our research group, is presented for SLN detection surgery in this paper. The software is based on the fluorescence-based surgical navigation hardware system (SNHS) which has been developed in our lab, and is designed specifically for intraoperative imaging and postoperative data analysis. The surgical navigation imaging software consists of the following software modules, which mainly include the control module, the image grabbing module, the real-time display module, the data saving module and the image processing module. And some algorithms have been designed to achieve the performance of the software, for example, the image registration algorithm based on correlation matching. Some of the key features of the software include: setting the control parameters of the SNS; acquiring, display and storing the intraoperative imaging data in real-time automatically; analysis and processing of the saved image data. The developed software has been used to successfully detect the SLNs in 21 cases of breast cancer patients. In the near future, we plan to improve the software performance and it will be extensively used for clinical purpose.

The Trans-Visible Navigator: A See-Through Neuronavigation System Using Augmented Reality.

PubMed

Watanabe, Eiju; Satoh, Makoto; Konno, Takehiko; Hirai, Masahiro; Yamaguchi, Takashi

2016-03-01

The neuronavigator has become indispensable for brain surgery and works in the manner of point-to-point navigation. Because the positional information is indicated on a personal computer (PC) monitor, surgeons are required to rotate the dimension of the magnetic resonance imaging/computed tomography scans to match the surgical field. In addition, they must frequently alternate their gaze between the surgical field and the PC monitor. To overcome these difficulties, we developed an augmented reality-based navigation system with whole-operation-room tracking. A tablet PC is used for visualization. The patient's head is captured by the back-face camera of the tablet. Three-dimensional images of intracranial structures are extracted from magnetic resonance imaging/computed tomography and are superimposed on the video image of the head. When viewed from various directions around the head, intracranial structures are displayed with corresponding angles as viewed from the camera direction, thus giving the surgeon the sensation of seeing through the head. Whole-operation-room tracking is realized using a VICON tracking system with 6 cameras. A phantom study showed a spatial resolution of about 1 mm. The present system was evaluated in 6 patients who underwent tumor resection surgery, and we showed that the system is useful for planning skin incisions as well as craniotomy and the localization of superficial tumors. The main advantage of the present system is that it achieves volumetric navigation in contrast to conventional point-to-point navigation. It extends augmented reality images directly onto real surgical images, thus helping the surgeon to integrate these 2 dimensions intuitively. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Does intraoperative navigation improve the accuracy of mandibular angle osteotomy: Comparison between augmented reality navigation, individualised templates and free-hand techniques.

PubMed

Zhu, Ming; Liu, Fei; Zhou, Chaozheng; Lin, Li; Zhang, Yan; Chai, Gang; Xie, Le; Qi, Fazhi; Li, Qingfeng

2018-04-11

Augmented reality (AR)-based navigation surgery has evolved to be an advanced assisted technology. The aim of this study is to manifest the accuracy of AR navigation for the intraoperative mandibular angle osteotomy by comparing the navigation with other interventional techniques. A retrospective study was conducted with 93 post-surgical patients with mandibular angle hypertrophy admitted at our plastic and reconstructive surgery department between September 2011 and June 2016. Thirty-one patients received osteotomy conducted using a navigation system based on augmented reality (AR group), 28 patients received osteotomy conducted using individualised templates (IT group) and the remaining 34 patients received osteotomy performed by free hand (free-hand group). The post-operative computed tomography (CT) images were reviewed and analysed by comparing with pre-surgical planning generated by three-dimensional (3D) software. The preparation time, cutting time, whole operating time and discrepancy in osteotomy lines were measured. The preparation time was much shorter for the free-hand group than that for the AR group and the IT group (P < 0.01). However, no significant difference in the whole operating time was observed among the three groups (P > 0.05). In addition, the discrepancy in osteotomy lines was lower for the AR group and in the IT group than for the free-hand group (P < 0.01). The navigation system based on AR has a higher accuracy, more reliability and better user friendliness for some particular clinical procedures than for other techniques, which has a promising clinical prospect. Copyright © 2018. Published by Elsevier Ltd.

Navigation in head and neck oncological surgery: an emerging concept.

PubMed

Gangloff, P; Mastronicola, R; Cortese, S; Phulpin, B; Sergeant, C; Guillemin, F; Eluecque, H; Perrot, C; Dolivet, G

2011-01-01

Navigation surgery, initially applied in rhinology, neurosurgery and orthopaedic cases, has been developed over the last twenty years. Surgery based on computed tomography data has become increasingly important in the head and neck region. The technique for hardware fusion between RMI and computed tomography is also becoming more useful. We use such device since 2006 in head and neck carcinologic situation. Navigation allows control of the resection in order to avoid and protect the precise anatomical structures (vessels and nerves). It also guides biopsy and radiofrequency. Therefore, quality of life is much more increased and morbidity is decreased for these patients who undergo major and mutilating head and neck surgery. Here we report the results of 33 navigation procedures performed for 31 patients in our institution.

The developments and achievements of endoscopic surgery, robotic surgery and function-preserving surgery.

PubMed

Yoshida, Masashi; Furukawa, Toshiharu; Morikawa, Yasuhide; Kitagawa, Yuko; Kitajima, Masaki

2010-09-01

The breakthrough in laparoscopic surgery has been the development of a charge-coupled device camera system and Mouret performing cholecystectomy in 1987. The short-term benefits of laparoscopic surgery are widely accepted and the long-term benefit of less incidence of bowel obstruction can be expected. The important developments have been the articulating instrumentation via new laparoscopic access ports. Since 2007, single-incision laparoscopic surgery has spread all over the world. Not only single-scar but also no-scar operation is a current topic. In 2004, Kalloo reported the flexible transgastric peritoneoscopy as a novel approach to therapeutic interventions. In 2007, Marescaux reported transvaginal cholecystectomy in a patient. The breakthrough in robotic surgery was the development of the da Vinci Surgical System. It was introduced to Keio University Hospital in March 2000. Precision in the surgery will reach a higher level with the use of robotics. In collaboration with the faculty of technology and science, Keio University, the combined master-slave manipulator has been developed. The haptic forceps, which measure the elasticity of organs, have also been developed. The first possible sites of lymphatic metastasis are known as sentinel nodes. Otani reported vagus-sparing segmental gastrectomy under sentinel node navigation. This kind of function-preserving surgery will be performed frequently if the results of the multicenter prospective trial of the dual tracer method are favorable. Indocyanine green fluorescence-guided method using the HyperEye charge-coupled device camera system can be a highly sensitive method without using the radioactive colloid. 'Minimally invasive, function-preserving and precise surgery under sentinel node navigation in community hospital' may be a goal for us.

Modelling and Experiment Based on a Navigation System for a Cranio-Maxillofacial Surgical Robot.

PubMed

Duan, Xingguang; Gao, Liang; Wang, Yonggui; Li, Jianxi; Li, Haoyuan; Guo, Yanjun

2018-01-01

In view of the characteristics of high risk and high accuracy in cranio-maxillofacial surgery, we present a novel surgical robot system that can be used in a variety of surgeries. The surgical robot system can assist surgeons in completing biopsy of skull base lesions, radiofrequency thermocoagulation of the trigeminal ganglion, and radioactive particle implantation of skull base malignant tumors. This paper focuses on modelling and experimental analyses of the robot system based on navigation technology. Firstly, the transformation relationship between the subsystems is realized based on the quaternion and the iterative closest point registration algorithm. The hand-eye coordination model based on optical navigation is established to control the end effector of the robot moving to the target position along the planning path. The closed-loop control method, "kinematics + optics" hybrid motion control method, is presented to improve the positioning accuracy of the system. Secondly, the accuracy of the system model was tested by model experiments. And the feasibility of the closed-loop control method was verified by comparing the positioning accuracy before and after the application of the method. Finally, the skull model experiments were performed to evaluate the function of the surgical robot system. The results validate its feasibility and are consistent with the preoperative surgical planning.

Modelling and Experiment Based on a Navigation System for a Cranio-Maxillofacial Surgical Robot

PubMed Central

Duan, Xingguang; Gao, Liang; Li, Jianxi; Li, Haoyuan; Guo, Yanjun

2018-01-01

In view of the characteristics of high risk and high accuracy in cranio-maxillofacial surgery, we present a novel surgical robot system that can be used in a variety of surgeries. The surgical robot system can assist surgeons in completing biopsy of skull base lesions, radiofrequency thermocoagulation of the trigeminal ganglion, and radioactive particle implantation of skull base malignant tumors. This paper focuses on modelling and experimental analyses of the robot system based on navigation technology. Firstly, the transformation relationship between the subsystems is realized based on the quaternion and the iterative closest point registration algorithm. The hand-eye coordination model based on optical navigation is established to control the end effector of the robot moving to the target position along the planning path. The closed-loop control method, “kinematics + optics” hybrid motion control method, is presented to improve the positioning accuracy of the system. Secondly, the accuracy of the system model was tested by model experiments. And the feasibility of the closed-loop control method was verified by comparing the positioning accuracy before and after the application of the method. Finally, the skull model experiments were performed to evaluate the function of the surgical robot system. The results validate its feasibility and are consistent with the preoperative surgical planning. PMID:29599948

The utilization of cranial models created using rapid prototyping techniques in the development of models for navigation training.

PubMed

Waran, V; Pancharatnam, Devaraj; Thambinayagam, Hari Chandran; Raman, Rajagopal; Rathinam, Alwin Kumar; Balakrishnan, Yuwaraj Kumar; Tung, Tan Su; Rahman, Z A

2014-01-01

Navigation in neurosurgery has expanded rapidly; however, suitable models to train end users to use the myriad software and hardware that come with these systems are lacking. Utilizing three-dimensional (3D) industrial rapid prototyping processes, we have been able to create models using actual computed tomography (CT) data from patients with pathology and use these models to simulate a variety of commonly performed neurosurgical procedures with navigation systems. To assess the possibility of utilizing models created from CT scan dataset obtained from patients with cranial pathology to simulate common neurosurgical procedures using navigation systems. Three patients with pathology were selected (hydrocephalus, right frontal cortical lesion, and midline clival meningioma). CT scan data following an image-guidance surgery protocol in DIACOM format and a Rapid Prototyping Machine were taken to create the necessary printed model with the corresponding pathology embedded. The ability in registration, planning, and navigation of two navigation systems using a variety of software and hardware provided by these platforms was assessed. We were able to register all models accurately using both navigation systems and perform the necessary simulations as planned. Models with pathology utilizing 3D rapid prototyping techniques accurately reflect data of actual patients and can be used in the simulation of neurosurgical operations using navigation systems. Georg Thieme Verlag KG Stuttgart · New York.

Implant alignment in total elbow arthroplasty: conventional vs. navigated techniques

NASA Astrophysics Data System (ADS)

McDonald, Colin P.; Johnson, James A.; King, Graham J. W.; Peters, Terry M.

2009-02-01

Incorrect selection of the native flexion-extension axis during implant alignment in elbow replacement surgery is likely a significant contributor to failure of the prosthesis. Computer and image-assisted surgery is emerging as a useful surgical tool in terms of improving the accuracy of orthopaedic procedures. This study evaluated the accuracy of implant alignment using an image-based navigation technique compared against a conventional non-navigated approach. Implant alignment error was 0.8 +/- 0.3 mm in translation and 1.1 +/- 0.4° in rotation for the navigated alignment, compared with 3.1 +/- 1.3 mm and 5.0 +/- 3.8° for the non-navigated alignment. Five (5) of the 11 non-navigated alignments were malaligned greater than 5° while none of the navigated alignments were placed with an error of greater than 2.0°. It is likely that improved implant positioning will lead to reduced implant loading and wear, resulting in fewer implantrelated complications and revision surgeries.

Seven years of clinical experience with teleconsultation in craniomaxillofacial surgery.

PubMed

Ewers, Rolf; Schicho, Kurt; Wagner, Arne; Undt, Gerhard; Seemann, Rudolf; Figl, Michael; Truppe, Michael

2005-10-01

In this work the experiences from 50 telemedically supported treatments in craniomaxillofacial surgery are summarized and different setups for their technical realization are described. Furthermore, for the first time the innovative UMTS (universal mobile telecommunication system) is applied for the transmission of arthroscopic videos of the temporomandibular joint and other craniomaxillofacial structures. The combination of computer-assisted navigation technology in augmented reality environments with telecommunication is used for execution of interactive stereotaxic teleconsultation. Furthermore, treatments without navigation are telemedically supported. This study is composed of 4 technical system configurations: 1) integrated services digital network (ISDN)-based videoconferencing without remote control of the navigation computer; 2) transmission control protocol/internet protocol (TCP/IP)-based interactive teleconsultation via bundled ISDN lines (including remote control of the navigation computer); 3) TCP/IP-based interactive teleconsultation via network; 4) combination of TCP/IP-connection and ISDN-based videoconferencing. The telemedically supported treatments are: orbitozygomatic osteotomies, positioning of the mandibular condyle in orthognathic surgery, insertion of implants, positioning of the maxilla in orthognathic surgery, distraction osteogenesis, arthroscopies of the temporomandibular joint, and operation simulations on stereolithographic models. The surgical interventions are evaluated on a 5-level system performance scale from the technical point of view. In a separate trial 20 videosequences of arthroscopies of the temporomandibular joint are transmitted via UMTS cellular phones and independently evaluated by 3 experts (ie, a total of 60 streamings) to investigate feasibility of this technology in the field of craniomaxillofacial surgery. In the years from 1996 to 2002 a total of 50 treatments were telemedically supported. All intraoperative applications were successfully finished; 48 of 60 UMTS transmissions were finished without any interruptions in constant quality, slight interruptions were observed in 8 tests, and a complete breakdown was observed during 4 streamings that required a restart of the transmission. Resolution was sufficient to diagnose even tiny anatomic structures inside the temporomandibular joint, but orientation was hardly recognizable. In many applications telecommunication technology can contribute to a quality improvement in cranio- and maxillofacial surgery because of the global availability of specialized knowledge. The required technical expenditure for teleconsultation crucially depends on the infrastructure that is already available at the clinic and the remote site. UMTS is a promising technology with the potential to be valuable in numerous craniomaxillofacial applications.

Minimally invasive surgical video analysis: a powerful tool for surgical training and navigation.

PubMed

Sánchez-González, P; Oropesa, I; Gómez, E J

2013-01-01

Analysis of minimally invasive surgical videos is a powerful tool to drive new solutions for achieving reproducible training programs, objective and transparent assessment systems and navigation tools to assist surgeons and improve patient safety. This paper presents how video analysis contributes to the development of new cognitive and motor training and assessment programs as well as new paradigms for image-guided surgery.

Computer Assisted Navigation in Knee Arthroplasty

PubMed Central

Bae, Dae Kyung

2011-01-01

Computer assisted surgery (CAS) was used to improve the positioning of implants during total knee arthroplasty (TKA). Most studies have reported that computer assisted navigation reduced the outliers of alignment and component malpositioning. However, additional sophisticated studies are necessary to determine if the improvement of alignment will improve long-term clinical results and increase the survival rate of the implant. Knowledge of CAS-TKA technology and understanding the advantages and limitations of navigation are crucial to the successful application of the CAS technique in TKA. In this article, we review the components of navigation, classification of the system, surgical method, potential error, clinical results, advantages, and disadvantages. PMID:22162787

Binocular Goggle Augmented Imaging and Navigation System provides real-time fluorescence image guidance for tumor resection and sentinel lymph node mapping

NASA Astrophysics Data System (ADS)

B. Mondal, Suman; Gao, Shengkui; Zhu, Nan; Sudlow, Gail P.; Liang, Kexian; Som, Avik; Akers, Walter J.; Fields, Ryan C.; Margenthaler, Julie; Liang, Rongguang; Gruev, Viktor; Achilefu, Samuel

2015-07-01

The inability to identify microscopic tumors and assess surgical margins in real-time during oncologic surgery leads to incomplete tumor removal, increases the chances of tumor recurrence, and necessitates costly repeat surgery. To overcome these challenges, we have developed a wearable goggle augmented imaging and navigation system (GAINS) that can provide accurate intraoperative visualization of tumors and sentinel lymph nodes in real-time without disrupting normal surgical workflow. GAINS projects both near-infrared fluorescence from tumors and the natural color images of tissue onto a head-mounted display without latency. Aided by tumor-targeted contrast agents, the system detected tumors in subcutaneous and metastatic mouse models with high accuracy (sensitivity = 100%, specificity = 98% ± 5% standard deviation). Human pilot studies in breast cancer and melanoma patients using a near-infrared dye show that the GAINS detected sentinel lymph nodes with 100% sensitivity. Clinical use of the GAINS to guide tumor resection and sentinel lymph node mapping promises to improve surgical outcomes, reduce rates of repeat surgery, and improve the accuracy of cancer staging.

Computer-assisted spinal osteotomy: a technical note and report of four cases.

PubMed

Fujibayashi, Shunsuke; Neo, Masashi; Takemoto, Mitsuru; Ota, Masato; Nakayama, Tomitaka; Toguchida, Junya; Nakamura, Takashi

2010-08-15

A report of 4 cases of spinal osteotomy performed under the guidance of a computer-assisted navigation system and a technical note about the use of the navigation system for spinal osteotomy. To document the surgical technique and usefulness of computer-assisted surgery for spinal osteotomy. A computer-assisted navigation system provides accurate 3-dimensional (3D) real-time surgical information during the operation. Although there are many reports on the accuracy and usefulness of a navigation system for pedicle screw placement, there are few reports on the application for spinal osteotomy. We report on 4 complex cases including 3 solitary malignant spinal tumors and 1 spinal kyphotic deformity of ankylosing spondylitis, which were treated surgically using a computer-assisted spinal osteotomy. The surgical technique and postoperative clinical and radiologic results are presented. 3D spinal osteotomy under the guidance of a computer-assisted navigation system was performed successfully in 4 patients. All malignant tumors were resected en bloc, and the spinal deformity was corrected precisely according to the preoperative plan. Pathologic analysis confirmed the en bloc resection without tumor exposure in the 3 patients with a spinal tumor. The use of a computer-assisted navigation system will help ensure the safety and efficacy of a complex 3D spinal osteotomy.

Is computer navigation when used in the surgery of iliosacral pelvic bone tumours safer for the patient?

PubMed

Laitinen, M K; Parry, M C; Albergo, J I; Grimer, R J; Jeys, L M

2017-02-01

Due to the complex anatomy of the pelvis, limb-sparing resections of pelvic tumours achieving adequate surgical margins, can often be difficult. The advent of computer navigation has improved the precision of resection of these lesions, though there is little evidence comparing resection with or without the assistance of navigation. Our aim was to evaluate the efficacy of navigation-assisted surgery for the resection of pelvic bone tumours involving the posterior ilium and sacrum. Using our prospectively updated institutional database, we conducted a retrospective case control study of 21 patients who underwent resection of the posterior ilium and sacrum, for the treatment of a primary sarcoma of bone, between 1987 and 2015. The resection was performed with the assistance of navigation in nine patients and without navigation in 12. We assessed the accuracy of navigation-assisted surgery, as defined by the surgical margin and how this affects the rate of local recurrence, the disease-free survival and the effects on peri-and post-operative morbidity. The mean age of the patients was 36.4 years (15 to 66). The mean size of the tumour was 10.9 cm. In the navigation-assisted group, the margin was wide in two patients (16.7%), marginal in six (66.7%) and wide-contaminated in one (11.1%) with no intralesional margin. In the non-navigated-assisted group; the margin was wide in two patients (16.7%), marginal in five (41.7%), intralesional in three (25.0%) and wide-contaminated in two (16.7%). Local recurrence occurred in two patients in the navigation-assisted group (22.2%) and six in the non-navigation-assisted group (50.0%). The disease-free survival was significantly better when operated with navigation-assistance (p = 0.048). The blood loss and operating time were less in the navigated-assisted group, as was the risk of a foot drop post-operatively. The introduction of navigation-assisted surgery for the resection of tumours of the posterior ilium and sacrum has increased the safety for the patients and allows for a better oncological outcome. Cite this article: Bone Joint J 2017;99-B:261-6. ©2017 The British Editorial Society of Bone & Joint Surgery.

[Basic concept in computer assisted surgery].

PubMed

Merloz, Philippe; Wu, Hao

2006-03-01

To investigate application of medical digital imaging systems and computer technologies in orthopedics. The main computer-assisted surgery systems comprise the four following subcategories. (1) A collection and recording process for digital data on each patient, including preoperative images (CT scans, MRI, standard X-rays), intraoperative visualization (fluoroscopy, ultrasound), and intraoperative position and orientation of surgical instruments or bone sections (using 3D localises). Data merging based on the matching of preoperative imaging (CT scans, MRI, standard X-rays) and intraoperative visualization (anatomical landmarks, or bone surfaces digitized intraoperatively via 3D localiser; intraoperative ultrasound images processed for delineation of bone contours). (2) In cases where only intraoperative images are used for computer-assisted surgical navigation, the calibration of the intraoperative imaging system replaces the merged data system, which is then no longer necessary. (3) A system that provides aid in decision-making, so that the surgical approach is planned on basis of multimodal information: the interactive positioning of surgical instruments or bone sections transmitted via pre- or intraoperative images, display of elements to guide surgical navigation (direction, axis, orientation, length and diameter of a surgical instrument, impingement, etc. ). And (4) A system that monitors the surgical procedure, thereby ensuring that the optimal strategy defined at the preoperative stage is taken into account. It is possible that computer-assisted orthopedic surgery systems will enable surgeons to better assess the accuracy and reliability of the various operative techniques, an indispensable stage in the optimization of surgery.

SU-F-P-42: “To Navigate, Or Not to Navigate: HDR BT in Recurrent Spine Lesions”

DOE Office of Scientific and Technical Information (OSTI.GOV)

Voros, L; Cohen, G; Zaider, M

Purpose: We compare the accuracy of HDR catheter placement for paraspinal lesions using O-arm CBCT imaging combined with StealthStation navigation and traditional fluoroscopically guided catheter placement. Methods: CT and MRI scans were acquired pre-treatment to outline the lesions and design treatment plans (pre-plans) to meet dosimetric constrains. The pre-planned catheter trajectories were transferred into the StealthStation Navigation system prior to the surgery. The StealthStation is an infra red (IR) optical navigation system used for guidance of surgical instruments. An intraoperative CBCT scan (O-arm) was acquired with reference IR optical fiducials anchored onto the patient and registered with the preplan imagemore » study to guide surgical instruments in relation to the patients’ anatomy and to place the brachytherapy catheters along the pre-planned trajectories. The final treatment plan was generated based on a 2nd intraoperative CBCT scan reflecting achieved implant geometry. The 2nd CBCT was later registered with the initial CT scan to compare the preplanned dwell positions with actual dwell positions (catheter placements). Similar workflow was used in placement of 8 catheters (1 patient) without navigation, but under fluoroscopy guidance in an interventional radiology suite. Results: A total of 18 catheters (3 patients) were placed using navigation assisted surgery. Average displacement of 0.66 cm (STD=0.37cm) was observed between the pre-plan source positions and actual source positions in the 3 dimensional space. This translates into an average 0.38 cm positioning error in one direction including registration errors, digitization errors, and the surgeons ability to follow the planned trajectory. In comparison, average displacement of non-navigated catheters was 0.50 cm (STD=0.22cm). Conclusion: Spinal lesion HDR brachytherapy planning is a difficult task. Catheter placement has a direct impact on target coverage and dose to critical structures. While limited to a handful of patients, our experience shows navigation and fluoroscopy guided placement yield similar results.« less

Computer-Assisted Orthopedic Surgery: Current State and Future Perspective

PubMed Central

Zheng, Guoyan; Nolte, Lutz P.

2015-01-01

Introduced about two decades ago, computer-assisted orthopedic surgery (CAOS) has emerged as a new and independent area, due to the importance of treatment of musculoskeletal diseases in orthopedics and traumatology, increasing availability of different imaging modalities, and advances in analytics and navigation tools. The aim of this paper is to present the basic elements of CAOS devices and to review state-of-the-art examples of different imaging modalities used to create the virtual representations, of different position tracking devices for navigation systems, of different surgical robots, of different methods for registration and referencing, and of CAOS modules that have been realized for different surgical procedures. Future perspectives will also be outlined. PMID:26779486

Gender-affirming Surgeries in the Era of Insurance Coverage: Developing a Framework for Psychosocial Support and Care Navigation in the Perioperative Period.

PubMed

Deutsch, Madeline B

2016-01-01

Transgender people have a gender identity different from their birth-assigned sex. Transgender people may seek gender-affirming surgeries to align their body with their identified gender. With increasing visibility of transgender identities, and recognition of the importance of gender-affirming care, has come a policy shift toward mandated coverage or provision of blanket exclusions of these procedures by insurance companies and Medicaid. The World Professional Association for Transgender Health provides guidance to mental health professionals evaluating patients for gender-affirming surgeries, including making a diagnosis and assessing for capacity to consent. However the expansion of covered gender-affirming surgeries to safety-net populations has highlighted the need for an expanded presurgical process which includes a psychosocial assessment and care navigation. The proposed framework expands the preoperative assessment to include these components, and can be used to guide both health systems and insurance providers in the development of transgender medicine programs.

Hybrid DynaCT-guided electromagnetic navigational bronchoscopic biopsy†.

PubMed

Ng, Calvin S H; Yu, Simon C H; Lau, Rainbow W H; Yim, Anthony P C

2016-01-01

Electromagnetic navigational bronchoscopy-guided biopsy of small pulmonary nodules can be challenging. Navigational error of the system and movement of the biopsy tool during its deployment adversely affect biopsy success. Furthermore, conventional methods to confirm navigational success such as fluoroscopy and radial endobronchial ultrasound become less useful for the biopsy of small lesions. A hybrid operating theatre can provide unparalleled real-time imaging through DynaCT scan to guide and confirm successful navigation and biopsy of difficult-to-reach or small lesions. We describe our technique for DynaCT image-guided electromagnetic navigational bronchoscopic biopsy of a small pulmonary nodule in the hybrid operating theatre. The advantages, disadvantages and special considerations in adopting this approach are discussed. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

A Google Glass navigation system for ultrasound and fluorescence dual-mode image-guided surgery

NASA Astrophysics Data System (ADS)

Zhang, Zeshu; Pei, Jing; Wang, Dong; Hu, Chuanzhen; Ye, Jian; Gan, Qi; Liu, Peng; Yue, Jian; Wang, Benzhong; Shao, Pengfei; Povoski, Stephen P.; Martin, Edward W.; Yilmaz, Alper; Tweedle, Michael F.; Xu, Ronald X.

2016-03-01

Surgical resection remains the primary curative intervention for cancer treatment. However, the occurrence of a residual tumor after resection is very common, leading to the recurrence of the disease and the need for re-resection. We develop a surgical Google Glass navigation system that combines near infrared fluorescent imaging and ultrasonography for intraoperative detection of sites of tumor and assessment of surgical resection boundaries, well as for guiding sentinel lymph node (SLN) mapping and biopsy. The system consists of a monochromatic CCD camera, a computer, a Google Glass wearable headset, an ultrasonic machine and an array of LED light sources. All the above components, except the Google Glass, are connected to a host computer by a USB or HDMI port. Wireless connection is established between the glass and the host computer for image acquisition and data transport tasks. A control program is written in C++ to call OpenCV functions for image calibration, processing and display. The technical feasibility of the system is tested in both tumor simulating phantoms and in a human subject. When the system is used for simulated phantom resection tasks, the tumor boundaries, invisible to the naked eye, can be clearly visualized with the surgical Google Glass navigation system. This system has also been used in an IRB approved protocol in a single patient during SLN mapping and biopsy in the First Affiliated Hospital of Anhui Medical University, demonstrating the ability to successfully localize and resect all apparent SLNs. In summary, our tumor simulating phantom and human subject studies have demonstrated the technical feasibility of successfully using the proposed goggle navigation system during cancer surgery.

Prototype of a single probe Compton camera for laparoscopic surgery

NASA Astrophysics Data System (ADS)

Koyama, A.; Nakamura, Y.; Shimazoe, K.; Takahashi, H.; Sakuma, I.

2017-02-01

Image-guided surgery (IGS) is performed using a real-time surgery navigation system with three-dimensional (3D) position tracking of surgical tools. IGS is fast becoming an important technology for high-precision laparoscopic surgeries, in which the field of view is limited. In particular, recent developments in intraoperative imaging using radioactive biomarkers may enable advanced IGS for supporting malignant tumor removal surgery. In this light, we develop a novel intraoperative probe with a Compton camera and a position tracking system for performing real-time radiation-guided surgery. A prototype probe consisting of Ce :Gd3 Al2 Ga3 O12 (GAGG) crystals and silicon photomultipliers was fabricated, and its reconstruction algorithm was optimized to enable real-time position tracking. The results demonstrated the visualization capability of the radiation source with ARM = ∼ 22.1 ° and the effectiveness of the proposed system.

Improved surgical procedure using intraoperative navigation for the implantation of the SPG microstimulator in patients with chronic cluster headache.

PubMed

Kohlmeier, Carsten; Behrens, Peter; Böger, Andreas; Ramachandran, Brinda; Caparso, Anthony; Schulze, Dirk; Stude, Philipp; Heiland, Max; Assaf, Alexandre T

2017-12-01

The ATI SPG microstimulator is designed to be fixed on the posterior maxilla, with the integrated lead extending into the pterygopalatine fossa to electrically stimulate the sphenopalatine ganglion (SPG) as a treatment for cluster headache. Preoperative surgical planning to ensure the placement of the microstimulator in close proximity (within 5 mm) to the SPG is critical for treatment efficacy. The aim of this study was to improve the surgical procedure by navigating the initial dissection prior to implantation using a passive optical navigation system and to match the post-operative CBCT images with the preoperative treatment plan to verify the accuracy of the intraoperative placement of the microstimulator. Custom methods and software were used that result in a 3D rotatable digitally reconstructed fluoroscopic image illustrating the patient-specific placement with the ATI SPG microstimulator. Those software tools were preoperatively integrated with the planning software of the navigation system to be used intraoperatively for navigated placement. Intraoperatively, the SPG microstimulator was implanted by completing the initial dissection with CT navigation, while the final position of the stimulator was verified by 3D CBCT. Those reconstructed images were then immediately matched with the preoperative CT scans with the digitally inserted SPG microstimulator. This method allowed for visual comparison of both CT scans and verified correct positioning of the SPG microstimulator. Twenty-four surgeries were performed using this new method of CT navigated assistance during SPG microstimulator implantation. Those results were compared to results of 21 patients previously implanted without the assistance of CT navigation. Using CT navigation during the initial dissection, an average distance reduction of 1.2 mm between the target point and electrode tip of the SPG microstimulator was achieved. Using the navigation software for navigated implantation and matching the preoperative planned scans with those performed post-operatively, the average distance was 2.17 mm with navigation, compared to 3.37 mm in the 28 surgeries without navigation. Results from this new procedure showed a significant reduction (p = 0.009) in the average distance from the SPG microstimulator to the desired target point. Therefore, a distinct improvement could be achieved in positioning of the SPG microstimulator through the use of intraoperative navigation during the initial dissection and by post-operative matching of pre- and post-operatively performed CBCT scans.

Augmented real-time navigation with critical structure proximity alerts for endoscopic skull base surgery.

PubMed

Dixon, Benjamin J; Daly, Michael J; Chan, Harley; Vescan, Allan; Witterick, Ian J; Irish, Jonathan C

2014-04-01

Image-guided surgery (IGS) systems are frequently utilized during cranial base surgery to aid in orientation and facilitate targeted surgery. We wished to assess the performance of our recently developed localized intraoperative virtual endoscopy (LIVE)-IGS prototype in a preclinical setting prior to deployment in the operating room. This system combines real-time ablative instrument tracking, critical structure proximity alerts, three-dimensional virtual endoscopic views, and intraoperative cone-beam computed tomographic image updates. Randomized-controlled trial plus qualitative analysis. Skull base procedures were performed on 14 cadaver specimens by seven fellowship-trained skull base surgeons. Each subject performed two endoscopic transclival approaches; one with LIVE-IGS and one using a conventional IGS system in random order. National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores were documented for each dissection, and a semistructured interview was recorded for qualitative assessment. The NASA-TLX scores for mental demand, effort, and frustration were significantly reduced with the LIVE-IGS system in comparison to conventional navigation (P < .05). The system interface was judged to be intuitive and most useful when there was a combination of high spatial demand, reduced or absent surface landmarks, and proximity to critical structures. The development of auditory icons for proximity alerts during the trial better informed the surgeon while limiting distraction. The LIVE-IGS system provided accurate, intuitive, and dynamic feedback to the operating surgeon. Further refinements to proximity alerts and visualization settings will enhance orientation while limiting distraction. The system is currently being deployed in a prospective clinical trial in skull base surgery. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Using Free Navigation Reference Points and Prefabricated Bone Plates for Zygoma Fracture Model Surgeries.

PubMed

Wang, Tien-Hsiang; Ma, Hsu; Tseng, Ching-Shiow; Chou, Yi-Hong; Cai, Kun-Lin

Surgical navigation systems have been an important tool in maxillofacial surgery, helping surgeons create a presurgical plan, locate lesions, and provide guidance. For secondary facial bone reductions, a good presurgical plan and proper execution are the key to success. Previous studies used predetermined markers and screw holes as navigation references; however, unexpected situations may occur, making the predetermined surgical plan unreliable. Instead of determining positions preoperatively, this study proposes a method that surgeons can use intraoperatively to choose surface markers in a more flexible manner. Eight zygomatic fractures were created in four skull models, and preoperative computed tomography (CT) image data were imported into a self-developed navigation program for presurgical planning. This program also calculates the ideal positions of navigation references points for screw holes. During reduction surgery, markers on fractured bone are selected, registered, and calculated as free navigation reference points (FNRPs). The surface markers and FNRPs are used to monitor the position of the dislocated bone. Titanium bone plates were prefabricated on stereolithography models for osteosynthesis. Two reductions with only FNRPs, as well as six reductions with FNRPs and prefabricated bone plates, were successfully performed. Postoperative CT data were obtained, and surgical errors in the six-reduction group were evaluated. The average deviation from the screw hole drilling positions was 0.92 ± 0.38 mm. The average deviation included displacement and rotation of the zygomas. The mean displacement was 0.83 ± 0.38 mm, and the average rotations around the x, y, and z axes were 0.66 ± 0.59°, 0.77 ± 0.54°, and 0.79 ± 0.42°, respectively. The results show that combining presurgical planning and the developed navigation program to generate FNRPs for assisting in secondary zygoma reduction is an accurate and practical method. Further study is necessary to prove its clinical value.

Intraoperative computed tomography with integrated navigation system in spinal stabilizations.

PubMed

Zausinger, Stefan; Scheder, Ben; Uhl, Eberhard; Heigl, Thomas; Morhard, Dominik; Tonn, Joerg-Christian

2009-12-15

STUDY DESIGN.: A prospective interventional case-series study plus a retrospective analysis of historical patients for comparison of data. OBJECTIVE.: To evaluate workflow, feasibility, and clinical outcome of navigated stabilization procedures with data acquisition by intraoperative computed tomography. SUMMARY OF BACKGROUND DATA.: Routine fluoroscopy to assess pedicle screw placement is not consistently reliable. Our hypothesis was that image-guided spinal navigation using an intraoperative CT-scanner can improve the safety and precision of spinal stabilization surgery. METHODS.: CT data of 94 patients (thoracolumbar [n = 66], C1/2 [n = 12], cervicothoracic instability [n = 16]) were acquired after positioning the patient in the final surgical position. A sliding gantry 40-slice CT was used for image acquisition. Data were imported to a frameless infrared-based neuronavigation workstation. Intraoperative CT was obtained to assess the accuracy of instrumentation and, if necessary, the extent of decompression. All patients were clinically evaluated by Odom-criteria after surgery and after 3 months. RESULTS.: Computed accuracy of the navigation system reached <2 mm (0.95 +/- 0.3 mm) in all cases. Additional time necessary for the preoperative image acquisition including data transfer was 14 +/- 5 minutes. The duration of interrupting the surgical process for iCT until resumption of surgery was 9 +/- 2.5 minutes. Control-iCT revealed incorrect screw position >/=2 mm without persistent neurologic or vascular damage in 20/414 screws (4.8%) leading to immediate correction of 10 screws (2.4%). Control-iCT changed the course of surgery in 8 cases (8.5% of all patients). The overall revision rate was 8.5% (4 wound revisions, 2 CSF fistulas, and 2 epidural hematomas). There was no reoperation due to implant malposition. According to Odom-criteria all patients experienced a clinical improvement. A retrospective analysis of 182 patients with navigated thoracolumbar transpedicular stabilizations in the preiCT era revealed an overall revision rate of 10.4% with 4.4% of patients requiring screw revision. CONCLUSION.: Intraoperative CT in combination with neuronavigation provides high accuracy of screw placement and thus safety for patients undergoing spinal stabilization. Reoperations due to implant malpositions could be completely avoided. The system can be installed into a pre-existing operating environment without need for special surgical instruments. The procedure is rapid and easy to perform without restricted access to the patient and-by replacing pre- and postoperative imaging-is not associated with an additional exposure to radiation. Multidisciplinary use increases utilization of the system and thus improves cost-efficiency relation.

Augmented Reality-Based Navigation System for Wrist Arthroscopy: Feasibility

PubMed Central

Zemirline, Ahmed; Agnus, Vincent; Soler, Luc; Mathoulin, Christophe L.; Liverneaux, Philippe A.; Obdeijn, Miryam

2013-01-01

Purpose In video surgery, and more specifically in arthroscopy, one of the major problems is positioning the camera and instruments within the anatomic environment. The concept of computer-guided video surgery has already been used in ear, nose, and throat (ENT), gynecology, and even in hip arthroscopy. These systems, however, rely on optical or mechanical sensors, which turn out to be restricting and cumbersome. The aim of our study was to develop and evaluate the accuracy of a navigation system based on electromagnetic sensors in video surgery. Methods We used an electromagnetic localization device (Aurora, Northern Digital Inc., Ontario, Canada) to track the movements in space of both the camera and the instruments. We have developed a dedicated application in the Python language, using the VTK library for the graphic display and the OpenCV library for camera calibration. Results A prototype has been designed and evaluated for wrist arthroscopy. It allows display of the theoretical position of instruments onto the arthroscopic view with useful accuracy. Discussion The augmented reality view represents valuable assistance when surgeons want to position the arthroscope or locate their instruments. It makes the maneuver more intuitive, increases comfort, saves time, and enhances concentration. PMID:24436832

Binocular Goggle Augmented Imaging and Navigation System provides real-time fluorescence image guidance for tumor resection and sentinel lymph node mapping

PubMed Central

B. Mondal, Suman; Gao, Shengkui; Zhu, Nan; Sudlow, Gail P.; Liang, Kexian; Som, Avik; Akers, Walter J.; Fields, Ryan C.; Margenthaler, Julie; Liang, Rongguang; Gruev, Viktor; Achilefu, Samuel

2015-01-01

The inability to identify microscopic tumors and assess surgical margins in real-time during oncologic surgery leads to incomplete tumor removal, increases the chances of tumor recurrence, and necessitates costly repeat surgery. To overcome these challenges, we have developed a wearable goggle augmented imaging and navigation system (GAINS) that can provide accurate intraoperative visualization of tumors and sentinel lymph nodes in real-time without disrupting normal surgical workflow. GAINS projects both near-infrared fluorescence from tumors and the natural color images of tissue onto a head-mounted display without latency. Aided by tumor-targeted contrast agents, the system detected tumors in subcutaneous and metastatic mouse models with high accuracy (sensitivity = 100%, specificity = 98% ± 5% standard deviation). Human pilot studies in breast cancer and melanoma patients using a near-infrared dye show that the GAINS detected sentinel lymph nodes with 100% sensitivity. Clinical use of the GAINS to guide tumor resection and sentinel lymph node mapping promises to improve surgical outcomes, reduce rates of repeat surgery, and improve the accuracy of cancer staging. PMID:26179014

Augmented reality-based navigation system for wrist arthroscopy: feasibility.

PubMed

Zemirline, Ahmed; Agnus, Vincent; Soler, Luc; Mathoulin, Christophe L; Obdeijn, Miryam; Liverneaux, Philippe A

2013-11-01

In video surgery, and more specifically in arthroscopy, one of the major problems is positioning the camera and instruments within the anatomic environment. The concept of computer-guided video surgery has already been used in ear, nose, and throat (ENT), gynecology, and even in hip arthroscopy. These systems, however, rely on optical or mechanical sensors, which turn out to be restricting and cumbersome. The aim of our study was to develop and evaluate the accuracy of a navigation system based on electromagnetic sensors in video surgery. We used an electromagnetic localization device (Aurora, Northern Digital Inc., Ontario, Canada) to track the movements in space of both the camera and the instruments. We have developed a dedicated application in the Python language, using the VTK library for the graphic display and the OpenCV library for camera calibration. A prototype has been designed and evaluated for wrist arthroscopy. It allows display of the theoretical position of instruments onto the arthroscopic view with useful accuracy. The augmented reality view represents valuable assistance when surgeons want to position the arthroscope or locate their instruments. It makes the maneuver more intuitive, increases comfort, saves time, and enhances concentration.

Awake craniotomy using electromagnetic navigation technology without rigid pin fixation.

PubMed

Morsy, Ahmed A; Ng, Wai Hoe

2015-11-01

We report our institutional experience using an electromagnetic navigation system, without rigid head fixation, for awake craniotomy patients. The StealthStation® S7 AxiEM™ navigation system (Medtronic, Inc.) was used for this technique. Detailed preoperative clinical and neuropsychological evaluations, patient education and contrast-enhanced MRI (thickness 1.5mm) were performed for each patient. The AxiEM Mobile Emitter was typically placed in a holder, which was mounted to the operating room table, and a non-invasive patient tracker was used as the patient reference device. A monitored conscious sedation technique was used in all awake craniotomy patients, and the AxiEM Navigation Pointer was used for navigation during the procedure. This offers the same accuracy as optical navigation, but without head pin fixation or interference with intraoperative neurophysiological techniques and surgical instruments. The application of the electromagnetic neuronavigation technology without rigid head fixation during an awake craniotomy is accurate, and offers superior patient comfort. It is recommended as an effective adjunctive technique for the conduct of awake surgery. Copyright © 2015 Elsevier Ltd. All rights reserved.

Navigation and Image Injection for Control of Bone Removal and Osteotomy Planes in Spine Surgery.

PubMed

Kosterhon, Michael; Gutenberg, Angelika; Kantelhardt, Sven Rainer; Archavlis, Elefterios; Giese, Alf

2017-04-01

In contrast to cranial interventions, neuronavigation in spinal surgery is used in few applications, not tapping into its full technological potential. We have developed a method to preoperatively create virtual resection planes and volumes for spinal osteotomies and export 3-D operation plans to a navigation system controlling intraoperative visualization using a surgical microscope's head-up display. The method was developed using a Sawbone ® model of the lumbar spine, demonstrating feasibility with high precision. Computer tomographic and magnetic resonance image data were imported into Amira ® , a 3-D visualization software. Resection planes were positioned, and resection volumes representing intraoperative bone removal were defined. Fused to the original Digital Imaging and Communications in Medicine data, the osteotomy planes were exported to the cranial version of a Brainlab ® navigation system. A navigated surgical microscope with video connection to the navigation system allowed intraoperative image injection to visualize the preplanned resection planes. The workflow was applied to a patient presenting with a congenital hemivertebra of the thoracolumbar spine. Dorsal instrumentation with pedicle screws and rods was followed by resection of the deformed vertebra guided by the in-view image injection of the preplanned resection planes into the optical path of a surgical microscope. Postoperatively, the patient showed no neurological deficits, and the spine was found to be restored in near physiological posture. The intraoperative visualization of resection planes in a microscope's head-up display was found to assist the surgeon during the resection of a complex-shaped bone wedge and may help to further increase accuracy and patient safety. Copyright © 2017 by the Congress of Neurological Surgeons

Surgical navigation in urology: European perspective.

PubMed

Rassweiler, Jens; Rassweiler, Marie-Claire; Müller, Michael; Kenngott, Hannes; Meinzer, Hans-Peter; Teber, Dogu

2014-01-01

Use of virtual reality to navigate open and endoscopic surgery has significantly evolved during the last decade. Current status of seven most interesting projects inside the European Association of Urology section of uro-technology is summarized with review of literature. Marker-based endoscopic tracking during laparoscopic radical prostatectomy using high-definition technology reduces positive margins. Marker-based endoscopic tracking during laparoscopic partial nephrectomy by mechanical overlay of three-dimensional-segmented virtual anatomy is helpful during planning of trocar placement and dissection of renal hilum. Marker-based, iPAD-assisted puncture of renal collecting system shows more benefit for trainees with reduction of radiation exposure. Three-dimensional laser-assisted puncture of renal collecting system using Uro-Dyna-CT realized in an ex-vivo model enables minimal radiation time. Electromagnetic tracking for puncture of renal collecting system using a sensor at the tip of ureteral catheter worked in an in-vivo model of porcine ureter and kidney. Attitude tracking for ultrasound-guided puncture of renal tumours by accelerometer reduces the puncture error from 4.7 to 1.8 mm. Feasibility of electromagnetic and optical tracking with the da Vinci telemanipulator was shown in vitro as well as using in-vivo model of oesophagectomy. Target registration error was 11.2 mm because of soft-tissue deformation. Intraoperative navigation is helpful during percutaneous puncture collecting system and biopsy of renal tumour using various tracking techniques. Early clinical studies demonstrate advantages of marker-based navigation during laparoscopic radical prostatectomy and partial nephrectomy. Combination of different tracking techniques may further improve this interesting addition to video-assisted surgery.

Application of image guidance in pituitary surgery

PubMed Central

de Lara, Danielle; Filho, Leo F. S. Ditzel; Prevedello, Daniel M.; Otto, Bradley A.; Carrau, Ricardo L.

2012-01-01

Background: Surgical treatment of pituitary pathologies has evolved along the years, adding safety and decreasing morbidity related to the procedure. Advances in the field of radiology, coupled with stereotactic technology and computer modeling, have culminated in the contemporary and widespread use of image guidance systems, as we know them today. Image guidance navigation has become a frequently used technology that provides continuous three-dimensional information for the accurate performance of neurosurgical procedures. We present a discussion about the application of image guidance in pituitary surgeries. Methods: Major indications for image guidance neuronavigation application in pituitary surgery are presented and demonstrated with illustrative cases. Limitations of this technology are also presented. Results: Patients presenting a history of previous transsphenoidal surgeries, anatomical variances of the sphenoid sinus, tumors with a close relation to the internal carotid arteries, and extrasellar tumors are the most important indications for image guidance in pituitary surgeries. The high cost of the equipment, increased time of surgery due to setup time, and registration and the need of specific training for the operating room personnel could be pointed as limitations of this technology. Conclusion: Intraoperative image guidance systems provide real-time images, increasing surgical accuracy and enabling safe, minimally invasive interventions. However, the use of intraoperative navigation is not a replacement for surgical experience and a systematic knowledge of regional anatomy. It must be recognized as a tool by which the neurosurgeon can reduce the risk associated with surgical approach and treatment of pituitary pathologies. PMID:22826819

Basic Study for Ultrasound-Based Navigation for Pedicle Screw Insertion Using Transmission and Backscattered Methods

PubMed Central

Chen, Ziqiang; Wu, Bing; Zhai, Xiao; Bai, Yushu; Zhu, Xiaodong; Luo, Beier; Chen, Xiao; Li, Chao; Yang, Mingyuan; Xu, Kailiang; Liu, Chengcheng; Wang, Chuanfeng; Zhao, Yingchuan; Wei, Xianzhao; Chen, Kai; Yang, Wu; Ta, Dean; Li, Ming

2015-01-01

The purpose of this study was to understand the acoustic properties of human vertebral cancellous bone and to study the feasibility of ultrasound-based navigation for posterior pedicle screw fixation in spinal fusion surgery. Fourteen human vertebral specimens were disarticulated from seven un-embalmed cadavers (four males, three females, 73.14 ± 9.87 years, two specimens from each cadaver). Seven specimens were used to measure the transmission, including tests of attenuation and phase velocity, while the other seven specimens were used for backscattered measurements to inspect the depth of penetration and A-Mode signals. Five pairs of unfocused broadband ultrasonic transducers were used for the detection, with center frequencies of 0.5 MHz, 1 MHz, 1.5 MHz, 2.25 MHz, and 3.5 MHz. As a result, good and stable results were documented. With increased frequency, the attenuation increased (P<0.05), stability of the speed of sound improved (P<0.05), and penetration distance decreased (P>0.05). At about 0.6 cm away from the cortical bone, warning signals were easily observed from the backscattered measurements. In conclusion, the ultrasonic system proved to be an effective, moveable, and real-time imaging navigation system. However, how ultrasonic navigation will benefit pedicle screw insertion in spinal surgery needs to be determined. Therefore, ultrasound-guided pedicle screw implantation is theoretically effective and promising. PMID:25861053

A novel electromagnetic navigation tool for acetabular surgery.

PubMed

Lehmann, Wolfgang; Rueger, Johannes M; Nuechtern, Jakob; Grossterlinden, Lars; Kammal, Michael; Hoffmann, Michael

2015-10-01

Acetabular fracture surgery is demanding and screw placement along narrow bony corridors remains challenging. It necessitates x-ray radiation for fluoroscopically assisted screw insertion. The purpose of this cadaver study was to evaluate the feasibility, accuracy and operation time of a novel electromagnetic navigation system for screw insertion along predefined acetabular corridors. A controlled laboratory study with a total of 24 electromagnetically navigated screw insertions was performed on 8 cadaveric acetabula. 3 peri-acetabular bony corridors (QSS, Quadrilateral Surface Screw; IAS, Infra-Acetabular Screw; PCS, Posterior Column Screw) were defined and screws were placed in a defined order without fluoroscopy. Operation time was documented. Postoperative CT scans were performed to analyse accuracy of screw placement. Mean cadaver age was 70.4 ± 11.7. Successful screw placement was accomplished in 22 out of 24 (91.7%) cases. The overall mean time for all 3 acetabular screws was 576.6 ± 75.9s. All 3 complications occurred during the placement of the IAS due to an impassable narrow bony corridor. QSS mean length was 50 ± 5mm, IAS mean length was 85 ± 10mm and PCS mean length was 120 ± 5mm. In this cadaver study the novel electromagnetic navigation system was feasible to allow accurate screw placement without fluoroscopy in defined narrow peri-acetabular bony corridors. Copyright © 2015 Elsevier Ltd. All rights reserved.

Electromagnetic image-guided orbital decompression: technique, principles, and preliminary experience with 6 consecutive cases.

PubMed

Servat, Juan J; Elia, Maxwell Dominic; Gong, Dan; Manes, R Peter; Black, Evan H; Levin, Flora

2014-12-01

To assess the feasibility of routine use of electromagnetic image guidance systems in orbital decompression. Six consecutive patients underwent stereotactic-guided three wall orbital decompression using the novel Fusion ENT Navigation System (Medtronic), a portable and expandable electromagnetic guidance system with multi-instrument tracking capabilities. The system consists of the Medtronic LandmarX System software-enabled computer station, signal generator, field-generating magnet, head-mounted marker coil, and surgical tracking instruments. In preparation for use of the LandmarX/Fusion protocol, all patients underwent preoperative non-contrast CT scan from the superior aspect of the frontal sinuses to the inferior aspect of the maxillary sinuses that includes the nasal tip. The Fusion ENT Navigation System (Medtronic™) was used in 6 patients undergoing maximal 3-wall orbital decompression for Graves' orbitopthy after a minimum of six months of disease inactivity. Preoperative Hertel exophthalmometry measured more than 27 mm in all patients. The navigation system proved to be no more difficult technically than the traditional orbital decompression approach. Electromagnetic image guidance is a stereotactic surgical navigation system that provides additional intraoperative flexibility in orbital surgery. Electromagnetic image-guidance offers the ability to perform more aggressive orbital decompressions with reduced risk.

Kinect based real-time position calibration for nasal endoscopic surgical navigation system

NASA Astrophysics Data System (ADS)

Fan, Jingfan; Yang, Jian; Chu, Yakui; Ma, Shaodong; Wang, Yongtian

2016-03-01

Unanticipated, reactive motion of the patient during skull based tumor resective surgery is the source of the consequence that the nasal endoscopic tracking system is compelled to be recalibrated. To accommodate the calibration process with patient's movement, this paper developed a Kinect based Real-time positional calibration method for nasal endoscopic surgical navigation system. In this method, a Kinect scanner was employed as the acquisition part of the point cloud volumetric reconstruction of the patient's head during surgery. Then, a convex hull based registration algorithm aligned the real-time image of the patient head with a model built upon the CT scans performed in the preoperative preparation to dynamically calibrate the tracking system if a movement was detected. Experimental results confirmed the robustness of the proposed method, presenting a total tracking error within 1 mm under the circumstance of relatively violent motions. These results point out the tracking accuracy can be retained stably and the potential to expedite the calibration of the tracking system against strong interfering conditions, demonstrating high suitability for a wide range of surgical applications.

Benchtop and Animal Validation of a Projective Imaging System for Potential Use in Intraoperative Surgical Guidance

PubMed Central

Gan, Qi; Wang, Dong; Ye, Jian; Zhang, Zeshu; Wang, Xinrui; Hu, Chuanzhen; Shao, Pengfei; Xu, Ronald X.

2016-01-01

We propose a projective navigation system for fluorescence imaging and image display in a natural mode of visual perception. The system consists of an excitation light source, a monochromatic charge coupled device (CCD) camera, a host computer, a projector, a proximity sensor and a Complementary metal–oxide–semiconductor (CMOS) camera. With perspective transformation and calibration, our surgical navigation system is able to achieve an overall imaging speed higher than 60 frames per second, with a latency of 330 ms, a spatial sensitivity better than 0.5 mm in both vertical and horizontal directions, and a projection bias less than 1 mm. The technical feasibility of image-guided surgery is demonstrated in both agar-agar gel phantoms and an ex vivo chicken breast model embedding Indocyanine Green (ICG). The biological utility of the system is demonstrated in vivo in a classic model of ICG hepatic metabolism. Our benchtop, ex vivo and in vivo experiments demonstrate the clinical potential for intraoperative delineation of disease margin and image-guided resection surgery. PMID:27391764

The Evolution of Computer-Assisted Total Hip Arthroplasty and Relevant Applications.

PubMed

Chang, Jun-Dong; Kim, In-Sung; Bhardwaj, Atul M; Badami, Ramachandra N

2017-03-01

In total hip arthroplasty (THA), the accurate positioning of implants is the key to achieve a good clinical outcome. Computer-assisted orthopaedic surgery (CAOS) has been developed for more accurate positioning of implants during the THA. There are passive, semi-active, and active systems in CAOS for THA. Navigation is a passive system that only provides information and guidance to the surgeon. There are 3 types of navigation: imageless navigation, computed tomography (CT)-based navigation, and fluoroscopy-based navigation. In imageless navigation system, a new method of registration without the need to register the anterior pelvic plane was introduced. CT-based navigation can be efficiently used for pelvic plane reference, the functional pelvic plane in supine which adjusts anterior pelvic plane sagittal tilt for targeting the cup orientation. Robot-assisted system can be either active or semi-active. The active robotic system performs the preparation for implant positioning as programmed preoperatively. It has been used for only femoral implant cavity preparation. Recently, program for cup positioning was additionally developed. Alternatively, for ease of surgeon acceptance, semi-active robot systems are developed. It was initially applied only for cup positioning. However, with the development of enhanced femoral workflows, this system can now be used to position both cup and stem. Though there have been substantial advancements in computer-assisted THA, its use can still be controversial at present due to the steep learning curve, intraoperative technical issues, high cost and etc. However, in the future, CAOS will certainly enable the surgeon to operate more accurately and lead to improved outcomes in THA as the technology continues to evolve rapidly.

Pedicle Perforation While Inserting Screws Using O-Arm Navigation During Surgery for Adolescent Idiopathic Scoliosis: Risk Factors and Effect of Insertion Order.

PubMed

Oba, Hiroki; Ebata, Shigeto; Takahashi, Jun; Koyama, Kensuke; Uehara, Masashi; Kato, Hiroyuki; Haro, Hirotaka; Ohba, Tetsuro

2018-06-11

Observational cohort study. To compare the rate of pedicle perforation while inserting screws (PS) using O-arm navigation during surgery for scoliosis with that reported previously, and to determine risk factors specific to O-arm navigation. O-arm navigation provides intraoperative three-dimensional fluoroscopic imaging with an image quality similar to that of computed tomography. Surgeons have started using O-arm navigation in treatment of adolescent idiopathic sclerosis (AIS). However, there are few reports of the perforation rate when using O-arm navigation to insert pedicle screws for AIS. To our knowledge, no information has been published regarding risk factors for pedicle perforation by PS when using O-arm navigation during surgery for AIS. We retrospectively reviewed the cases of 23 consecutive patients with AIS (all female; mean age 15.4 years, range 12-19 years) who had all undergone PS fixation under O-arm navigation. There were 11 major pedicle perforations (Grade 2 or 3) by the 404 screws (2.7%). For both Grade 1-3 and Grade 2 or 3 perforations, the pedicle perforation rate by the ninth or subsequent screws was significantly higher than that for the other two groups (screws 1-4, 5-8) (P < 0.01). Grade 1-3, Grades 2 or 3, and Grade 3 perforation rates after a previous perforation were significantly higher than those in patients without a previous perforation (P < 0.01). The rate of screw deviation can increase significantly to 12.2% after insertion of 8. The rate of major perforation of pedicles after inserting PS using O-arm navigation during surgery for AIS is relatively low. However, we recommend caution using intraoperative navigation after inserting 8 pedicle screws because after this, the trajectory deviation rate can increase significantly. 3.

A Wearable Goggle Navigation System for Dual-Mode Optical and Ultrasound Localization of Suspicious Lesions: Validation Studies Using Tissue-Simulating Phantoms and an Ex Vivo Human Breast Tissue Model

PubMed Central

Wang, Dong; Gan, Qi; Ye, Jian; Yue, Jian; Wang, Benzhong; Povoski, Stephen P.; Martin, Edward W.; Hitchcock, Charles L.; Yilmaz, Alper; Tweedle, Michael F.; Shao, Pengfei; Xu, Ronald X.

2016-01-01

Surgical resection remains the primary curative treatment for many early-stage cancers, including breast cancer. The development of intraoperative guidance systems for identifying all sites of disease and improving the likelihood of complete surgical resection is an area of active ongoing research, as this can lead to a decrease in the need of subsequent additional surgical procedures. We develop a wearable goggle navigation system for dual-mode optical and ultrasound imaging of suspicious lesions. The system consists of a light source module, a monochromatic CCD camera, an ultrasound system, a Google Glass, and a host computer. It is tested in tissue-simulating phantoms and an ex vivo human breast tissue model. Our experiments demonstrate that the surgical navigation system provides useful guidance for localization and core needle biopsy of simulated tumor within the tissue-simulating phantom, as well as a core needle biopsy and subsequent excision of Indocyanine Green (ICG)—fluorescing sentinel lymph nodes. Our experiments support the contention that this wearable goggle navigation system can be potentially very useful and fully integrated by the surgeon for optimizing many aspects of oncologic surgery. Further engineering optimization and additional in vivo clinical validation work is necessary before such a surgical navigation system can be fully realized in the everyday clinical setting. PMID:27367051

A Wearable Goggle Navigation System for Dual-Mode Optical and Ultrasound Localization of Suspicious Lesions: Validation Studies Using Tissue-Simulating Phantoms and an Ex Vivo Human Breast Tissue Model.

PubMed

Zhang, Zeshu; Pei, Jing; Wang, Dong; Gan, Qi; Ye, Jian; Yue, Jian; Wang, Benzhong; Povoski, Stephen P; Martin, Edward W; Hitchcock, Charles L; Yilmaz, Alper; Tweedle, Michael F; Shao, Pengfei; Xu, Ronald X

2016-01-01

Surgical resection remains the primary curative treatment for many early-stage cancers, including breast cancer. The development of intraoperative guidance systems for identifying all sites of disease and improving the likelihood of complete surgical resection is an area of active ongoing research, as this can lead to a decrease in the need of subsequent additional surgical procedures. We develop a wearable goggle navigation system for dual-mode optical and ultrasound imaging of suspicious lesions. The system consists of a light source module, a monochromatic CCD camera, an ultrasound system, a Google Glass, and a host computer. It is tested in tissue-simulating phantoms and an ex vivo human breast tissue model. Our experiments demonstrate that the surgical navigation system provides useful guidance for localization and core needle biopsy of simulated tumor within the tissue-simulating phantom, as well as a core needle biopsy and subsequent excision of Indocyanine Green (ICG)-fluorescing sentinel lymph nodes. Our experiments support the contention that this wearable goggle navigation system can be potentially very useful and fully integrated by the surgeon for optimizing many aspects of oncologic surgery. Further engineering optimization and additional in vivo clinical validation work is necessary before such a surgical navigation system can be fully realized in the everyday clinical setting.

Preliminary development of augmented reality systems for spinal surgery

NASA Astrophysics Data System (ADS)

Nguyen, Nhu Q.; Ramjist, Joel M.; Jivraj, Jamil; Jakubovic, Raphael; Deorajh, Ryan; Yang, Victor X. D.

2017-02-01

Surgical navigation has been more actively deployed in open spinal surgeries due to the need for improved precision during procedures. This is increasingly difficult in minimally invasive surgeries due to the lack of visual cues caused by smaller exposure sites, and increases a surgeon's dependence on their knowledge of anatomical landmarks as well as the CT or MRI images. The use of augmented reality (AR) systems and registration technologies in spinal surgeries could allow for improvements to techniques by overlaying a 3D reconstruction of patient anatomy in the surgeon's field of view, creating a mixed reality visualization. The AR system will be capable of projecting the 3D reconstruction onto a field and preliminary object tracking on a phantom. Dimensional accuracy of the mixed media will also be quantified to account for distortions in tracking.

Augmented virtuality for arthroscopic knee surgery.

PubMed

Li, John M; Bardana, Davide D; Stewart, A James

2011-01-01

This paper describes a computer system to visualize the location and alignment of an arthroscope using augmented virtuality. A 3D computer model of the patient's joint (from CT) is shown, along with a model of the tracked arthroscopic probe and the projection of the camera image onto the virtual joint. A user study, using plastic bones instead of live patients, was made to determine the effectiveness of this navigated display; the study showed that the navigated display improves target localization in novice residents.

Short-term outcome of 1,465 computer-navigated primary total knee replacements 2005-2008.

PubMed

Gøthesen, Oystein; Espehaug, Birgitte; Havelin, Leif; Petursson, Gunnar; Furnes, Ove

2011-06-01

and purpose Improvement of positioning and alignment by the use of computer-assisted surgery (CAS) might improve longevity and function in total knee replacements, but there is little evidence. In this study, we evaluated the short-term results of computer-navigated knee replacements based on data from the Norwegian Arthroplasty Register. Primary total knee replacements without patella resurfacing, reported to the Norwegian Arthroplasty Register during the years 2005-2008, were evaluated. The 5 most common implants and the 3 most common navigation systems were selected. Cemented, uncemented, and hybrid knees were included. With the risk of revision for any cause as the primary endpoint and intraoperative complications and operating time as secondary outcomes, 1,465 computer-navigated knee replacements (CAS) and 8,214 conventionally operated knee replacements (CON) were compared. Kaplan-Meier survival analysis and Cox regression analysis with adjustment for age, sex, prosthesis brand, fixation method, previous knee surgery, preoperative diagnosis, and ASA category were used. Kaplan-Meier estimated survival at 2 years was 98% (95% CI: 97.5-98.3) in the CON group and 96% (95% CI: 95.0-97.8) in the CAS group. The adjusted Cox regression analysis showed a higher risk of revision in the CAS group (RR = 1.7, 95% CI: 1.1-2.5; p = 0.02). The LCS Complete knee had a higher risk of revision with CAS than with CON (RR = 2.1, 95% CI: 1.3-3.4; p = 0.004)). The differences were not statistically significant for the other prosthesis brands. Mean operating time was 15 min longer in the CAS group. With the introduction of computer-navigated knee replacement surgery in Norway, the short-term risk of revision has increased for computer-navigated replacement with the LCS Complete. The mechanisms of failure of these implantations should be explored in greater depth, and in this study we have not been able to draw conclusions regarding causation.

Intraoperative computed tomography with integrated navigation system in a multidisciplinary operating suite.

PubMed

Uhl, Eberhard; Zausinger, Stefan; Morhard, Dominik; Heigl, Thomas; Scheder, Benjamin; Rachinger, Walter; Schichor, Christian; Tonn, Jörg-Christian

2009-05-01

We report our preliminary experience in a prospective series of patients with regard to feasibility, work flow, and image quality using a multislice computed tomographic (CT) scanner combined with a frameless neuronavigation system (NNS). A sliding gantry 40-slice CT scanner was installed in a preexisting operating room. The scanner was connected to a frameless infrared-based NNS. Image data was transferred directly from the scanner into the navigation system. This allowed updating of the NNS during surgery by automated image registration based on the position of the gantry. Intraoperative CT angiography was possible. The patient was positioned on a radiolucent operating table that fits within the bore of the gantry. During image acquisition, the gantry moved over the patient. This table allowed all positions and movements like any normal operating table without compromising the positioning of the patient. For cranial surgery, a carbon-made radiolucent head clamp was fixed to the table. Experience with the first 230 patients confirms the feasibility of intraoperative CT scanning (136 patients with intracranial pathology, 94 patients with spinal lesions). After a specific work flow, interruption of surgery for intraoperative scanning can be limited to 10 to 15 minutes in cranial surgery and to 9 minutes in spinal surgery. Intraoperative imaging changed the course of surgery in 16 of the 230 cases either because control CT scans showed suboptimal screw position (17 of 307 screws, with 9 in 7 patients requiring correction) or that tumor resection was insufficient (9 cases). Intraoperative CT angiography has been performed in 7 cases so far with good image quality to determine residual flow in an aneurysm. Image quality was excellent in spinal and cranial base surgery. The system can be installed in a preexisting operating environment without the need for special surgical instruments. It increases the safety of the patient and the surgeon without necessitating a change in the existing surgical protocol and work flow. Imaging and updating of the NNS can be performed at any time during surgery with very limited time and modification of the surgical setup. Multidisciplinary use increases utilization of the system and thus improves the cost-efficiency relationship.

Advanced Endoscopic Navigation: Surgical Big Data, Methodology, and Applications.

PubMed

Luo, Xiongbiao; Mori, Kensaku; Peters, Terry M

2018-06-04

Interventional endoscopy (e.g., bronchoscopy, colonoscopy, laparoscopy, cystoscopy) is a widely performed procedure that involves either diagnosis of suspicious lesions or guidance for minimally invasive surgery in a variety of organs within the body cavity. Endoscopy may also be used to guide the introduction of certain items (e.g., stents) into the body. Endoscopic navigation systems seek to integrate big data with multimodal information (e.g., computed tomography, magnetic resonance images, endoscopic video sequences, ultrasound images, external trackers) relative to the patient's anatomy, control the movement of medical endoscopes and surgical tools, and guide the surgeon's actions during endoscopic interventions. Nevertheless, it remains challenging to realize the next generation of context-aware navigated endoscopy. This review presents a broad survey of various aspects of endoscopic navigation, particularly with respect to the development of endoscopic navigation techniques. First, we investigate big data with multimodal information involved in endoscopic navigation. Next, we focus on numerous methodologies used for endoscopic navigation. We then review different endoscopic procedures in clinical applications. Finally, we discuss novel techniques and promising directions for the development of endoscopic navigation.

A pilot study of SPECT/CT-based mixed-reality navigation towards the sentinel node in patients with melanoma or Merkel cell carcinoma of a lower extremity.

PubMed

van den Berg, Nynke S; Engelen, Thijs; Brouwer, Oscar R; Mathéron, Hanna M; Valdés-Olmos, Renato A; Nieweg, Omgo E; van Leeuwen, Fijs W B

2016-08-01

To explore the feasibility of an intraoperative navigation technology based on preoperatively acquired single photon emission computed tomography combined with computed tomography (SPECT/CT) images during sentinel node (SN) biopsy in patients with melanoma or Merkel cell carcinoma. Patients with a melanoma (n=4) or Merkel cell carcinoma (n=1) of a lower extremity scheduled for wide re-excision of the primary lesion site and SN biopsy were studied. Following a Tc-nanocolloid injection and lymphoscintigraphy, SPECT/CT images were acquired with a reference target (ReTp) fixed on the leg or the iliac spine. Intraoperatively, a sterile ReTp was placed at the same site to enable SPECT/CT-based mixed-reality navigation of a gamma ray detection probe also containing a reference target (ReTgp).The accuracy of the navigation procedure was determined in the coronal plane (x, y-axis) by measuring the discrepancy between standard gamma probe-based SN localization and mixed-reality-based navigation to the SN. To determine the depth accuracy (z-axis), the depth estimation provided by the navigation system was compared to the skin surface-to-node distance measured in the computed tomography component of the SPECT/CT images. In four of five patients, it was possible to navigate towards the preoperatively defined SN. The average navigational error was 8.0 mm in the sagittal direction and 8.5 mm in the coronal direction. Intraoperative sterile ReTp positioning and tissue movement during surgery exerted a distinct influence on the accuracy of navigation. Intraoperative navigation during melanoma or Merkel cell carcinoma surgery is feasible and can provide the surgeon with an interactive 3D roadmap towards the SN or SNs in the groin. However, further technical optimization of the modality is required before this technology can become routine practice.

Navigated Breast Tumor Excision Using Electromagnetically Tracked Ultrasound and Surgical Instruments.

PubMed

Ungi, Tamas; Gauvin, Gabrielle; Lasso, Andras; Yeo, Caitlin T; Pezeshki, Padina; Vaughan, Thomas; Carter, Kaci; Rudan, John; Engel, C Jay; Fichtinger, Gabor

2016-03-01

Lumpectomy, breast conserving tumor excision, is the standard surgical treatment in early stage breast cancer. A common problem with lumpectomy is that the tumor may not be completely excised, and additional surgery becomes necessary. We investigated if a surgical navigation system using intraoperative ultrasound improves the outcomes of lumpectomy and if such a system can be implemented in the clinical environment. Position sensors were applied on the tumor localization needle, the ultrasound probe, and the cautery, and 3-D navigation views were generated using real-time tracking information. The system was tested against standard wire-localization procedures on phantom breast models by eight surgical residents. Clinical safety and feasibility was tested in six palpable tumor patients undergoing lumpectomy by two experienced surgical oncologists. Navigation resulted in significantly less tissue excised compared to control procedures (10.3 ± 4.4 versus 18.6 ± 8.7 g, p = 0.01) and lower number of tumor-positive margins (1/8 versus 4/8) in the phantom experiments. Excision-tumor distance was also more consistently outside the tumor margins with navigation in phantoms. The navigation system has been successfully integrated in an operating room, and user experience was rated positively by surgical oncologists. Electromagnetic navigation may improve the outcomes of lumpectomy by making the tumor excision more accurate. Breast cancer is the most common cancer in women, and lumpectomy is its first choice treatment. Therefore, the improvement of lumpectomy outcomes has a significant impact on a large patient population.

Photoacoustic image-guided navigation system for surgery (Conference Presentation)

NASA Astrophysics Data System (ADS)

Park, Sara; Jang, Jongseong; Kim, Jeesu; Kim, Young Soo; Kim, Chulhong

2017-03-01

Identifying and delineating invisible anatomical and pathological details during surgery guides surgical procedures in real time. Various intraoperative imaging modalities have been increasingly employed to minimize such surgical risks as anatomical changes, damage to normal tissues, and human error. However, current methods provide only structural information, which cannot identify critical structures such as blood vessels. The logical next step is an intraoperative imaging modality that can provide functional information. Here, we have successfully developed a photoacoustic (PA) image-guided navigation system for surgery by integrating a position tracking system and a real-time clinical photoacoustic/ultrasound (PA/US) imaging system. PA/US images were acquired in real time and overlaid on pre-acquired cross-sectional magnetic resonance (MR) images. In the overlaid images, PA images represent the optical absorption characteristics of the surgical field, while US and MR images represent the morphological structure of surrounding tissues. To test the feasibility of the system, we prepared a tissue mimicking phantom which contained two samples, methylene blue as a contrast agent and water as a control. We acquired real-time overlaid PA/US/MR images of the phantom, which were well-matched with the optical and morphological properties of the samples. The developed system is the first approach to a novel intraoperative imaging technology based on PA imaging, and we believe that the system can be utilized in various surgical environments in the near future, improving the efficacy of surgical guidance.

Intraoperative Localization of Tantalum Markers for Proton Beam Radiation of Choroidal Melanoma by an Opto-Electronic Navigation System: A Novel Technique

DOE Office of Scientific and Technical Information (OSTI.GOV)

Amstutz, Christoph A., E-mail: christoph.amstutz@usz.ch; Bechrakis, Nikolaos E.; Foerster, Michael H.

2012-03-15

Purpose: External beam proton radiation therapy has been used since 1975 to treat choroidal melanoma. For tumor location determination during proton radiation treatment, surgical tantalum clips are registered with image data. This report introduces the intraoperative application of an opto-electronic navigation system to determine with high precision the position of the tantalum markers and their spatial relationship to the tumor and anatomical landmarks. The application of the technique in the first 4 patients is described. Methods and Materials: A navigated reference base was attached noninvasively to the eye, and a navigated pointer device was used to record the spatial positionmore » of the tantalum markers, the tumor, and anatomical landmarks. Measurement accuracy was assessed on ex vivo porcine eye specimen by repetitive recording of the tantalum marker positions. The method was applied intraoperatively on 4 patients undergoing routine tantalum clip surgery. The spatial position information delivered by the navigation system was compared to the geometric data generated by the EYEPLAN software. Results: In the ex vivo experiments, the maximum repetition error was 0.34 mm. For the intraoperative application, the root mean square error of paired-points matching of the marker positions from the navigation system and from the EYEPLAN software was 0.701-1.25 mm. Conclusions: Navigation systems are a feasible tool for accurate localization of tantalum markers and anatomic landmarks. They can provide additional geometric information, and therefore have the potential to increase the reliability and accuracy of external beam proton radiation therapy for choroidal melanoma.« less

The Evolution of Computer-Assisted Total Hip Arthroplasty and Relevant Applications

PubMed Central

Kim, In-Sung; Bhardwaj, Atul M.; Badami, Ramachandra N.

2017-01-01

In total hip arthroplasty (THA), the accurate positioning of implants is the key to achieve a good clinical outcome. Computer-assisted orthopaedic surgery (CAOS) has been developed for more accurate positioning of implants during the THA. There are passive, semi-active, and active systems in CAOS for THA. Navigation is a passive system that only provides information and guidance to the surgeon. There are 3 types of navigation: imageless navigation, computed tomography (CT)-based navigation, and fluoroscopy-based navigation. In imageless navigation system, a new method of registration without the need to register the anterior pelvic plane was introduced. CT-based navigation can be efficiently used for pelvic plane reference, the functional pelvic plane in supine which adjusts anterior pelvic plane sagittal tilt for targeting the cup orientation. Robot-assisted system can be either active or semi-active. The active robotic system performs the preparation for implant positioning as programmed preoperatively. It has been used for only femoral implant cavity preparation. Recently, program for cup positioning was additionally developed. Alternatively, for ease of surgeon acceptance, semi-active robot systems are developed. It was initially applied only for cup positioning. However, with the development of enhanced femoral workflows, this system can now be used to position both cup and stem. Though there have been substantial advancements in computer-assisted THA, its use can still be controversial at present due to the steep learning curve, intraoperative technical issues, high cost and etc. However, in the future, CAOS will certainly enable the surgeon to operate more accurately and lead to improved outcomes in THA as the technology continues to evolve rapidly. PMID:28316957

A 6-DOF parallel bone-grinding robot for cervical disc replacement surgery.

PubMed

Tian, Heqiang; Wang, Chenchen; Dang, Xiaoqing; Sun, Lining

2017-12-01

Artificial cervical disc replacement surgery has become an effective and main treatment method for cervical disease, which has become a more common and serious problem for people with sedentary work. To improve cervical disc replacement surgery significantly, a 6-DOF parallel bone-grinding robot is developed for cervical bone-grinding by image navigation and surgical plan. The bone-grinding robot including mechanical design and low level control is designed. The bone-grinding robot navigation is realized by optical positioning with spatial registration coordinate system defined. And a parametric robot bone-grinding plan and high level control have been developed for plane grinding for cervical top endplate and tail endplate grinding by a cylindrical grinding drill and spherical grinding for two articular surfaces of bones by a ball grinding drill. Finally, the surgical flow for a robot-assisted cervical disc replacement surgery procedure is present. The final experiments results verified the key technologies and performance of the robot-assisted surgery system concept excellently, which points out a promising clinical application with higher operability. Finally, study innovations, study limitations, and future works of this present study are discussed, and conclusions of this paper are also summarized further. This bone-grinding robot is still in the initial stage, and there are many problems to be solved from a clinical point of view. Moreover, the technique is promising and can give a good support for surgeons in future clinical work.

The future of spine surgery: New horizons in the treatment of spinal disorders

PubMed Central

Kazemi, Noojan; Crew, Laura K.; Tredway, Trent L.

2013-01-01

Background and Methods: As with any evolving surgical discipline, it is difficult to predict the future of the practice and science of spine surgery. In the last decade, there have been dramatic developments in both the techniques as well as the tools employed in the delivery of better outcomes to patients undergoing such surgery. In this article, we explore four specific areas in spine surgery: namely the role of minimally invasive spine surgery; motion preservation; robotic-aided surgery and neuro-navigation; and the use of biological substances to reduce the number of traditional and revision spine surgeries. Results: Minimally invasive spine surgery has flourished in the last decade with an increasing amount of surgeries being performed for a wide variety of degenerative, traumatic, and neoplastic processes. Particular progress in the development of a direct lateral approach as well as improvement of tubular retractors has been achieved. Improvements in motion preservation techniques have led to a significant number of patients achieving arthroplasty where fusion was the only option previously. Important caveats to the indications for arthroplasty are discussed. Both robotics and neuro-navigation have become further refined as tools to assist in spine surgery and have been demonstrated to increase accuracy in spinal instrumentation placement. There has much debate and refinement in the use of biologically active agents to aid and augment function in spine surgery. Biological agents targeted to the intervertebral disc space could increase function and halt degeneration in this anatomical region. Conclusions: Great improvements have been achieved in developing better techniques and tools in spine surgery. It is envisaged that progress in the four focus areas discussed will lead to better outcomes and reduced burdens on the future of both our patients and the health care system. PMID:23653885

Computerized lateral endoscopic approach to invertebral bodies

NASA Astrophysics Data System (ADS)

Abbasi, Hamid R.; Hariri, Sanaz; Kim, Daniel; Shahidi, Ramin; Steinberg, Gary

2001-05-01

Spinal surgery is often necessary to ease back pain symptoms. Neuronavigation (NN) allows the surgeon to localize the position of his instruments in 3D using pre- operative CT scans registered to intra-operative marker positions in cranial surgeries. However, this tool is unavailable in spinal surgeries for a variety of reasons. For example, because of the spine's many degrees of freedom and flexibility, the geometric relationship of the skin to the internal spinal anatomy is not fixed. Guided by the currently available imperfect 2D images, it is difficult for the surgeon to correct a patient's spinal anomaly; thus surgical relief of back pain is often only temporary. The Image Guidance Laborator's (IGL) goal is to combine the direct optical control of traditional endoscopy with the 3D orientation of NN. This powerful tool requires registration of the patient's anatomy to the surgical navigation system using internal landmarks rather than skin markers. Pre- operative CT scans matched with intraoperative fluoroscopic images can overcome the problem of spinal movement in NN registration. The combination of endoscopy with fluoroscopic registration of vertebral bodies in a NN system provides a 3D intra-operative navigational system for spinal neurosurgery to visualize the internal surgical environment from any orientation in real time. The accuracy of this system integration is being evaluated by assessing the success of nucleotomies and marker implantations guided by NN-registered endoscopy.

Three dimensional computed tomography lung modeling is useful in simulation and navigation of lung cancer surgery.

PubMed

Ikeda, Norihiko; Yoshimura, Akinobu; Hagiwara, Masaru; Akata, Soichi; Saji, Hisashi

2013-01-01

The number of minimally invasive operations, such as video-assisted thoracoscopic surgery (VATS) lobectomy or segmentectomy, has enormously increased in recent years. These operations require extreme knowledge of the anatomy of pulmonary vessels and bronchi in each patient, and surgeons must carefully dissect the branches of pulmonary vessels during operation. Thus, foreknowledge of the anatomy of each patient would greatly contribute to the safety and accuracy of the operation. The development of multi-detector computed tomography (MDCT) has promoted three dimensional (3D) images of lung structures. It is possible to see the vascular and bronchial structures from the view of the operator; therefore, it is employed for preoperative simulation as well as navigation during operation. Due to advances in software, even small vessels can be accurately imaged, which is useful in performing segmentectomy. Surgical simulation and navigation systems based on high quality 3D lung modeling, including vascular and bronchial structures, can be used routinely to enhance the safety operation, education of junior staff, as well as providing a greater sense of security to the operators.

A projective surgical navigation system for cancer resection

NASA Astrophysics Data System (ADS)

Gan, Qi; Shao, Pengfei; Wang, Dong; Ye, Jian; Zhang, Zeshu; Wang, Xinrui; Xu, Ronald

2016-03-01

Near infrared (NIR) fluorescence imaging technique can provide precise and real-time information about tumor location during a cancer resection surgery. However, many intraoperative fluorescence imaging systems are based on wearable devices or stand-alone displays, leading to distraction of the surgeons and suboptimal outcome. To overcome these limitations, we design a projective fluorescence imaging system for surgical navigation. The system consists of a LED excitation light source, a monochromatic CCD camera, a host computer, a mini projector and a CMOS camera. A software program is written by C++ to call OpenCV functions for calibrating and correcting fluorescence images captured by the CCD camera upon excitation illumination of the LED source. The images are projected back to the surgical field by the mini projector. Imaging performance of this projective navigation system is characterized in a tumor simulating phantom. Image-guided surgical resection is demonstrated in an ex-vivo chicken tissue model. In all the experiments, the projected images by the projector match well with the locations of fluorescence emission. Our experimental results indicate that the proposed projective navigation system can be a powerful tool for pre-operative surgical planning, intraoperative surgical guidance, and postoperative assessment of surgical outcome. We have integrated the optoelectronic elements into a compact and miniaturized system in preparation for further clinical validation.

Preliminary development of a workstation for craniomaxillofacial surgical procedures: introducing a computer-assisted planning and execution system.

PubMed

Gordon, Chad R; Murphy, Ryan J; Coon, Devin; Basafa, Ehsan; Otake, Yoshito; Al Rakan, Mohammed; Rada, Erin; Susarla, Srinivas; Susarla, Sriniras; Swanson, Edward; Fishman, Elliot; Santiago, Gabriel; Brandacher, Gerald; Liacouras, Peter; Grant, Gerald; Armand, Mehran

2014-01-01

Facial transplantation represents one of the most complicated scenarios in craniofacial surgery because of skeletal, aesthetic, and dental discrepancies between donor and recipient. However, standard off-the-shelf vendor computer-assisted surgery systems may not provide custom features to mitigate the increased complexity of this particular procedure. We propose to develop a computer-assisted surgery solution customized for preoperative planning, intraoperative navigation including cutting guides, and dynamic, instantaneous feedback of cephalometric measurements/angles as needed for facial transplantation and other related craniomaxillofacial procedures. We developed the Computer-Assisted Planning and Execution (CAPE) workstation to assist with planning and execution of facial transplantation. Preoperative maxillofacial computed tomography (CT) scans were obtained on 4 size-mismatched miniature swine encompassing 2 live face-jaw-teeth transplants. The system was tested in a laboratory setting using plastic models of mismatched swine, after which the system was used in 2 live swine transplants. Postoperative CT imaging was obtained and compared with the preoperative plan and intraoperative measures from the CAPE workstation for both transplants. Plastic model tests familiarized the team with the CAPE workstation and identified several defects in the workflow. Live swine surgeries demonstrated utility of the CAPE system in the operating room, showing submillimeter registration error of 0.6 ± 0.24 mm and promising qualitative comparisons between intraoperative data and postoperative CT imaging. The initial development of the CAPE workstation demonstrated that integration of computer planning and intraoperative navigation for facial transplantation are possible with submillimeter accuracy. This approach can potentially improve preoperative planning, allowing ideal donor-recipient matching despite significant size mismatch, and accurate surgical execution for numerous types of craniofacial and orthognathic surgical procedures.

Computer-assisted surgery of the paranasal sinuses: technical and clinical experience with 368 patients, using the Vector Vision Compact system.

PubMed

Stelter, K; Andratschke, M; Leunig, A; Hagedorn, H

2006-12-01

This paper presents our experience with a navigation system for functional endoscopic sinus surgery. In this study, we took particular note of the surgical indications and risks and the measurement precision and preparation time required, and we present one brief case report as an example. Between 2000 and 2004, we performed functional endoscopic sinus surgery on 368 patients at the Ludwig Maximilians University, Munich, Germany. We used the Vector Vision Compact system (BrainLAB) with laser registration. The indications for surgery ranged from severe nasal polyps and chronic sinusitis to malignant tumours of the paranasal sinuses and skull base. The time needed for data preparation was less than five minutes. The time required for preparation and patient registration depended on the method used and the experience of the user. In the later cases, it took 11 minutes on average, using Z-Touch registration. The clinical plausibility test produced an average deviation of 1.3 mm. The complications of system use comprised one intra-operative re-registration (18 per cent) and one complete failure (5 per cent). Despite the assistance of an accurate working computer, the anterior ethmoidal artery was incised in one case. However, in all 368 cases, we experienced no cerebrospinal fluid leaks, optic nerve lesions, retrobulbar haematomas or intracerebral bleeding. There were no deaths. From our experience with computer-guided surgical procedures, we conclude that computer-guided navigational systems are so accurate that the risk of misleading the surgeon is minimal. In the future, their use in certain specialized procedures will be not only sensible but mandatory. We recommend their use not only in difficult surgical situations but also in routine procedures and for surgical training.

Severely infected pneumoceles of the frontal sinus in patients with mental retardation and brain atrophy treated by endoscopic sinus surgery.

PubMed

Tojima, Ichiro; Kikuoka, Hirotaka; Ogawa, Takao; Shimizu, Takeshi

2018-04-01

We herein present three cases of abnormally expanded frontal sinuses (pneumoceles) with severe infection in patients with mental retardation and brain atrophy. Two patients previously underwent laryngotracheal separation surgery, and bacteriological examinations of purulent nasal discharge revealed infections caused by drug-resistant bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii. As conservative medical treatments were ineffective, all three patients were treated by computed tomography-guided endoscopic sinus surgery. This navigation system is useful for safer surgery in the area of anatomic deformity. The clinical findings, possible etiologies and surgical treatment of these cases are discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

Improved accuracy of component alignment with the implementation of image-free navigation in total knee arthroplasty.

PubMed

Rosenberger, Ralf E; Hoser, Christian; Quirbach, Sebastian; Attal, Rene; Hennerbichler, Alfred; Fink, Christian

2008-03-01

Accuracy of implant positioning and reconstruction of the mechanical leg axis are major requirements for achieving good long-term results in total knee arthroplasty (TKA). The purpose of the present study was to determine whether image-free computer navigation technology has the potential to improve the accuracy of component alignment in TKA cohorts of experienced surgeons immediately and constantly. One hundred patients with primary arthritis of the knee underwent the unilateral total knee arthroplasty. The cohort of 50 TKAs implanted with conventional instrumentation was directly followed by the cohort of the very first 50 computer-assisted TKAs. All surgeries were performed by two senior surgeons. All patients received the Zimmer NexGen total knee prosthesis (Zimmer Inc., Warsaw, IN, USA). There was no variability regarding surgeons or surgical technique, except for the use of the navigation system (StealthStation) Treon plus Medtronic Inc., Minnesota, MI, USA). Accuracy of implant positioning was measured on postoperative long-leg standing radiographs and standard lateral X-rays with regard to the valgus angle and the coronal and sagittal component angles. In addition, preoperative deformities of the mechanical leg axis, tourniquet time, age, and gender were correlated. Statistical analyses were performed using the SPSS 15.0 (SPSS Inc., Chicago, IL, USA) software package. Independent t-tests were used, with significance set at P < 0.05 (two-tailed) to compare differences in mean angular values and frontal mechanical alignment between the two cohorts. To compute the rate of optimally implanted prostheses between the two groups we used the chi(2) test. The average postoperative radiological frontal mechanical alignment was 1.88 degrees of varus (range 6.1 degrees of valgus-10.1 degrees of varus; SD 3.68 degrees ) in the conventional cohort and 0.28 degrees of varus (range 3.7 degrees -6.0 degrees of varus; SD 1.97 degrees ) in the navigated cohort. Including all criteria for optimal implant alignment, 16 cases (32%) in the conventional cohort and 31 cases (62%) in the navigated cohort have been implanted optimally. The average difference in tourniquet time was modest with additional 12.9 min in the navigated cohort compared to the conventional cohort. Our findings suggest that the experienced knee surgeons can improve immediately and constantly the accuracy of component orientation using an image-free computer-assisted navigation system in TKA. The computer-assisted technology has shown to be easy to use, safe, and efficient in routine knee replacement surgery. We believe that navigation is a key technology for various current and future surgical alignment topics and minimal-invasive lower limb surgery.

Economics of image guidance and navigation in spine surgery.

PubMed

Al-Khouja, Lutfi; Shweikeh, Faris; Pashman, Robert; Johnson, J Patrick; Kim, Terrence T; Drazin, Doniel

2015-01-01

Image-guidance and navigation in spinal surgery is becoming more widely utilized. Several studies have shown the use of this technology to increase accuracy of pedicle screw placement, decrease the rates of revision surgery, and minimize radiation exposure. In this paper, the authors analyze the economics of image-guided surgery (IGS) and navigation in spine surgery. A literature review was performed using PubMed, the CEA Registry, and the National Health Service Economic Evaluation Database. Each article was screened for inclusion and exclusion criteria, including costs, reoperation, readmission rates, operating room time, and length of stay. Thirteen studies were included in the analysis. Six studies were identified to meet the inclusion criteria for reporting costs and seven met the criteria for analysis of efficacy. Average costs ranged from $17,650 to $39,643. Pedicle screw misplacement rates using IGS ranged from 1.20% to 15.07% while reoperation rates ranged from 0% to 7.42%. There is currently an insufficient amount of studies reporting on the economics of spinal navigation to accurately conclude on its cost-effectiveness in clinical practice. Although a few of these studies showed less costs associated with intraoperative imaging, none were able to establish a statistically significant difference. Preliminary findings drawn from this study indicate a possible cost-effectiveness advantage with IGS, but more comprehensive data on costs need to be reported in order to validate its utilization.

[Development of a Surgical Navigation System with Beam Split and Fusion of the Visible and Near-Infrared Fluorescence].

PubMed

Yang, Xiaofeng; Wu, Wei; Wang, Guoan

2015-04-01

This paper presents a surgical optical navigation system with non-invasive, real-time, and positioning characteristics for open surgical procedure. The design was based on the principle of near-infrared fluorescence molecular imaging. The in vivo fluorescence excitation technology, multi-channel spectral camera technology and image fusion software technology were used. Visible and near-infrared light ring LED excitation source, multi-channel band pass filters, spectral camera 2 CCD optical sensor technology and computer systems were integrated, and, as a result, a new surgical optical navigation system was successfully developed. When the near-infrared fluorescence was injected, the system could display anatomical images of the tissue surface and near-infrared fluorescent functional images of surgical field simultaneously. The system can identify the lymphatic vessels, lymph node, tumor edge which doctor cannot find out with naked eye intra-operatively. Our research will guide effectively the surgeon to remove the tumor tissue to improve significantly the success rate of surgery. The technologies have obtained a national patent, with patent No. ZI. 2011 1 0292374. 1.

Surgical Navigation: A Systematic Review of Indications, Treatments, and Outcomes in Oral and Maxillofacial Surgery.

PubMed

Azarmehr, Iman; Stokbro, Kasper; Bell, R Bryan; Thygesen, Torben

2017-09-01

This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indications are discussed. A systematic search in relevant electronic databases, journals, and bibliographies of the included articles was carried out. Clinical studies with 5 or more patients published between 2010 and 2015 were included. Traumatology, orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign body removal were the areas of interests. The search generated 13 articles dealing with traumatology; 5, 6, 2, and 0 studies were found that dealt with the topics of orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign body removal, respectively. The average technical system accuracy and intraoperative precision reported were less than 1 mm and 1 to 2 mm, respectively. In general, SN is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were identified in the field of traumatology. Treatment of complex orbital fractures was considerably improved by the use of SN compared with traditionally treated control groups. SN seems to be a very promising addition to the surgical toolkit. Planning details of the surgical procedure in a 3-dimensional virtual environment and execution with real-time guidance can significantly improve precision. Among factors to be considered are the financial investments necessary and the learning curve. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. All rights reserved.

Preservation of the Acetabular Cup During Revision Total Hip Arthroplasty Using a Novel Mini-navigation Tool: A Case Report.

PubMed

Vincent, John; Alshaygy, Ibrahim; Muir, Jeffrey M; Kuzyk, Paul

2018-01-01

While intraoperative navigation systems have been shown to improve outcomes in primary total hip arthroplasty (THA), their use in the context of revision has been largely overlooked. This case report presents the first documented use of an imageless navigation tool in the context of revision THA, and an unexpected benefit to the surgical procedure as a result. An 84-year-old female patient presented following five episodes of dislocation of the left hip and with pain in the left buttock, groin, and posterior aspect of her hip. Relevant surgical history included primary hip arthroplasty in 1999 and the first revision in 2014. Preoperative analysis revealed a constrained liner that had become disengaged and migrated inferiorly, lodging at the distal aspect of the femoral neck. Acetabular protrusion was also noted. The pre-operative plan included the replacement of the fragmented liner and likely of the acetabular cup due to hardware failure. Intraoperative assessment, however, revealed that the cup was in good condition and would be difficult to remove due to substantial bony ingrowth. With the assistance of imageless navigation, the orientation of the acetabular cup was determined and a new constrained liner was cemented into the preexisting acetabular component at an altered orientation, correcting anteversion by 7°. In revision hip arthroplasty cases, image-based navigation is limited by the presence of existing implants and corresponding metal artefact. This case demonstrates the successful use of an imageless navigation tool for revision surgery. Use of navigation led to the unexpected intraoperative discovery that the acetabular cup was in an acceptable state, and allowed the surgical team to correct the position of the cup using a constrained liner, thus preserving the cup. This significantly benefitted patient outcome, due to the risks associated with the removal of a firmly fixated acetabular cup. While more extensive research is required, this case demonstrates that imageless navigation may be an indispensable tool for revision surgery.

Accuracy analysis of pedicle screw placement in posterior scoliosis surgery: comparison between conventional fluoroscopic and computer-assisted technique.

PubMed

Kotani, Yoshihisa; Abumi, Kuniyoshi; Ito, Manabu; Takahata, Masahiko; Sudo, Hideki; Ohshima, Shigeki; Minami, Akio

2007-06-15

The accuracy of pedicle screw placement was evaluated in posterior scoliosis surgeries with or without the use of computer-assisted surgical techniques. In this retrospective cohort study, the pedicle screw placement accuracy in posterior scoliosis surgery was compared between conventional fluoroscopic and computer-assisted surgical techniques. There has been no study systemically analyzing the perforation pattern and comparative accuracy of pedicle screw placement in posterior scoliosis surgery. The 45 patients who received posterior correction surgeries were divided into 2 groups: Group C, manual control (25 patients); and Group N, navigation surgery (20 patients). The average Cobb angles were 73.7 degrees and 73.1 degrees before surgery in Group C and Group N, respectively. Using CT images, vertebral rotation, pedicle axes as measured to anteroposterior sacral axis and vertebral axis, and insertion angle error were measured. In perforation cases, the angular tendency, insertion point, and length abnormality were evaluated. The perforation was observed in 11% of Group C and 1.8% in Group N. In Group C, medial perforations of left screws were demonstrated in 8 of 9 perforated screws and 55% were distributed either in L1 or T12. The perforation consistently occurred in pedicles in which those axes approached anteroposterior sacral axis within 5 degrees . The average insertion errors were 8.4 degrees and 5.0 degrees in Group C and Group N, respectively, which were significantly different (P < 0.02). The medial perforation in Group C occurred around L1, especially when pedicle axis approached anteroposterior sacral axis. This consistent tendency was considered as the limitation of fluoroscopic screw insertion in which horizontal vertebral image was not visible. The use of surgical navigation system successfully reduced the perforation rate and insertion angle errors, demonstrating the clear advantage in safe and accurate pedicle screw placement of scoliosis surgery.

Short-term outcome of 1,465 computer-navigated primary total knee replacements 2005–2008

PubMed Central

2011-01-01

Background and purpose Improvement of positioning and alignment by the use of computer-assisted surgery (CAS) might improve longevity and function in total knee replacements, but there is little evidence. In this study, we evaluated the short-term results of computer-navigated knee replacements based on data from the Norwegian Arthroplasty Register. Patients and methods Primary total knee replacements without patella resurfacing, reported to the Norwegian Arthroplasty Register during the years 2005–2008, were evaluated. The 5 most common implants and the 3 most common navigation systems were selected. Cemented, uncemented, and hybrid knees were included. With the risk of revision for any cause as the primary endpoint and intraoperative complications and operating time as secondary outcomes, 1,465 computer-navigated knee replacements (CAS) and 8,214 conventionally operated knee replacements (CON) were compared. Kaplan-Meier survival analysis and Cox regression analysis with adjustment for age, sex, prosthesis brand, fixation method, previous knee surgery, preoperative diagnosis, and ASA category were used. Results Kaplan-Meier estimated survival at 2 years was 98% (95% CI: 97.5–98.3) in the CON group and 96% (95% CI: 95.0–97.8) in the CAS group. The adjusted Cox regression analysis showed a higher risk of revision in the CAS group (RR = 1.7, 95% CI: 1.1–2.5; p = 0.02). The LCS Complete knee had a higher risk of revision with CAS than with CON (RR = 2.1, 95% CI: 1.3–3.4; p = 0.004)). The differences were not statistically significant for the other prosthesis brands. Mean operating time was 15 min longer in the CAS group. Interpretation With the introduction of computer-navigated knee replacement surgery in Norway, the short-term risk of revision has increased for computer-navigated replacement with the LCS Complete. The mechanisms of failure of these implantations should be explored in greater depth, and in this study we have not been able to draw conclusions regarding causation. PMID:21504309

Real-time image guidance in laparoscopic liver surgery: first clinical experience with a guidance system based on intraoperative CT imaging.

PubMed

Kenngott, Hannes G; Wagner, Martin; Gondan, Matthias; Nickel, Felix; Nolden, Marco; Fetzer, Andreas; Weitz, Jürgen; Fischer, Lars; Speidel, Stefanie; Meinzer, Hans-Peter; Böckler, Dittmar; Büchler, Markus W; Müller-Stich, Beat P

2014-03-01

Laparoscopic liver surgery is particularly challenging owing to restricted access, risk of bleeding, and lack of haptic feedback. Navigation systems have the potential to improve information on the exact position of intrahepatic tumors, and thus facilitate oncological resection. This study aims to evaluate the feasibility of a commercially available augmented reality (AR) guidance system employing intraoperative robotic C-arm cone-beam computed tomography (CBCT) for laparoscopic liver surgery. A human liver-like phantom with 16 target fiducials was used to evaluate the Syngo iPilot(®) AR system. Subsequently, the system was used for the laparoscopic resection of a hepatocellular carcinoma in segment 7 of a 50-year-old male patient. In the phantom experiment, the AR system showed a mean target registration error of 0.96 ± 0.52 mm, with a maximum error of 2.49 mm. The patient successfully underwent the operation and showed no postoperative complications. The use of intraoperative CBCT and AR for laparoscopic liver resection is feasible and could be considered an option for future liver surgery in complex cases.

Real-time advanced spinal surgery via visible patient model and augmented reality system.

PubMed

Wu, Jing-Ren; Wang, Min-Liang; Liu, Kai-Che; Hu, Ming-Hsien; Lee, Pei-Yuan

2014-03-01

This paper presents an advanced augmented reality system for spinal surgery assistance, and develops entry-point guidance prior to vertebroplasty spinal surgery. Based on image-based marker detection and tracking, the proposed camera-projector system superimposes pre-operative 3-D images onto patients. The patients' preoperative 3-D image model is registered by projecting it onto the patient such that the synthetic 3-D model merges with the real patient image, enabling the surgeon to see through the patients' anatomy. The proposed method is much simpler than heavy and computationally challenging navigation systems, and also reduces radiation exposure. The system is experimentally tested on a preoperative 3D model, dummy patient model and animal cadaver model. The feasibility and accuracy of the proposed system is verified on three patients undergoing spinal surgery in the operating theater. The results of these clinical trials are extremely promising, with surgeons reporting favorably on the reduced time of finding a suitable entry point and reduced radiation dose to patients. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Navigation-based tibial rotation at 90° of flexion is associated with better range of motion in navigated total knee arthroplasty.

PubMed

Ishida, Kazunari; Shibanuma, Nao; Matsumoto, Tomoyuki; Sasaki, Hiroshi; Takayama, Koji; Hiroshima, Yuji; Kuroda, Ryosuke; Kurosaka, Masahiro

2016-08-01

In clinical practice, people with better femorotibial rotation in the flexed position often achieve a favourable postoperative maximum flexion angle (MFA). However, no objective data have been reported to support this clinical observation. In the present study, we aimed to investigate the correlation between the amount of intraoperative rotation and the pre- and postoperative flexion angles. Fifty-five patients with varus osteoarthritis undergoing computer-assisted posterior-stabilized total knee arthroplasty (TKA) were enrolled. After registration, rotational stress was applied towards the knee joint, and the rotational angles were recorded by using a navigation system at maximum extension and 90° of flexion. After implantation, rotational stress was applied for a second time, and the angles were recorded once more. The MFA was measured before surgery and 1 month after surgery, and the correlation between the amount of femorotibial rotation during surgery and the MFA was statistically evaluated. Although the amount of tibial rotation at maximum extension was not correlated with the MFA, the amount of tibial rotation at 90° of flexion after registration was positively correlated with the pre- and postoperative MFA (both p < 0.005). However, no significant relationship was observed between the amount of tibial rotation after implantation and the postoperative MFA (n.s.). The results showed that better femorotibial rotation at 90° of flexion is associated with a favourable postoperative MFA, suggesting that the flexibility of the surrounding soft tissues is an important factor for obtaining a better MFA, which has important clinical relevance. Hence, further evaluation of navigation-based kinematics during TKA may provide useful information on MFA. Diagnostic studies, development of diagnostic criteria in a consecutive series of patients, and a universally applied "gold" standard, Level II.

Computer-assisted surgery: virtual- and augmented-reality displays for navigation during urological interventions.

PubMed

van Oosterom, Matthias N; van der Poel, Henk G; Navab, Nassir; van de Velde, Cornelis J H; van Leeuwen, Fijs W B

2018-03-01

To provide an overview of the developments made for virtual- and augmented-reality navigation procedures in urological interventions/surgery. Navigation efforts have demonstrated potential in the field of urology by supporting guidance for various disorders. The navigation approaches differ between the individual indications, but seem interchangeable to a certain extent. An increasing number of pre- and intra-operative imaging modalities has been used to create detailed surgical roadmaps, namely: (cone-beam) computed tomography, MRI, ultrasound, and single-photon emission computed tomography. Registration of these surgical roadmaps with the real-life surgical view has occurred in different forms (e.g. electromagnetic, mechanical, vision, or near-infrared optical-based), whereby the combination of approaches was suggested to provide superior outcome. Soft-tissue deformations demand the use of confirmatory interventional (imaging) modalities. This has resulted in the introduction of new intraoperative modalities such as drop-in US, transurethral US, (drop-in) gamma probes and fluorescence cameras. These noninvasive modalities provide an alternative to invasive technologies that expose the patients to X-ray doses. Whereas some reports have indicated navigation setups provide equal or better results than conventional approaches, most trials have been performed in relatively small patient groups and clear follow-up data are missing. The reported computer-assisted surgery research concepts provide a glimpse in to the future application of navigation technologies in the field of urology.

Development and refinement of computer-assisted planning and execution system for use in face-jaw-teeth transplantation to improve skeletal and dento-occlusal outcomes.

PubMed

Hashemi, Sepehr; Armand, Mehran; Gordon, Chad R

2016-10-01

To describe the development and refinement of the computer-assisted planning and execution (CAPE) system for use in face-jaw-teeth transplants (FJTTs). Although successful, some maxillofacial transplants result in suboptimal hybrid occlusion and may require subsequent surgical orthognathic revisions. Unfortunately, the use of traditional dental casts and splints pose several compromising shortcomings in the context of FJTT and hybrid occlusion. Computer-assisted surgery may overcome these challenges. Therefore, the use of computer-assisted orthognathic techniques and functional planning may prevent the need for such revisions and improve facial-skeletal outcomes. A comprehensive CAPE system for use in FJTT was developed through a multicenter collaboration and refined using plastic models, live miniature swine surgery, and human cadaver models. The system marries preoperative surgical planning and intraoperative execution by allowing on-table navigation of the donor fragment relative to recipient cranium, and real-time reporting of patient's cephalometric measurements relative to a desired dental-skeletal outcome. FJTTs using live-animal and cadaveric models demonstrate the CAPE system to be accurate in navigation and beneficial in improving hybrid occlusion and other craniofacial outcomes. Future refinement of the CAPE system includes integration of more commonly performed orthognathic/maxillofacial procedures.

Precision of computer-assisted core decompression drilling of the knee.

PubMed

Beckmann, J; Goetz, J; Bäthis, H; Kalteis, T; Grifka, J; Perlick, L

2006-06-01

Core decompression by exact drilling into the ischemic areas is the treatment of choice in early stages of osteonecrosis of the femoral condyle. Computer-aided surgery might enhance the precision of the drilling and lower the radiation exposure time of both staff and patients. The aim of this study was to evaluate the precision of the fluoroscopically based VectorVision-navigation system in an in vitro model. Thirty sawbones were prepared with a defect filled up with a radiopaque gypsum sphere mimicking the osteonecrosis. 20 sawbones were drilled by guidance of an intraoperative navigation system VectorVision (BrainLAB, Munich, Germany). Ten sawbones were drilled by fluoroscopic control only. A statistically significant difference with a mean distance of 0.58 mm in the navigated group and 0.98 mm in the control group regarding the distance to the desired mid-point of the lesion could be stated. Significant difference was further found in the number of drilling corrections as well as radiation time needed. The fluoroscopic-based VectorVision-navigation system shows a high feasibility and precision of computer-guided drilling with simultaneously reduction of radiation time and therefore could be integrated into clinical routine.

Navigation of a robot-integrated fluorescence laparoscope in preoperative SPECT/CT and intraoperative freehand SPECT imaging data: a phantom study

NASA Astrophysics Data System (ADS)

van Oosterom, Matthias Nathanaël; Engelen, Myrthe Adriana; van den Berg, Nynke Sjoerdtje; KleinJan, Gijs Hendrik; van der Poel, Henk Gerrit; Wendler, Thomas; van de Velde, Cornelis Jan Hadde; Navab, Nassir; van Leeuwen, Fijs Willem Bernhard

2016-08-01

Robot-assisted laparoscopic surgery is becoming an established technique for prostatectomy and is increasingly being explored for other types of cancer. Linking intraoperative imaging techniques, such as fluorescence guidance, with the three-dimensional insights provided by preoperative imaging remains a challenge. Navigation technologies may provide a solution, especially when directly linked to both the robotic setup and the fluorescence laparoscope. We evaluated the feasibility of such a setup. Preoperative single-photon emission computed tomography/X-ray computed tomography (SPECT/CT) or intraoperative freehand SPECT (fhSPECT) scans were used to navigate an optically tracked robot-integrated fluorescence laparoscope via an augmented reality overlay in the laparoscopic video feed. The navigation accuracy was evaluated in soft tissue phantoms, followed by studies in a human-like torso phantom. Navigation accuracies found for SPECT/CT-based navigation were 2.25 mm (coronal) and 2.08 mm (sagittal). For fhSPECT-based navigation, these were 1.92 mm (coronal) and 2.83 mm (sagittal). All errors remained below the <1-cm detection limit for fluorescence imaging, allowing refinement of the navigation process using fluorescence findings. The phantom experiments performed suggest that SPECT-based navigation of the robot-integrated fluorescence laparoscope is feasible and may aid fluorescence-guided surgery procedures.

Intraoperative adaptation and visualization of preoperative risk analyses for oncologic liver surgery

NASA Astrophysics Data System (ADS)

Hansen, Christian; Schlichting, Stefan; Zidowitz, Stephan; Köhn, Alexander; Hindennach, Milo; Kleemann, Markus; Peitgen, Heinz-Otto

2008-03-01

Tumor resections from the liver are complex surgical interventions. With recent planning software, risk analyses based on individual liver anatomy can be carried out preoperatively. However, additional tumors within the liver are frequently detected during oncological interventions using intraoperative ultrasound. These tumors are not visible in preoperative data and their existence may require changes to the resection strategy. We propose a novel method that allows an intraoperative risk analysis adaptation by merging newly detected tumors with a preoperative risk analysis. To determine the exact positions and sizes of these tumors we make use of a navigated ultrasound-system. A fast communication protocol enables our application to exchange crucial data with this navigation system during an intervention. A further motivation for our work is to improve the visual presentation of a moving ultrasound plane within a complex 3D planning model including vascular systems, tumors, and organ surfaces. In case the ultrasound plane is located inside the liver, occlusion of the ultrasound plane by the planning model is an inevitable problem for the applied visualization technique. Our system allows the surgeon to focus on the ultrasound image while perceiving context-relevant planning information. To improve orientation ability and distance perception, we include additional depth cues by applying new illustrative visualization algorithms. Preliminary evaluations confirm that in case of intraoperatively detected tumors a risk analysis adaptation is beneficial for precise liver surgery. Our new GPU-based visualization approach provides the surgeon with a simultaneous visualization of planning models and navigated 2D ultrasound data while minimizing occlusion problems.

Evaluation of a novel flexible snake robot for endoluminal surgery.

PubMed

Patel, Nisha; Seneci, Carlo A; Shang, Jianzhong; Leibrandt, Konrad; Yang, Guang-Zhong; Darzi, Ara; Teare, Julian

2015-11-01

Endoluminal therapeutic procedures such as endoscopic submucosal dissection are increasingly attractive given the shift in surgical paradigm towards minimally invasive surgery. This novel three-channel articulated robot was developed to overcome the limitations of the flexible endoscope which poses a number of challenges to endoluminal surgery. The device enables enhanced movement in a restricted workspace, with improved range of motion and with the accuracy required for endoluminal surgery. To evaluate a novel flexible robot for therapeutic endoluminal surgery. Bench-top studies. Research laboratory. Targeting and navigation tasks of the robot were performed to explore the range of motion and retroflexion capabilities. Complex endoluminal tasks such as endoscopic mucosal resection were also simulated. Successful completion, accuracy and time to perform the bench-top tasks were the main outcome measures. The robot ranges of movement, retroflexion and navigation capabilities were demonstrated. The device showed significantly greater accuracy of targeting in a retroflexed position compared to a conventional endoscope. Bench-top study and small study sample. We were able to demonstrate a number of simulated endoscopy tasks such as navigation, targeting, snaring and retroflexion. The improved accuracy of targeting whilst in a difficult configuration is extremely promising and may facilitate endoluminal surgery which has been notoriously challenging with a conventional endoscope.

Comparison of ultra-congruent mobile- and fixed-bearing navigation-assisted total knee arthroplasty with minimum 5-year follow-up.

PubMed

Kim, Seong Hwan; Lim, Jung-Won; Ko, Young-Bong; Song, Min-Gu; Lee, Han-Jun

2016-11-01

The purpose of this study was to compare the midterm outcomes between fixed and mobile ultra-congruent (UC) bearings in total knee arthroplasty (TKA). This is a retrospective matched-pairs case-control study of patients who underwent primary navigation-assisted TKA with a minimum 5-year follow-up. A total of 182 cases involved the fixed UC bearing system as Group 1 and 101 cases involved mobile UC bearing system group as Group 2. After 1:1 matching, 73 knees in each group were enrolled. Clinical and radiographic outcomes were evaluated. The overall survival was 143 of 146 cases (97.9 %) at final follow-up, and 72 of 73 cases (96.3 %) in Group 1 and 71 of 73 cases (95.8 %) in Group 2 at final follow-up based on an endpoint of revision surgery. The reasons of revision TKA were periprosthetic fracture in Group 1, infection and bearing dislocation in Group 2. There was no statistical difference in Hospital for Special Surgery (HSS) scores, Knee Society Scores (KSS), WOMAC index score evaluations between groups. This study demonstrated that the fixed-bearing UC prosthesis could provide satisfactory performance compared with that of the mobile-bearing UC prosthesis with minimum 5-year follow-up. The fixed-bearing UC prosthesis could be considered in navigation-assisted TKA with theoretical advantages of UC design. IV.

Use of Indocyanine Green for Detecting the Sentinel Lymph Node in Breast Cancer Patients: From Preclinical Evaluation to Clinical Validation

PubMed Central

Chi, Chongwei; Ye, Jinzuo; Ding, Haolong; He, De; Huang, Wenhe; Zhang, Guo-Jun; Tian, Jie

2013-01-01

Assessment of the sentinel lymph node (SLN) in patients with early stage breast cancer is vital in selecting the appropriate surgical approach. However, the existing methods, including methylene blue and nuclides, possess low efficiency and effectiveness in mapping SLNs, and to a certain extent exert side effects during application. Indocyanine green (ICG), as a fluorescent dye, has been proved reliable usage in SLN detection by several other groups. In this paper, we introduce a novel surgical navigation system to detect SLN with ICG. This system contains two charge-coupled devices (CCD) to simultaneously capture real-time color and fluorescent video images through two different bands. During surgery, surgeons only need to follow the fluorescence display. In addition, the system saves data automatically during surgery enabling surgeons to find the registration point easily according to image recognition algorithms. To test our system, 5 mice and 10 rabbits were used for the preclinical setting and 22 breast cancer patients were utilized for the clinical evaluation in our experiments. The detection rate was 100% and an average of 2.7 SLNs was found in 22 patients. Our results show that the usage of our surgical navigation system with ICG to detect SLNs in breast cancer patients is technically feasible. PMID:24358319

Intraoperative 3D Navigation for Single or Multiple 125I-Seed Localization in Breast-Preserving Cancer Surgery.

PubMed

Pouw, Bas; de Wit-van der Veen, Linda J; van Duijnhoven, Frederieke; Rutgers, Emiel J Th; Stokkel, Marcel P M; Valdés Olmos, Renato A; Vrancken Peeters, Marie-Jeanne T F D

2016-05-01

Mammographic screening has led to the identification of more women with nonpalpable breast cancer, many of them to be treated with breast-preserving surgery. To accomplish radical tumor excision, adequate localization techniques such as radioactive seed localization (RSL) are required. For RSL, a radioactive I-seed is implanted central in the tumor to enable intraoperative localization using a γ-probe. In case of extensive tumor or multifocal carcinoma, multiple I-seeds can be used to delineate the involved area. Preoperative imaging is performed different from surgical positioning; therefore, exact I-seed depth remains unknown during surgery. Twenty patients (mean age, 56.8 years) with 25 implanted I-seeds scheduled for RSL were included. Sixteen patients had 1 I-seed implanted in the primary lesion, 3 patients had 2 I-seeds, and 1 patient had 3 I-seeds. Freehand SPECT localized I-seeds by measuring γ-counts from different directions, all registered by an optical tracking system. A reconstruction and visualization algorithm enabled 3-dimensional (3D) navigation toward the I-seeds. Freehand SPECT visualized all I-seeds in primary tumors and provided preincision depth information. The deviation, mean (SD), between the freehand SPECT depth and the surgical depth estimation was 1.9 (2.1) mm (range, 0-7 mm). Three-dimensional freehand SPECT was especially useful identifying multiple implanted I-seeds because the conventional γ-probe has more difficulty discriminating I-seeds transcutaneous. Freehand SPECT with 3D navigation is a valuable tool in RSL for both single and multiple implanted I-seeds in breast-preserving cancer surgery. Freehand SPECT provides continuous updating 3D imaging with information about depth and location of the I-seeds contributing to adequate excision of nonpalpable breast cancer.

The combination design for open and endoscopic surgery using fluorescence molecular imaging technology

NASA Astrophysics Data System (ADS)

Mao, Yamin; Jiang, Shixin; Ye, Jinzuo; An, Yu; Yang, Xin; Chi, Chongwei; Tian, Jie

2015-03-01

For clinical surgery, it is still a challenge to objectively determine tumor margins during surgery. With the development of medical imaging technology, fluorescence molecular imaging (FMI) method can provide real-time intraoperative tumor margin information. Furthermore, surgical navigation system based on FMI technology plays an important role for the aid of surgeons' precise tumor margin decision. However, detection depth is the most limitation exists in the FMI technique and the method convenient for either macro superficial detection or micro deep tissue detection is needed. In this study, we combined advantages of both open surgery and endoscopic imaging systems with FMI technology. Indocyanine green (ICG) experiments were performed to confirm the feasibility of fluorescence detection in our system. Then, the ICG signal was photographed in the detection area with our system. When the system connected with endoscope lens, the minimum quantity of ICG detected by our system was 0.195 ug. For aspect of C mount lens, the sensitivity of ICG detection with our system was 0.195ug. Our experiments results proved that it was feasible to detect fluorescence images with this combination method. Our system shows great potential in the clinical applications of precise dissection of various tumors

Telemedicine and robotics: paving the way to the globalization of surgery.

PubMed

Senapati, S; Advincula, A P

2005-12-01

The concept of delivering health services at a distance, or telemedicine is becoming an emerging tool for the field of surgery. For the surgical services, telepresence surgery through robotics is gradually being incorporated into health care practices. This article will provide a brief overview of the principles surrounding telemedicine and telepresence surgery as they specifically relate to robotics. Where limitations have been reached in laparoscopy, robotics has allowed further steps forward. The development of robotics in medicine has been a progression from passive to immersive technology. In gynecology, the utilization of robotics has evolved from the use of Aesop, a robotic arm for camera manipulation, to full robotic systems such as Zeus, and the daVinci surgical system. These systems have not only been used directly for a variety of procedures but have also become a useful tool for conferencing and the mentoring of surgeons from afar. As this mode of technology becomes assimilated into the culture of surgery and medicine globally, caution must be taken to carefully navigate the economic, legal and ethical implications of telemedicine. Despite the challenges faced, telepresence surgery holds promise for more widespread applications.

A review of computer-aided oral and maxillofacial surgery: planning, simulation and navigation.

PubMed

Chen, Xiaojun; Xu, Lu; Sun, Yi; Politis, Constantinus

2016-11-01

Currently, oral and maxillofacial surgery (OMFS) still poses a significant challenge for surgeons due to the anatomic complexity and limited field of view of the oral cavity. With the great development of computer technologies, he computer-aided surgery has been widely used for minimizing the risks and improving the precision of surgery. Areas covered: The major goal of this paper is to provide a comprehensive reference source of current and future development of computer-aided OMFS including surgical planning, simulation and navigation for relevant researchers. Expert commentary: Compared with the traditional OMFS, computer-aided OMFS overcomes the disadvantage that the treatment on the region of anatomically complex maxillofacial depends almost exclusively on the experience of the surgeon.

[Further technical and digital development in minimally invasive and conventional surgery].

PubMed

Feussner, H; Reiser, S B; Bauer, M; Kranzfelder, M; Schirren, R; Kleeff, J; Wilhelm, D

2014-03-01

Technological innovations have initiated a fundamental change in invasive therapeutic approaches which has led to a welcome reduction of surgical trauma but was also associated with a declining role of conventional surgery. Active utilization of future technological developments is decisive to promote new therapeutic strategies and to avoid a further loss of importance of surgery. This includes individualized preoperative therapy planning as well as intraoperative diagnostic work-up and navigation and the use of new functional intelligent implants. The working environment "surgical operating room" has to be refurbished into an integrated cooperating functional system. The impact of new technological developments is particularly obvious in minimally invasive surgery. There is a clear tendency towards further reduction in trauma in the surgical access. The incision will become smaller and the number of ports will be further reduced, with the aim of ultimately having just one port (monoport surgery) or even via natural access routes (scarless surgery). Among others, improved visualization including, e.g. autostereoscopy, digital image processing and intelligent support systems, which are able to assist in a cooperative way, will enable these goals to be achieved.

Physicians' perspectives of adopting computer-assisted navigation in orthopedic surgery.

PubMed

Hsu, Hui-Mei; Chang, I-Chiu; Lai, Ta-Wei

2016-10-01

Using Computer-assisted orthopedic navigation surgery system (CAOS) has many advantages but is not mandatory to use during an orthopedic surgery. Therefore, opinions obtained from clinical orthopedists with this system are valuable. This paper integrates technology acceptance model and theory of planned behavior to examine the determinants of continued CAOS use to facilitate user management. Opinions from orthopedists who had used a CAOS for at least two years were collected through a cross-sectional survey to verify the research framework. Follow-up interviews with an expert panel based on their experiences of CAOS were conducted to reason the impacts of factors of the research framework. The results show that factors of "perceived usefulness" and "facilitating condition" determine the intention to continue using CAOS, and "perceived usefulness" was driving by "complexity of task" and "social influence". Additionally, support in practice from high-level managers had an influence on orthopedists' satisfaction after using a CAOS. The aging population is accompanied by the increasing requirements for medical care and medical care attendant expenses, especially in total knee replacement. More precision and improvements on survivorship of patients' artificial joints are needed. This study facilitates suggestions in user management when encountering an obstacle in implementing a CAOS. Based on these findings, scientific and practical implications are then discussed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Deformable 3D-2D registration for guiding K-wire placement in pelvic trauma surgery

NASA Astrophysics Data System (ADS)

Goerres, J.; Jacobson, M.; Uneri, A.; de Silva, T.; Ketcha, M.; Reaungamornrat, S.; Vogt, S.; Kleinszig, G.; Wolinsky, J.-P.; Osgood, G.; Siewerdsen, J. H.

2017-03-01

Pelvic Kirschner wire (K-wire) insertion is a challenging surgical task requiring interpretation of complex 3D anatomical shape from 2D projections (fluoroscopy) and delivery of device trajectories within fairly narrow bone corridors in proximity to adjacent nerves and vessels. Over long trajectories ( 10-25 cm), K-wires tend to curve (deform), making conventional rigid navigation inaccurate at the tip location. A system is presented that provides accurate 3D localization and guidance of rigid or deformable surgical devices ("components" - e.g., K-wires) based on 3D-2D registration. The patient is registered to a preoperative CT image by virtually projecting digitally reconstructed radiographs (DRRs) and matching to two or more intraoperative x-ray projections. The K-wire is localized using an analogous procedure matching DRRs of a deformably parametrized model for the device component (deformable known-component registration, or dKC-Reg). A cadaver study was performed in which a K-wire trajectory was delivered in the pelvis. The system demonstrated target registration error (TRE) of 2.1 ± 0.3 mm in location of the K-wire tip (median ± interquartile range, IQR) and 0.8 ± 1.4º in orientation at the tip (median ± IQR), providing functionality analogous to surgical tracking / navigation using imaging systems already in the surgical arsenal without reliance on a surgical tracker. The method offers quantitative 3D guidance using images (e.g., inlet / outlet views) already acquired in the standard of care, potentially extending the advantages of navigation to broader utilization in trauma surgery to improve surgical precision and safety.

Navigation surgery using an augmented reality for pancreatectomy.

PubMed

Okamoto, Tomoyoshi; Onda, Shinji; Yasuda, Jungo; Yanaga, Katsuhiko; Suzuki, Naoki; Hattori, Asaki

2015-01-01

The aim of this study was to evaluate the utility of navigation surgery using augmented reality technology (AR-based NS) for pancreatectomy. The 3D reconstructed images from CT were created by segmentation. The initial registration was performed by using the optical location sensor. The reconstructed images were superimposed onto the real organs in the monitor display. Of the 19 patients who had undergone hepatobiliary and pancreatic surgery using AR-based NS, the accuracy, visualization ability, and utility of our system were assessed in five cases with pancreatectomy. The position of each organ in the surface-rendering image corresponded almost to that of the actual organ. Reference to the display image allowed for safe dissection while preserving the adjacent vessels or organs. The locations of the lesions and resection line on the targeted organ were overlaid on the operating field. The initial mean registration error was improved to approximately 5 mm by our refinements. However, several problems such as registration accuracy, portability and cost still remain. AR-based NS contributed to accurate and effective surgical resection in pancreatectomy. The pancreas appears to be a suitable organ for further investigations. This technology is promising to improve surgical quality, training, and education. © 2015 S. Karger AG, Basel.

New generation intraoperative three-dimensional imaging (O-arm) in 100 spine surgeries: does it change the surgical procedure?

PubMed

Sembrano, Jonathan N; Santos, Edward Rainier G; Polly, David W

2014-02-01

The O-arm (Medtronic Sofamor Danek, Inc., Memphis, TN, USA), an intraoperative CT scan imaging system, may provide high-quality imaging information to the surgeon. To our knowledge, its impact on spine surgery has not been studied. We reviewed 100 consecutive spine surgical procedures which utilized the new generation mobile intraoperative CT imaging system (O-arm). The most common diagnoses were degenerative conditions (disk disease, spondylolisthesis, stenosis and acquired kyphosis), seen in 49 patients. The most common indication for imaging was spinal instrumentation in 81 patients (74 utilized pedicle screws). In 52 (70%) of these, the O-arm was used to assess screw position after placement; in 22 (30%), it was coupled with Stealth navigation (Medtronic Sofamor Danek, Inc.) to guide screw placement. Another indication was to assess adequacy of spinal decompression in 38 patients; in 19 (50%) of these, intrathecal contrast material was used to obtain an intraoperative CT myelogram. In 20 patients O-arm findings led to direct surgeon intervention in the form of screw removal/repositioning (n=13), further decompression (n=6), interbody spacer repositioning (n=1), and removal of kyphoplasty trocar (n=1). In 20% of spine surgeries, the procedure was changed based on O-arm imaging findings. We found the O-arm to be useful for assessment of instrumentation position, adequacy of spinal decompression, and confirmation of balloon containment and cement filling in kyphoplasty. When used with navigation for image-guided surgery, it obviated the need for registration. Published by Elsevier Ltd.

Accuracy of neuro-navigated cranial screw placement using optical surface imaging (Conference Presentation)

NASA Astrophysics Data System (ADS)

Jakubovic, Raphael; Gupta, Shuarya; Guha, Daipayan; Mainprize, Todd; Yang, Victor X. D.

2017-02-01

Cranial neurosurgical procedures are especially delicate considering that the surgeon must localize the subsurface anatomy with limited exposure and without the ability to see beyond the surface of the surgical field. Surgical accuracy is imperative as even minor surgical errors can cause major neurological deficits. Traditionally surgical precision was highly dependent on surgical skill. However, the introduction of intraoperative surgical navigation has shifted the paradigm to become the current standard of care for cranial neurosurgery. Intra-operative image guided navigation systems are currently used to allow the surgeon to visualize the three-dimensional subsurface anatomy using pre-acquired computed tomography (CT) or magnetic resonance (MR) images. The patient anatomy is fused to the pre-acquired images using various registration techniques and surgical tools are typically localized using optical tracking methods. Although these techniques positively impact complication rates, surgical accuracy is limited by the accuracy of the navigation system and as such quantification of surgical error is required. While many different measures of registration accuracy have been presented true navigation accuracy can only be quantified post-operatively by comparing a ground truth landmark to the intra-operative visualization. In this study we quantified the accuracy of cranial neurosurgical procedures using a novel optical surface imaging navigation system to visualize the three-dimensional anatomy of the surface anatomy. A tracked probe was placed on the screws of cranial fixation plates during surgery and the reported position of the centre of the screw was compared to the co-ordinates of the post-operative CT or MR images, thus quantifying cranial neurosurgical error.

Microcirculation and its relation to continuous subcutaneous glucose sensor accuracy in cardiac surgery patients in the intensive care unit.

PubMed

Siegelaar, Sarah E; Barwari, Temo; Hermanides, Jeroen; van der Voort, Peter H J; Hoekstra, Joost B L; DeVries, J Hans

2013-11-01

Continuous glucose monitoring could be helpful for glucose regulation in critically ill patients; however, its accuracy is uncertain and might be influenced by microcirculation. We investigated the microcirculation and its relation to the accuracy of 2 continuous glucose monitoring devices in patients after cardiac surgery. The present prospective, observational study included 60 patients admitted for cardiac surgery. Two continuous glucose monitoring devices (Guardian Real-Time and FreeStyle Navigator) were placed before surgery. The relative absolute deviation between continuous glucose monitoring and the arterial reference glucose was calculated to assess the accuracy. Microcirculation was measured using the microvascular flow index, perfused vessel density, and proportion of perfused vessels using sublingual sidestream dark-field imaging, and tissue oxygenation using near-infrared spectroscopy. The associations were assessed using a linear mixed-effects model for repeated measures. The median relative absolute deviation of the Navigator was 11% (interquartile range, 8%-16%) and of the Guardian was 14% (interquartile range, 11%-18%; P = .05). Tissue oxygenation significantly increased during the intensive care unit admission (maximum 91.2% [3.9] after 6 hours) and decreased thereafter, stabilizing after 20 hours. A decrease in perfused vessel density accompanied the increase in tissue oxygenation. Microcirculatory variables were not associated with sensor accuracy. A lower peripheral temperature (Navigator, b = -0.008, P = .003; Guardian, b = -0.006, P = .048), and for the Navigator, also a higher Acute Physiology and Chronic Health Evaluation IV predicted mortality (b = 0.017, P < .001) and age (b = 0.002, P = .037) were associated with decreased sensor accuracy. The results of the present study have shown acceptable accuracy for both sensors in patients after cardiac surgery. The microcirculation was impaired to a limited extent compared with that in patients with sepsis and healthy controls. This impairment was not related to sensor accuracy but the peripheral temperature for both sensors and patient age and Acute Physiology and Chronic Health Evaluation IV predicted mortality for the Navigator were. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Electromagnetic navigational bronchoscopy and robotic-assisted thoracic surgery.

PubMed

Christie, Sara

2014-06-01

With the use of electromagnetic navigational bronchoscopy and robotics, lung lesions can be diagnosed and resected during one surgical procedure. Global positioning system technology allows surgeons to identify and mark a thoracic tumor, and then robotics technology allows them to perform minimally invasive resection and cancer staging procedures. Nurses on the perioperative robotics team must consider the logistics of providing safe and competent care when performing combined procedures during one surgical encounter. Instrumentation, OR organization and room setup, and patient positioning are important factors to consider to complete the procedure systematically and efficiently. This revolutionary concept of combining navigational bronchoscopy with robotics requires a team of dedicated nurses to facilitate the sequence of events essential for providing optimal patient outcomes in highly advanced surgical procedures. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Image guidance improves localization of sonographically occult colorectal liver metastases

NASA Astrophysics Data System (ADS)

Leung, Universe; Simpson, Amber L.; Adams, Lauryn B.; Jarnagin, William R.; Miga, Michael I.; Kingham, T. Peter

2015-03-01

Assessing the therapeutic benefit of surgical navigation systems is a challenging problem in image-guided surgery. The exact clinical indications for patients that may benefit from these systems is not always clear, particularly for abdominal surgery where image-guidance systems have failed to take hold in the same way as orthopedic and neurosurgical applications. We report interim analysis of a prospective clinical trial for localizing small colorectal liver metastases using the Explorer system (Path Finder Technologies, Nashville, TN). Colorectal liver metastases are small lesions that can be difficult to identify with conventional intraoperative ultrasound due to echogeneity changes in the liver as a result of chemotherapy and other preoperative treatments. Interim analysis with eighteen patients shows that 9 of 15 (60%) of these occult lesions could be detected with image guidance. Image guidance changed intraoperative management in 3 (17%) cases. These results suggest that image guidance is a promising tool for localization of small occult liver metastases and that the indications for image-guided surgery are expanding.

Pilot-study on the feasibility of sentinel node navigation surgery in combination with thoracolaparoscopic lymphadenectomy without esophagectomy in early esophageal adenocarcinoma patients.

PubMed

Künzli, H T; van Berge Henegouwen, M I; Gisbertz, S S; van Esser, S; Meijer, S L; Bennink, R J; Wiezer, M J; Seldenrijk, C A; Bergman, J J G H M; Weusten, B L A M

2017-11-01

High-risk submucosal esophageal adenocarcinoma's might be treated curatively by means of radical endoscopic resection, followed by thoracolaparoscopic lymphadenectomy without concomitant esophagectomy. A preclinical study has shown the feasibility and safety of this approach; however, no studies are performed in a clinical setting. In addition, sentinel node navigation surgery could be valuable in tailoring the extent of the lymphadenectomy. This study aimed to evaluate the feasibility and safety of thoracolaparoscopic lymphadenectomy without esophagectomy (phase I) and sentinel node navigation surgery (phase II) in patients with early esophageal adenocarcinoma. Patients with T1N0M0 early esophageal adenocarcinoma scheduled for esophagectomy without neoadjuvant therapy were included. Phase I: Two-field, esophagus preserving, thoracolaparoscopic lymphadenectomy was performed, followed by esophagectomy in the same session. Primary outcome parameters were the number of lymph nodes resected, and number of retained lymph nodes in the esophagectomy specimen. Phase II: A radioactive tracer was injected endoscopically the day before surgery. Static imaging was performed 15 and 120 minutes after injection. The day of surgery, sentinel node navigation surgery followed by esophagectomy was performed. Primary outcome parameters were the percentage of patients with a detectable sentinel node, and the concordance between static imaging and probe-based detection of sentinel node. Phase I: Five patients were included, and a median of 30 (IQR: 25-46) lymph nodes was resected. A median of 6 (IQR: 2-9) retained lymph nodes was found in the esophagectomy specimen. No acute adverse events occurred, but near the end of lymphadenectomy esophageal discoloration was observed, possibly indicating ischemia. Phase II: In all five included patients sentinel nodes could be visualized and resected, at a median of 3 (IQR: 2-5) locations. There was a high concordance between imaging and probe-based detection of sentinel nodes. In conclusion, sentinel node navigation surgery followed by lymphadenectomy without concomitant esophagectomy seems feasible in patients with high-risk submucosal early esophageal adenocarcinoma. More evidence is however needed before applying this technique in clinical practice. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Mono-stereo-autostereo: the evolution of 3-dimensional neurosurgical planning.

PubMed

Stadie, Axel T; Kockro, Ralf A

2013-01-01

In the past decade, surgery planning has changed significantly. The main reason is the improvements in computer graphical rendering power and display technology, which turned the plain graphics of the mid-1990s into interactive stereoscopic objects. To report our experiences with 2 virtual reality systems used for planning neurosurgical operations. A series of 208 operations were planned with the Dextroscope (Bracco AMT, Singapore) requiring the use of liquid crystal display shutter glasses. The participating neurosurgeons answered a questionnaire after the planning procedure and postoperatively. In a second prospective series of 33 patients, we used an autostereoscopic monitor system (MD20-3-D; Setred SA, Sweden) to plan intracranial operations. A questionnaire regarding the value of surgery planning was answered preoperatively and postoperatively. The Dextroscope could be integrated into daily surgical routine. Surgeons regarded their understanding of the pathoanatomical situation as improved, leading to enhanced intraoperative orientation and confidence compared with conventional planning. The autostereoscopic Setred system was regarded as helpful in establishing the surgical strategy and analyzing the pathoanatomical situation compared with conventional planning. Both systems were perceived as a backup in case of failure of the standard navigation system. Improvement of display and interaction techniques adds to the realism of the planning process and enables precise structural understanding preoperatively. This minimizes intraoperative guesswork and exploratory dissection. Autostereoscopic display techniques will further increase the value and acceptance of 3-dimensional planning and intraoperative navigation.

Advancements in Orthopedic Intervention: Retrograde Drilling and Bone Grafting of Osteochondral Lesions of the Knee Using Magnetic Resonance Imaging Guidance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Seebauer, Christian J., E-mail: christian.seebauer@charite.d; Bail, Hermann J., E-mail: hermann-josef.bail@klinikum-nuernberg.d; Rump, Jens C., E-mail: jens.rump@charite.de

Computer-assisted surgery is currently a novel challenge for surgeons and interventional radiologists. Magnetic resonance imaging (MRI)-guided procedures are still evolving. In this experimental study, we describe and assess an innovative passive-navigation method for MRI-guided treatment of osteochondritis dissecans of the knee. A navigation principle using a passive-navigation device was evaluated in six cadaveric knee joint specimens for potential applicability in retrograde drilling and bone grafting of osteochondral lesions using MRI guidance. Feasibility and accuracy were evaluated in an open MRI scanner (1.0 T Philips Panorama HFO MRI System). Interactive MRI navigation allowed precise drilling and bone grafting of osteochondral lesionsmore » of the knee. All lesions were hit with an accuracy of 1.86 mm in the coronal plane and 1.4 mm the sagittal plane. Targeting of all lesions was possible with a single drilling. MRI allowed excellent assessment of correct positioning of the cancellous bone cylinder during bone grafting. The navigation device and anatomic structures could be clearly identified and distinguished throughout the entire drilling procedure. MRI-assisted navigation method using a passive navigation device is feasible for the treatment of osteochondral lesions of the knee under MRI guidance and allows precise and safe drilling without exposure to ionizing radiation. This method may be a viable alternative to other navigation principles, especially for pediatric and adolescent patients. This MRI-navigated method is also potentially applicable in many other MRI-guided interventions.« less

American Epilepsy Society

MedlinePlus

... Epilepsy Society CLINICAL RESOURCES FAQs GUIDELINES IOM EPILEPSY MEDICAL MARIJUANA SUDEP SURGERY DEVICES GENETICS TREATMENTS Drug Alerts and ... RESOURCES Navigation CLINICAL RESOURCES FAQs GUIDELINES IOM EPILEPSY MEDICAL MARIJUANA SUDEP SURGERY DEVICES GENETICS TREATMENTS Drug Alerts and ...

Can Navigation-assisted Surgery Help Achieve Negative Margins in Resection of Pelvic and Sacral Tumors?

PubMed

Abraham, John A; Kenneally, Barry; Amer, Kamil; Geller, David S

2018-03-01

Navigation-assisted resection has been proposed as a useful adjunct to resection of malignant tumors in difficult anatomic sites such as the pelvis and sacrum where it is difficult to achieve tumor-free margins. Most of these studies are case reports or small case series, but these reports have been extremely promising. Very few reports, however, have documented benefits of navigation-assisted resection in series of pelvic and sacral primary tumors. Because this technology may add time and expense to the surgical procedure, it is important to determine whether navigation provides any such benefits or simply adds cost and time to an already complex procedure. (1) What proportion of pelvic and sacral bone sarcoma resections utilizing a computer-assisted resection technique achieves negative margins? (2) What are the oncologic outcomes associated with computer-assisted resection of pelvic and sacral bone sarcomas? (3) What complications are associated with navigation-assisted resection? Between 2009 and 2015 we performed 24 navigation-assisted resections of primary tumors of the pelvis or sacrum. Of those, four were lost to followup after the 2-year postoperative visit. In one patient, however, there was a failure of navigation as a result of inadequate imaging, so nonnavigated resection was performed; the remaining 23 were accounted for and were studied here at a mean of 27 months after surgery (range, 12-52 months). During this period, we performed navigation-assisted resections in all patients presenting with a pelvis or sacral tumor; there was no selection process. No patients were treated for primary tumors in these locations without navigation during this time with the exception of the single patient in whom the navigation system failed. We retrospectively evaluated the records of these 23 patients and evaluated the margin status of these resections. We calculated the proportion of patients with local recurrence, development of metastases, and overall survival at an average 27-month followup (range, 12-52 months). We queried a longitudinally maintained surgical database for any complications and noted which, if any, could have been directly related to the use of the navigation-assisted technique. In our series, 21 of 23 patients had a negative margin resection. In all patients the bone margin was negative, but two with sacral resections had positive soft tissue margins. Six of 23 patients experienced local recurrence within the study period. Three patients died during the study period. Seventeen patients demonstrated no evidence of disease at last recorded followup. We noted three intraoperative complications: one dural tear, one iliac vein laceration, and one bladder injury. Eight patients out of 23 had wound complications resulting in operative débridement. Two patients in the series developed transient postoperative femoral nerve palsy, which we believe were caused by stretch of the femoral nerve secondary to the placement of the reference array in the pubic ramus. Navigation-assisted resection of pelvic and sacral tumors resulted in a high likelihood of negative margin resection in this series, and we observed relatively few complications related specifically to the navigation. We have no comparison group without navigation, and future studies should indeed compare navigated with nonnavigated resection approaches in these anatomic locations. We did identify a potential navigation-related complication of femoral nerve palsy in this series and suggest careful placement and observation of the reference array during the operative procedure to lessen the likelihood of this previously unreported complication. We suggest it is worthwhile to consider the use of navigation-assisted surgery in resection of tumors of the pelvis and sacrum, but further study will be needed to determine its precise impact, if any, on local recurrence and other oncologic outcomes. Level IV, therapeutic study.

Secondary reconstruction of maxillofacial trauma.

PubMed

Castro-Núñez, Jaime; Van Sickels, Joseph E

2017-08-01

Craniomaxillofacial trauma is one of the most complex clinical conditions in contemporary maxillofacial surgery. Vital structures and possible functional and esthetic sequelae are important considerations following this type of trauma and intervention. Despite the best efforts of the primary surgery, there are a group of patients that will have poor outcomes requiring secondary reconstruction to restore form and function. The purpose of this study is to review current concepts on secondary reconstruction to the maxillofacial complex. The evaluation of a posttraumatic patient for a secondary reconstruction must include an assessment of the different subunits of the upper face, middle face, and lower face. Virtual surgical planning and surgical guides represent the most important innovations in secondary reconstruction over the past few years. Intraoperative navigational surgery/computed-assisted navigation is used in complex cases. Facial asymmetry can be corrected or significantly improved by segmentation of the computerized tomography dataset and mirroring of the unaffected side by means of virtual surgical planning. Navigational surgery/computed-assisted navigation allows for a more precise surgical correction when secondary reconstruction involves the replacement of extensive anatomical areas. The use of technology can result in custom-made replacements and prebent plates, which are more stable and resistant to fracture because of metal fatigue. Careful perioperative evaluation is the key to positive outcomes of secondary reconstruction after trauma. The advent of technological tools has played a capital role in helping the surgical team perform a given treatment plan in a more precise and predictable manner.

Conventional versus computer-navigated TKA: a prospective randomized study.

PubMed

Todesca, Alessandro; Garro, Luca; Penna, Massimo; Bejui-Hugues, Jacques

2017-06-01

The purpose of this study was to assess the midterm results of total knee arthroplasty (TKA) implanted with a specific computer navigation system in a group of patients (NAV) and to assess the same prosthesis implanted with the conventional technique in another group (CON); we hypothesized that computer navigation surgery would improve implant alignment, functional scores and survival of the implant compared to the conventional technique. From 2008 to 2009, 225 patients were enrolled in the study and randomly assigned in CON and NAV groups; 240 consecutive mobile-bearing ultra-congruent score (Amplitude, Valence, France) TKAs were performed by a single surgeon, 117 using the conventional method and 123 using the computer-navigated approach. Clinical outcome assessment was based on the Knee Society Score (KSS), the Hospital for Special Surgery Knee Score and the Western Ontario Mac Master University Index score. Component survival was calculated by Kaplan-Meier analysis. Median follow-up was 6.4 years (range 6-7 years). Two patients were lost to follow-up. No differences were seen between the two groups in age, sex, BMI and side of implantation. Three patients of CON group referred feelings of instability during walking, but clinical tests were all negative. NAV group showed statistical significant better KSS Score and wider ROM and fewer outliers from neutral mechanical axis, lateral distal femoral angle, medial proximal tibial angle and tibial slope in post-operative radiographic assessment. There was one case of early post-operative superficial infection (caused by Staph. Aureus) successfully treated with antibiotics. No mechanical loosening, mobile-bearing dislocation or patellofemoral complication was seen. At 7 years of follow-up, component survival in relation to the risk of aseptic loosening or other complications was 100 %. There were no implant revisions. This study demonstrates superior accuracy in implant positioning and statistical significant better functional outcomes of computer-navigated TKA. Computer navigation for TKAs should be used routinely in primary implants. II.

Cranial surgery navigation aided by a compact intraoperative magnetic resonance imager.

PubMed

Schulder, M; Liang, D; Carmel, P W

2001-06-01

In this article the authors report on a novel, compact device for magnetic resonance (MR) imaging that has been developed for use in a standard neurosurgical operating room. The device includes a permanent magnet with a field strength of 0.12 tesla. The poles of the magnet are vertically aligned, with a gap of 25 cm. When not in use the magnet is stored in a shielded cage in a corner of the operating room; it is easily moved into position and attaches to a regular operating table. The magnet is raised for imaging when needed and may be lowered to allow surgery to proceed unencumbered. Surgical navigation with optical and/or magnetic probes is incorporated into the system. Twenty-five patients have undergone removal of intracranial lesions with the aid of this device. Operations included craniotomy for tumor or other lesion in 18 patients and transsphenoidal resection of tumor in seven. The number of scans ranged from two to five per surgery (average 3.4); image quality was excellent in 45%, adequate in 43%, and poor in 12%. In four patients MR imaging revealed additional tumor that was then resected; in five others visual examination of the operative field was inconclusive but complete tumor removal was confirmed on MR imaging. In 21 patients early postoperative diagnostic MR studies corroborated the findings on the final intraoperative MR image. Using a water-covered phantom, the accuracy of the navigational tools was assessed; 120 data points were measured. The accuracy of the magnetic probe averaged 1.3 mm and 2.1 mm in the coronal and axial planes, respectively; the optical probe accuracy was 2.1 mm and 1.8 mm in those planes. This device provides high-quality intraoperative imaging and accurate surgical navigation with minimal disruption in a standard neurosurgical operating room.

Desktop-based computer-assisted orthopedic training system for spinal surgery.

PubMed

Rambani, Rohit; Ward, James; Viant, Warren

2014-01-01

Simulation and surgical training has moved on since its inception during the end of the last century. The trainees are getting more exposed to computers and laboratory training in different subspecialties. More needs to be done in orthopedic simulation in spinal surgery. To develop a training system for pedicle screw fixation and validate its effectiveness in a cohort of junior orthopedic trainees. Fully simulated computer-navigated training system is used to train junior orthopedic trainees perform pedicle screw insertion in the lumbar spine. Real patient computed tomography scans are used to produce the real-time fluoroscopic images of the lumbar spine. The training system was developed to simulate pedicle screw insertion in the lumbar spine. A total of 12 orthopedic senior house officers performed pedicle screw insertion in the lumbar spine before and after the training on training system. The results were assessed based on the scoring system, which included the amount of time taken, accuracy of pedicle screw insertion, and the number of exposures requested to complete the procedure. The result shows a significant improvement in amount of time taken, accuracy of fixation, and the number of exposures after the training on simulator system. This was statistically significant using paired Student t test (p < 0.05). Fully simulated computer-navigated training system is an efficient training tool for young orthopedic trainees. This system can be used to augment training in the operating room, and trainees acquire their skills in the comfort of their study room or in the training room in the hospital. The system has the potential to be used in various other orthopedic procedures for learning of technical skills in a manner aimed at ensuring a smooth escalation in task complexity leading to the better performance of procedures in the operating theater. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Augmented Endoscopic Images Overlaying Shape Changes in Bone Cutting Procedures.

PubMed

Nakao, Megumi; Endo, Shota; Nakao, Shinichi; Yoshida, Munehito; Matsuda, Tetsuya

2016-01-01

In microendoscopic discectomy for spinal disorders, bone cutting procedures are performed in tight spaces while observing a small portion of the target structures. Although optical tracking systems are able to measure the tip of the surgical tool during surgery, the poor shape information available during surgery makes accurate cutting difficult, even if preoperative computed tomography and magnetic resonance images are used for reference. Shape estimation and visualization of the target structures are essential for accurate cutting. However, time-varying shape changes during cutting procedures are still challenging issues for intraoperative navigation. This paper introduces a concept of endoscopic image augmentation that overlays shape changes to support bone cutting procedures. This framework handles the history of the location of the measured drill tip as a volume label and visualizes the remains to be cut overlaid on the endoscopic image in real time. A cutting experiment was performed with volunteers, and the feasibility of this concept was examined using a clinical navigation system. The efficacy of the cutting aid was evaluated with respect to the shape similarity, total moved distance of a cutting tool, and required cutting time. The results of the experiments showed that cutting performance was significantly improved by the proposed framework.

Complete diagnostics and clinical approach for a female patient with unusual glioblastoma: A case study.

PubMed

Samal, Filip; Stanek, Libor; Filip, Michal; Haninec, Pavel; Vícha, Ales; Musil, Zdenek; Tesarova, Petra; Petruzelka, Lubos; Springer, Drahomira; Kralickova, Milena; Kohoutova, Milada; Zima, Tomas

2016-07-01

The present study reports a case of a 44-year-old female patient with a large frontal lobe tumor who underwent surgery using a modern navigation system SonoWand that combines the advantages of a non-frame navigation system with intraoperative real-time ultrasound imaging. The right frontal lobe tumor consisted of two morphologically different sections. A diffuse astrocytoma grade II and a glioblastoma grade IV were identified. These tumors were relatively substantially separated. A 17 p deletion, including TP53 , was detected in a diffuse astrocytoma but not in a glioblastoma. EGFR and MDM2 amplifications were detected only in a glioblastoma. Detection of these amplifications is typical for primary glioblastomas. These findings support our assumption of two independent tumors. The KRAS , BRAF and EGFR gene mutations were also detected in a glioblastoma. Such an accumulation of molecular mutations is rare in one tumor. Following oncological treatment the patient was cared for in the oncological center and survived for 15 months after the surgery without any signs of a disease. This is an unusual case, and to the best of our knowledge, is not frequently published in literature.

Endoscopic Skull Base Surgery

PubMed Central

Senior, Brent A

2008-01-01

Endoscopic skull base surgery has undergone rapid advancement in the past decade moving from pituitary surgery to suprasellar lesions and now to a myriad of lesions extending from the cribriform plate to C2 and laterally out to the infratemporal fossa and petrous apex. Evolution of several technological advances as well as advances in understanding of endoscopic anatomy and the development of surgical techniques both in resection and reconstruction have fostered this capability. Management of benign disease via endoscopic methods is largely accepted now but more data is needed before the controversy on the role of endoscopic management of malignant disease is decided. Continued advances in surgical technique, navigation systems, endoscopic imaging technology, and robotics assure continued brisk evolution in this expanding field. PMID:19434274

The evolution of image-guided lumbosacral spine surgery.

PubMed

Bourgeois, Austin C; Faulkner, Austin R; Pasciak, Alexander S; Bradley, Yong C

2015-04-01

Techniques and approaches of spinal fusion have considerably evolved since their first description in the early 1900s. The incorporation of pedicle screw constructs into lumbosacral spine surgery is among the most significant advances in the field, offering immediate stability and decreased rates of pseudarthrosis compared to previously described methods. However, early studies describing pedicle screw fixation and numerous studies thereafter have demonstrated clinically significant sequelae of inaccurate surgical fusion hardware placement. A number of image guidance systems have been developed to reduce morbidity from hardware malposition in increasingly complex spine surgeries. Advanced image guidance systems such as intraoperative stereotaxis improve the accuracy of pedicle screw placement using a variety of surgical approaches, however their clinical indications and clinical impact remain debated. Beginning with intraoperative fluoroscopy, this article describes the evolution of image guided lumbosacral spinal fusion, emphasizing two-dimensional (2D) and three-dimensional (3D) navigational methods.

Method for evaluating compatibility of commercial electromagnetic (EM) microsensor tracking systems with surgical and imaging tables

NASA Astrophysics Data System (ADS)

Nafis, Christopher; Jensen, Vern; von Jako, Ron

2008-03-01

Electromagnetic (EM) tracking systems have been successfully used for Surgical Navigation in ENT, cranial, and spine applications for several years. Catheter sized micro EM sensors have also been used in tightly controlled cardiac mapping and pulmonary applications. EM systems have the benefit over optical navigation systems of not requiring a line-of-sight between devices. Ferrous metals or conductive materials that are transient within the EM working volume may impact tracking performance. Effective methods for detecting and reporting EM field distortions are generally well known. Distortion compensation can be achieved for objects that have a static spatial relationship to a tracking sensor. New commercially available micro EM tracking systems offer opportunities for expanded image-guided navigation procedures. It is important to know and understand how well these systems perform with different surgical tables and ancillary equipment. By their design and intended use, micro EM sensors will be located at the distal tip of tracked devices and therefore be in closer proximity to the tables. Our goal was to define a simple and portable process that could be used to estimate the EM tracker accuracy, and to vet a large number of popular general surgery and imaging tables that are used in the United States and abroad.

Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions.

PubMed

Makris, D; Scherpereel, A; Leroy, S; Bouchindhomme, B; Faivre, J-B; Remy, J; Ramon, P; Marquette, C-H

2007-06-01

The present study prospectively evaluated the diagnostic yield and safety of electromagnetic navigation-guided bronchoscopy biopsy, for small peripheral lung lesions in patients where standard techniques were nondiagnostic. The study was conducted in a tertiary medical centre on 40 consecutive patients considered unsuitable for straightforward surgery or computed tomography (CT)-guided transthoracic needle aspiration biopsy, due to comorbidities. The lung lesion diameter was mean+/-sem 23.5+/-1.5 mm and the depth from the visceral-costal pleura was 14.9+/-2 mm. Navigation was facilitated by an electromagnetic tracking system which could detect a position sensor incorporated into a flexible catheter advanced through a bronchoscope. Information obtained during bronchoscopy was superimposed on previously acquired CT data. Divergence between CT data and data obtained during bronchoscopy was calculated by the system's software as a measure of navigational accuracy. All but one of the target lesions was reached and the overall diagnostic yield was 62.5% (25-40). Diagnostic yield was significantly affected by CT-to-body divergence; yield was 77.2% when estimated divergence was

The effect of augmented real-time image guidance on task workload during endoscopic sinus surgery.

PubMed

Dixon, Benjamin J; Chan, Harley; Daly, Michael J; Vescan, Allan D; Witterick, Ian J; Irish, Jonathan C

2012-01-01

Due to proximity to critical structures, the need for spatial awareness during endoscopic sinus surgery (ESS) is essential. We have developed an augmented, real-time image-guided surgery (ART-IGS) system that provides live navigational data and proximity alerts to the operating surgeon during ablation. We wished to test the hypothesis that task workload would be reduced when using this technology. A trial involved 8 otolaryngology residents and fellows performing ESS on cadaveric specimens; 1 side in a conventional method (control) and 1 side with ART-IGS. After computed tomography scanning, anatomical contouring, and registration of the head, a three-dimensional (3D) virtual endoscopic view, ablative tool tracking, and proximity alerts were enabled. Each subject completed ESS tasks and rated their workload during and after the exercise using the National Aeronautics and Space Administration (NASA) Task Load Index (TLX). A questionnaire and open feedback interview were completed after the procedure. There was a significant reduction in mental demand, temporal demand, effort, and frustration when using the ART-IGS system in comparison to the control (p < 0.02). Perceived performance was increased (p = 0.02). Most subjects agreed that the system was sufficiently accurate, caused minimal interruption, and increased confidence. Optical tracking line-of-sight issues were frequently cited as the main limitation early in the study; however, this was largely resolved. ART-IGS reduces task workload for trainees performing ESS. Live navigation and alert zones may be a valuable intraoperative teaching aid. Copyright © 2012 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.

Basic research and 12 years of clinical experience in computer-assisted navigation technology: a review.

PubMed

Ewers, R; Schicho, K; Undt, G; Wanschitz, F; Truppe, M; Seemann, R; Wagner, A

2005-01-01

Computer-aided surgical navigation technology is commonly used in craniomaxillofacial surgery. It offers substantial improvement regarding esthetic and functional aspects in a range of surgical procedures. Based on augmented reality principles, where the real operative site is merged with computer generated graphic information, computer-aided navigation systems were employed, among other procedures, in dental implantology, arthroscopy of the temporomandibular joint, osteotomies, distraction osteogenesis, image guided biopsies and removals of foreign bodies. The decision to perform a procedure with or without computer-aided intraoperative navigation depends on the expected benefit to the procedure as well as on the technical expenditure necessary to achieve that goal. This paper comprises the experience gained in 12 years of research, development and routine clinical application. One hundred and fifty-eight operations with successful application of surgical navigation technology--divided into five groups--are evaluated regarding the criteria "medical benefit" and "technical expenditure" necessary to perform these procedures. Our results indicate that the medical benefit is likely to outweight the expenditure of technology with few exceptions (calvaria transplant, resection of the temporal bone, reconstruction of the orbital floor). Especially in dental implantology, specialized software reduces time and additional costs necessary to plan and perform procedures with computer-aided surgical navigation.

Radiation dose reduction in thoracic and lumbar spine instrumentation using navigation based on an intraoperative cone beam CT imaging system: a prospective randomized clinical trial.

PubMed

Pireau, Nathalie; Cordemans, Virginie; Banse, Xavier; Irda, Nadia; Lichtherte, Sébastien; Kaminski, Ludovic

2017-11-01

Spine surgery still remains a challenge for every spine surgeon, aware of the potential serious outcomes of misplaced instrumentation. Though many studies have highlighted that using intraoperative cone beam CT imaging and navigation systems provides higher accuracy than conventional freehand methods for placement of pedicle screws in spine surgery, few studies are concerned about how to reduce radiation exposure for patients with the use of such technology. One of the main focuses of this study is based on the ALARA principle (as low as reasonably achievable). A prospective randomized trial was conducted in the hybrid operating room between December 2015 and December 2016, including 50 patients operated on for posterior instrumented thoracic and/or lumbar spinal fusion. Patients were randomized to intraoperative 3D acquisition high-dose (standard dose) or low-dose protocol, and a total of 216 pedicle screws were analyzed in terms of screw position. Two different methods were used to measure ionizing radiation: the total skin dose (derived from the dose-area product) and the radiation dose evaluated by thermoluminescent dosimeters on the surgical field. According to Gertzbein and Heary classifications, low-dose protocol provided a significant higher accuracy of pedicle screw placement than the high-dose protocol (96.1 versus 92%, respectively). Seven screws (3.2%), all implanted with the high-dose protocol, needed to be revised intraoperatively. The use of low-dose acquisition protocols reduced patient exposure by a factor of five. This study emphasizes the paramount importance of using low-dose protocols for intraoperative cone beam CT imaging coupled with the navigation system, as it at least does not affect the accuracy of pedicle screw placement and irradiates drastically less.

Comparative Cohort Study of Percutaneous Pedicle Screw Implantation without Versus with Navigation in Patients Undergoing Surgery for Degenerative Lumbar Disc Disease.

PubMed

Fomekong, Edward; Pierrard, Julien; Raftopoulos, Christian

2018-03-01

The major limitation of computer-based three-dimensional fluoroscopy is increased radiation exposure of patients and operating room staff. Combining spine navigation with intraoperative three-dimensional fluoroscopy (io3DF) can likely overcome this shortcoming, while increasing pedicle screw accuracy rate. We compared data from a cohort of patients undergoing lumbar percutaneous pedicle screw placement using io3DF alone or in combination with spine navigation. This study consisted of 168 patients who underwent percutaneous pedicle screw implantation between 2009 and 2016. The primary endpoint was to compare pedicle screw accuracy between the 2 groups. Secondary endpoints were to compare radiation exposure of patients and operating room staff, duration of surgery, and postoperative complications. In group 1, 438 screws were placed without navigation guidance; in group 2, 276 screws were placed with spine navigation. Mean patient age in both groups was 58.6 ± 14.1 years. The final pedicle accuracy rate was 97.9% in group 1 and 99.6% in group 2. Average radiation dose per patient was significantly larger in group 1 (571.9 mGym 2 ) than in group 2 (365.6 mGym 2 ) (P = 0.000088). Surgery duration and complication rate were not significantly different between the 2 groups (P > 0.05). io3DF with spine navigation minimized radiation exposure of patients and operating room staff and provided an excellent percutaneous pedicle screw accuracy rate with no permanent complications compared with io3DF alone. This setup is recommended, especially for patients with a complex degenerative spine condition. Copyright © 2017 Elsevier Inc. All rights reserved.

Use of a gesture user interface as a touchless image navigation system in dental surgery: Case series report

PubMed Central

Elizondo, María L.

2014-01-01

Purpose The purposes of this study were to develop a workstation computer that allowed intraoperative touchless control of diagnostic and surgical images by a surgeon, and to report the preliminary experience with the use of the system in a series of cases in which dental surgery was performed. Materials and Methods A custom workstation with a new motion sensing input device (Leap Motion) was set up in order to use a natural user interface (NUI) to manipulate the imaging software by hand gestures. The system allowed intraoperative touchless control of the surgical images. Results For the first time in the literature, an NUI system was used for a pilot study during 11 dental surgery procedures including tooth extractions, dental implant placements, and guided bone regeneration. No complications were reported. The system performed very well and was very useful. Conclusion The proposed system fulfilled the objective of providing touchless access and control of the system of images and a three-dimensional surgical plan, thus allowing the maintenance of sterile conditions. The interaction between surgical staff, under sterile conditions, and computer equipment has been a key issue. The solution with an NUI with touchless control of the images seems to be closer to an ideal. The cost of the sensor system is quite low; this could facilitate its incorporation into the practice of routine dental surgery. This technology has enormous potential in dental surgery and other healthcare specialties. PMID:24944966

Electromagnetic Navigational Bronchoscopy Reduces the Time Required for Localization and Resection of Lung Nodules.

PubMed

Bolton, William David; Cochran, Thomas; Ben-Or, Sharon; Stephenson, James E; Ellis, William; Hale, Allyson L; Binks, Andrew P

The aims of the study were to evaluate electromagnetic navigational bronchoscopy (ENB) and computed tomography-guided placement as localization techniques for minimally invasive resection of small pulmonary nodules and determine whether electromagnetic navigational bronchoscopy is a safer and more effective method than computed tomography-guided localization. We performed a retrospective review of our thoracic surgery database to identify patients who underwent minimally invasive resection for a pulmonary mass and used either electromagnetic navigational bronchoscopy or computed tomography-guided localization techniques between July 2011 and May 2015. Three hundred eighty-three patients had a minimally invasive resection during our study period, 117 of whom underwent electromagnetic navigational bronchoscopy or computed tomography localization (electromagnetic navigational bronchoscopy = 81; computed tomography = 36). There was no significant difference between computed tomography and electromagnetic navigational bronchoscopy patient groups with regard to age, sex, race, pathology, nodule size, or location. Both computed tomography and electromagnetic navigational bronchoscopy were 100% successful at localizing the mass, and there was no difference in the type of definitive surgical resection (wedge, segmentectomy, or lobectomy) (P = 0.320). Postoperative complications occurred in 36% of all patients, but there were no complications related to the localization procedures. In terms of localization time and surgical time, there was no difference between groups. However, the down/wait time between localization and resection was significant (computed tomography = 189 minutes; electromagnetic navigational bronchoscopy = 27 minutes); this explains why the difference in total time (sum of localization, down, and surgery) was significant (P < 0.001). We found electromagnetic navigational bronchoscopy to be as safe and effective as computed tomography-guided wire placement and to provide a significantly decreased down time between localization and surgical resection.

Intra-operative fiducial-based CT/fluoroscope image registration framework for image-guided robot-assisted joint fracture surgery.

PubMed

Dagnino, Giulio; Georgilas, Ioannis; Morad, Samir; Gibbons, Peter; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja

2017-08-01

Joint fractures must be accurately reduced minimising soft tissue damages to avoid negative surgical outcomes. To this regard, we have developed the RAFS surgical system, which allows the percutaneous reduction of intra-articular fractures and provides intra-operative real-time 3D image guidance to the surgeon. Earlier experiments showed the effectiveness of the RAFS system on phantoms, but also key issues which precluded its use in a clinical application. This work proposes a redesign of the RAFS's navigation system overcoming the earlier version's issues, aiming to move the RAFS system into a surgical environment. The navigation system is improved through an image registration framework allowing the intra-operative registration between pre-operative CT images and intra-operative fluoroscopic images of a fractured bone using a custom-made fiducial marker. The objective of the registration is to estimate the relative pose between a bone fragment and an orthopaedic manipulation pin inserted into it intra-operatively. The actual pose of the bone fragment can be updated in real time using an optical tracker, enabling the image guidance. Experiments on phantom and cadavers demonstrated the accuracy and reliability of the registration framework, showing a reduction accuracy (sTRE) of about [Formula: see text] (phantom) and [Formula: see text] (cadavers). Four distal femur fractures were successfully reduced in cadaveric specimens using the improved navigation system and the RAFS system following the new clinical workflow (reduction error [Formula: see text], [Formula: see text]. Experiments showed the feasibility of the image registration framework. It was successfully integrated into the navigation system, allowing the use of the RAFS system in a realistic surgical application.

Flexible robotics: a new paradigm.

PubMed

Aron, Monish; Haber, Georges-Pascal; Desai, Mihir M; Gill, Inderbir S

2007-05-01

The use of robotics in urologic surgery has seen exponential growth over the last 5 years. Existing surgical robots operate rigid instruments on the master/slave principle and currently allow extraluminal manipulations and surgical procedures. Flexible robotics is an entirely novel paradigm. This article explores the potential of flexible robotic platforms that could permit endoluminal and transluminal surgery in the future. Computerized catheter-control systems are being developed primarily for cardiac applications. This development is driven by the need for precise positioning and manipulation of the catheter tip in the three-dimensional cardiovascular space. Such systems employ either remote navigation in a magnetic field or a computer-controlled electromechanical flexible robotic system. We have adapted this robotic system for flexible ureteropyeloscopy and have to date completed the initial porcine studies. Flexible robotics is on the horizon. It has potential for improved scope-tip precision, superior operative ergonomics, and reduced occupational radiation exposure. In the near future, in urology, we believe that it holds promise for endoluminal therapeutic ureterorenoscopy. Looking further ahead, within the next 3-5 years, it could enable transluminal surgery.

Time Demand and Radiation Dose in 3D-Fluoroscopy-based Navigation-assisted 3D-Fluoroscopy-controlled Pedicle Screw Instrumentations.

PubMed

Balling, Horst

2018-05-01

Prospective single-center cohort study to record additional time requirements and radiation dose in navigation-assisted O-arm-controlled pedicle screw (PS) instrumentations. The aim of this study was to evaluate amount of extra-time and radiation dose for navigation-assisted PS instrumentations of the thoracolumbosacral spine using O-arm 3D-real-time-navigation (O3DN) compared to non-navigated spinal procedures (NNSPs) with a single C-arm and postoperative computed tomography (CT) scan for controlling PS positions. 3D-navigation is reported to enhance PS insertion accuracy. But time-consuming navigational steps and considerable additional radiation doses seem to limit this modern technique's attraction. A detailed analysis of additional time demand and extra-radiation dose in 3D-navigated spine surgery is not provided in literature, yet. From February 2011 through July 2015, 306 consecutive posterior instrumentations were performed in vertebral levels T10-S1 using O3DN for PS insertion. The duration of procedure-specific navigational steps of the overall collective (I) and the last cohort of 50 consecutive O3DN-surgeries (II) was compared to the average duration of analogous surgical steps in 100 consecutive NNSP using a single C-arm. 3D-radiation dose (dose-length-product, DLP) of navigational and postinstrumentation O-arm scans in group I and II was compared to the average DLP of 100 diagnostic lumbar CT scans. The average presurgical time from patient positioning on the operating table to skin incision was 46.2 ± 10.1 minutes (O3DN, I) and 40.6 ± 9.8 minutes (O3DN, II) versus 30.6 ± 8.3 minutes (NNSP) (P < 0.001, each). Intraoperative interruptions for scanning and data processing took 3.0 ± 0.6 minutes. DLPs averaged 865.1 ± 360.8 mGycm (O3DN, I) and 562.1 ± 352.6 mGycm (O3DN, II) compared to 575.5 ± 316.5 mGycm in diagnostic lumbar CT scans (P < 0.001 (I), P ≈ 0.81 [II]). After procedural experience, navigated surgeries can be performed with an additional time demand of 13.0 minutes compared to NNSP, and with a total DLP below that of a diagnostic lumbar CT scan (P ≈ 0.81). 4.

[Application of diffusion tensor imaging fractography in minimally invasive surgery of brain tumors].

PubMed

Yang, Lei; Zhang, Mao-zhi; Zhang, Wei; Zhao, Yuan-li; Zhao, Ji-zong

2006-05-23

To investigate the effects and prospect of application of diffusion tensor imaging (DTI) fractography in minimally invasive surgery of brain tumors. DTI fractography was performed in 52 patients with malignant brain tumors. Based on the DTI fractography results, 34 of the 52 patients underwent operation under neuro-navigation, and 18 of the 52 patients underwent operation routine minimally invasive craniotomy and tumor resection without neuro-navigation. The rate of total tumor resection was 86.5% (45/52). The mortality was 1.9% (1/52). The disability rate was 11.5% (6/52). No case needed the second operation. DTI fractography has raised the minimally invasive neurosurgery to the level of protecting the nuclei and nerve tracts and guiding intra-operative management of infiltration of deep-seated tumors, especially when combined with neuro-navigation and interventional MRI.

Tracking multiple surgical instruments in a near-infrared optical system.

PubMed

Cai, Ken; Yang, Rongqian; Lin, Qinyong; Wang, Zhigang

2016-12-01

Surgical navigation systems can assist doctors in performing more precise and more efficient surgical procedures to avoid various accidents. The near-infrared optical system (NOS) is an important component of surgical navigation systems. However, several surgical instruments are used during surgery, and effectively tracking all of them is challenging. A stereo matching algorithm using two intersecting lines and surgical instrument codes is proposed in this paper. In our NOS, the markers on the surgical instruments can be captured by two near-infrared cameras. After automatically searching and extracting their subpixel coordinates in the left and right images, the coordinates of the real and pseudo markers are determined by the two intersecting lines. Finally, the pseudo markers are removed to achieve accurate stereo matching by summing the codes for the distances between a specific marker with the other two markers on the surgical instrument. Experimental results show that the markers on the different surgical instruments can be automatically and accurately recognized. The NOS can accurately track multiple surgical instruments.

Highly dexterous 2-module soft robot for intra-organ navigation in minimally invasive surgery.

PubMed

Abidi, Haider; Gerboni, Giada; Brancadoro, Margherita; Fras, Jan; Diodato, Alessandro; Cianchetti, Matteo; Wurdemann, Helge; Althoefer, Kaspar; Menciassi, Arianna

2018-02-01

For some surgical interventions, like the Total Mesorectal Excision (TME), traditional laparoscopes lack the flexibility to safely maneuver and reach difficult surgical targets. This paper answers this need through designing, fabricating and modelling a highly dexterous 2-module soft robot for minimally invasive surgery (MIS). A soft robotic approach is proposed that uses flexible fluidic actuators (FFAs) allowing highly dexterous and inherently safe navigation. Dexterity is provided by an optimized design of fluid chambers within the robot modules. Safe physical interaction is ensured by fabricating the entire structure by soft and compliant elastomers, resulting in a squeezable 2-module robot. An inner free lumen/chamber along the central axis serves as a guide of flexible endoscopic tools. A constant curvature based inverse kinematics model is also proposed, providing insight into the robot capabilities. Experimental tests in a surgical scenario using a cadaver model are reported, demonstrating the robot advantages over standard systems in a realistic MIS environment. Simulations and experiments show the efficacy of the proposed soft robot. Copyright © 2017 John Wiley & Sons, Ltd.

Navigation-based femorotibial rotation pattern correlated with flexion angle after total knee arthroplasty.

PubMed

Ishida, Kazunari; Shibanuma, Nao; Matsumoto, Tomoyuki; Sasaki, Hiroshi; Takayama, Koji; Matsuzaki, Tokio; Tei, Katsumasa; Kuroda, Ryosuke; Kurosaka, Masahiro

2016-01-01

To investigate whether intraoperative kinematics obtained by navigation systems can be divided into several kinematic patterns and to assess the correlation between the intraoperative kinematics with maximum flexion angles before and after total knee arthroplasty (TKA). Fifty-four posterior-stabilised (PS) TKA implanted using an image-free navigation system were evaluated. At registration and after implantation, tibial internal rotation angles at maximum extension, 30°, 45°, 60°, 90°, and maximum flexion were collected. The rotational patterns were divided into four groups and were examined the correlation with maximum flexion before and after operation. Tibial internal rotation from 90° of flexion to maximum flexion at registration was correlated with maximum flexion angles pre- and postoperatively. The four groups showed statistically different kinematic patterns. The group with tibial external rotation up to 90° of flexion, following tibial internal rotation at registration, achieved better flexion angles, compared to those of another groups (126.7° ± 12.0°, p < 0.05). The group with tibial external rotation showed the worst flexion angles (80.0° ± 40.4°, p < 0.05). Furthermore, the group with limited extension showed worse flexion angles (111.6° ± 8.9°, p < 0.05). Navigation-based kinematic patterns found at registration predict postoperative maximum flexion angle in PS TKA. Navigation-based kinematics can be useful information during TKA surgery. Diagnostic studies, development of diagnostic criteria in a consecutive series of patients and a universally applied "gold" standard, Level II.

Recent improvements in SPE3D: a VR-based surgery planning environment

NASA Astrophysics Data System (ADS)

Witkowski, Marcin; Sitnik, Robert; Verdonschot, Nico

2014-02-01

SPE3D is a surgery planning environment developed within TLEMsafe project [1] (funded by the European Commission FP7). It enables the operator to plan a surgical procedure on the customized musculoskeletal (MS) model of the patient's lower limbs, send the modified model to the biomechanical analysis module, and export the scenario's parameters to the surgical navigation system. The personalized patient-specific three-dimensional (3-D) MS model is registered with 3-D MRI dataset of lower limbs and the two modalities may be visualized simultaneously. Apart from main planes, any arbitrary MRI cross-section can be rendered on the 3-D MS model in real time. The interface provides tools for: bone cutting, manipulating and removal, repositioning muscle insertion points, modifying muscle force, removing muscles and placing implants stored in the implant library. SPE3D supports stereoscopic viewing as well as natural inspection/manipulation with use of haptic devices. Alternatively, it may be controlled with use of a standard computer keyboard, mouse and 2D display or a touch screen (e.g. in an operating room). The interface may be utilized in two main fields. Experienced surgeons may use it to simulate their operative plans and prepare input data for a surgical navigation system while student or novice surgeons can use it for training.

Availability of tissue rinse liquid-based cytology for the rapid diagnosis of sentinel lymph node metastasis and improved bilateral detection by photodynamic eye camera.

PubMed

Kato, Hidenori; Ohba, Yoko; Yamazaki, Hiroyuki; Minobe, Shin-Ichiro; Sudo, Satoko; Todo, Yukiharu; Okamoto, Kazuhira; Yamashiro, Katsushige

2015-08-01

On sentinel lymph node navigation surgery for early invasive cervical cancers, to gain high sensitivity and specificity, the sentinel nodes should be detected bilaterally and pathological diagnosis should be sensitive to detect micrometastasis. To improve these problems, we tried tissue rinse liquid-based cytology and the photodynamic eye. From 2005 to 2013, 102 patients with Stage Ib1 uterine cervical cancer were subjected to sentinel lymph node navigation surgery with Technetium-99 m colloid and blue dye. For the recent 11 patients with whom bilateral sentinel node detection was not available, the photodynamic eye was selectively examined. The detected sentinel node was cut along the minor axis into 2 mm slices, soaked in 10 ml CytoRich red and then subjected to tissue rinse liquid-based cytology at the time of surgery. With the accumulation of 102 Ib1 patients subjected to sentinel lymph node navigation surgery, the bilateral sentinel node detection rate was 67.7%. The photodynamic eye was examined for the recent 11 patients who did not have bilateral signals. Out of the 11, 10 patients obtained bilateral signals successfully. During the period of examining the photodynamic eye, a total of 34 patients were subjected to sentinel lymph node navigation surgery. Thus, the overall bilateral detection rate increased to 97% in this subset. Two hundred and five lymph nodes were available as sentinel nodes. The sensitivity of tissue rinse liquid-based cytology was 91.7%, and the specificity was 100%. False positivity was 0% and false negativity was 8.3%. Detection failure was observed only with one micrometastasis and one case of isolated tumor cells. Combination of photodynamic eye detection and tissue rinse liquid-based cytology pathology can be a promising method for more rewarding sentinel node detection. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A randomized clinical trial comparing guided implant surgery (bone- or mucosa-supported) with mental navigation or the use of a pilot-drill template.

PubMed

Vercruyssen, Marjolein; Cox, Catherine; Coucke, Wim; Naert, Ignace; Jacobs, Reinhilde; Quirynen, Marc

2014-07-01

To assess the accuracy of guided surgery (mucosa and bone-supported) compared to mental navigation or the use of a surgical template, in fully edentulous jaws, in a randomized controlled study. Fifty-nine patients (72 jaws), requiring four to six implants (maxilla or mandible), were consecutively recruited and randomly assigned to one of the following treatment groups; guidance via Materialise Universal(®)/mucosa, Materialise Universal(®)/bone, Facilitate™/mucosa, Facilitate™/bone, or mental navigation or a pilot-drill template. The precision was assessed by matching the planning computed tomography (CT) with a post-operative cone beam CT. A significant lower mean deviation at the entry point (1.4 mm, range: 0.3-3.7), at the apex (1.6 mm, range: 0.2-3.7) and angular deviation (3.0°, range: 0.2-16°) was observed for the guiding systems when compared to mental navigation (2.7 mm, range: 0.3-8.3; 2.9 mm, range: 0.5-7.4 and 9.9°, range: 1.5-27.8) and to the surgical template group (3.0 mm, range: 0.6-6.6; 3.4 mm, range: 0.3-7.5 and 8.4°, range: 0.6-21.3°). Differences between bone and mucosa support or type of guidance were negligible. Jaw and implant location (posterior-anterior, left-right), however, had a significant influence on the accuracy when guided. Based on these findings, guided implant placement appears to offer clear accuracy benefits. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Virtual modeling of robot-assisted manipulations in abdominal surgery.

PubMed

Berelavichus, Stanislav V; Karmazanovsky, Grigory G; Shirokov, Vadim S; Kubyshkin, Valeriy A; Kriger, Andrey G; Kondratyev, Evgeny V; Zakharova, Olga P

2012-06-27

To determine the effectiveness of using multidetector computed tomography (MDCT) data in preoperative planning of robot-assisted surgery. Fourteen patients indicated for surgery underwent MDCT using 64 and 256-slice MDCT. Before the examination, a specially constructed navigation net was placed on the patient's anterior abdominal wall. Processing of MDCT data was performed on a Brilliance Workspace 4 (Philips). Virtual vectors that imitate robotic and assistant ports were placed on the anterior abdominal wall of the 3D model of the patient, considering the individual anatomy of the patient and the technical capabilities of robotic arms. Sites for location of the ports were directed by projection on the roentgen-positive tags of the navigation net. There were no complications observed during surgery or in the post-operative period. We were able to reduce robotic arm interference during surgery. The surgical area was optimal for robotic and assistant manipulators without any need for reinstallation of the trocars. This method allows modeling of the main steps in robot-assisted intervention, optimizing operation of the manipulator and lowering the risk of injuries to internal organs.

Three-dimensional simulation, surgical navigation and thoracoscopic lung resection

PubMed Central

Kanzaki, Masato; Kikkawa, Takuma; Sakamoto, Kei; Maeda, Hideyuki; Wachi, Naoko; Komine, Hiroshi; Oyama, Kunihiro; Murasugi, Masahide; Onuki, Takamasa

2013-01-01

This report describes a 3-dimensional (3-D) video-assisted thoracoscopic lung resection guided by a 3-D video navigation system having a patient-specific 3-D reconstructed pulmonary model obtained by preoperative simulation. A 78-year-old man was found to have a small solitary pulmonary nodule in the left upper lobe in chest computed tomography. By a virtual 3-D pulmonary model the tumor was found to be involved in two subsegments (S1 + 2c and S3a). Complete video-assisted thoracoscopic surgery bi-subsegmentectomy was selected in simulation and was performed with lymph node dissection. A 3-D digital vision system was used for 3-D thoracoscopic performance. Wearing 3-D glasses, the patient's actual reconstructed 3-D model on 3-D liquid-crystal displays was observed, and the 3-D intraoperative field and the picture of 3-D reconstructed pulmonary model were compared. PMID:24964426

Sentinel lymph node detection in breast cancer patients using surgical navigation system based on fluorescence molecular imaging technology

NASA Astrophysics Data System (ADS)

Chi, Chongwei; Kou, Deqiang; Ye, Jinzuo; Mao, Yamin; Qiu, Jingdan; Wang, Jiandong; Yang, Xin; Tian, Jie

2015-03-01

Introduction: Precision and personalization treatments are expected to be effective methods for early stage cancer studies. Breast cancer is a major threat to women's health and sentinel lymph node biopsy (SLNB) is an effective method to realize precision and personalized treatment for axillary lymph node (ALN) negative patients. In this study, we developed a surgical navigation system (SNS) based on optical molecular imaging technology for the precise detection of the sentinel lymph node (SLN) in breast cancer patients. This approach helps surgeons in precise positioning during surgery. Methods: The SNS was mainly based on the technology of optical molecular imaging. A novel optical path has been designed in our hardware system and a feature-matching algorithm has been devised to achieve rapid fluorescence and color image registration fusion. Ten in vivo studies of SLN detection in rabbits using indocyanine green (ICG) and blue dye were executed for system evaluation and 8 breast cancer patients accepted the combination method for therapy. Results: The detection rate of the combination method was 100% and an average of 2.6 SLNs was found in all patients. Our results showed that the method of using SNS to detect SLN has the potential to promote its application. Conclusion: The advantage of this system is the real-time tracing of lymph flow in a one-step procedure. The results demonstrated the feasibility of the system for providing accurate location and reliable treatment for surgeons. Our approach delivers valuable information and facilitates more detailed exploration for image-guided surgery research.

Augmented reality and image overlay navigation with OsiriX in laparoscopic and robotic surgery: not only a matter of fashion.

PubMed

Volonté, Francesco; Pugin, François; Bucher, Pascal; Sugimoto, Maki; Ratib, Osman; Morel, Philippe

2011-07-01

New technologies can considerably improve preoperative planning, enhance the surgeon's skill and simplify the approach to complex procedures. Augmented reality techniques, robot assisted operations and computer assisted navigation tools will become increasingly important in surgery and in residents' education. We obtained 3D reconstructions from simple spiral computed tomography (CT) slides using OsiriX, an open source processing software package dedicated to DICOM images. These images were then projected on the patient's body with a beamer fixed to the operating table to enhance spatial perception during surgical intervention (augmented reality). Changing a window's deepness level allowed the surgeon to navigate through the patient's anatomy, highlighting regions of interest and marked pathologies. We used image overlay navigation for laparoscopic operations such cholecystectomy, abdominal exploration, distal pancreas resection and robotic liver resection. Augmented reality techniques will transform the behaviour of surgeons, making surgical interventions easier, faster and probably safer. These new techniques will also renew methods of surgical teaching, facilitating transmission of knowledge and skill to young surgeons.

A Novel Augmented Reality-Based Navigation System in Perforator Flap Transplantation - A Feasibility Study.

PubMed

Jiang, Taoran; Zhu, Ming; Zan, Tao; Gu, Bin; Li, Qingfeng

2017-08-01

In perforator flap transplantation, dissection of the perforator is an important but difficult procedure because of the high variability in vascular anatomy. Preoperative imaging techniques could provide substantial information about vascular anatomy; however, it cannot provide direct guidance for surgeons during the operation. In this study, a navigation system (NS) was established to overlie a vascular map on surgical sites to further provide a direct guide for perforator flap transplantation. The NS was established based on computed tomographic angiography and augmented reality techniques. A virtual vascular map was reconstructed according to computed tomographic angiography data and projected onto real patient images using ARToolKit software. Additionally, a screw-fixation marker holder was created to facilitate registration. With the use of a tracking and display system, we conducted the NS on an animal model and measured the system error on a rapid prototyping model. The NS assistance allowed for correct identification, as well as a safe and precise dissection of the perforator. The mean value of the system error was determined to be 3.474 ± 1.546 mm. Augmented reality-based NS can provide precise navigation information by directly displaying a 3-dimensional individual anatomical virtual model onto the operative field in real time. It will allow rapid identification and safe dissection of a perforator in free flap transplantation surgery.

[Navigated drilling for femoral head necrosis. Experimental and clinical results].

PubMed

Beckmann, J; Tingart, M; Perlick, L; Lüring, C; Grifka, J; Anders, S

2007-05-01

In the early stages of osteonecrosis of the femoral head, core decompression by exact drilling into the ischemic areas can reduce pain and achieve reperfusion. Using computer aided surgery, the precision of the drilling can be improved while simultaneously lowering radiation exposure time for both staff and patients. We describe the experimental and clinical results of drilling under the guidance of the fluoroscopically-based VectorVision navigation system (BrainLAB, Munich, Germany). A total of 70 sawbones were prepared mimicking an osteonecrosis of the femoral head. In two experimental models, bone only and obesity, as well as in a clinical setting involving ten patients with osteonecrosis of the femoral head, the precision and the duration of radiation exposure were compared between the VectorVision system and conventional drilling. No target was missed. For both models, there was a statistically significant difference in terms of the precision, the number of drilling corrections as well as the radiation exposure time. The average distance to the desired midpoint of the lesion of both models was 0.48 mm for navigated drilling and 1.06 mm for conventional drilling, the average drilling corrections were 0.175 and 2.1, and the radiation exposure time less than 1 s and 3.6 s, respectively. In the clinical setting, the reduction of radiation exposure (below 1 s for navigation compared to 56 s for the conventional technique) as well as of drilling corrections (0.2 compared to 3.4) was also significant. Computer guided drilling using the fluoroscopically based VectorVision navigation system shows a clearly improved precision with a enormous simultaneous reduction in radiation exposure. It is therefore recommended for clinical routine.

Precision of computer-assisted core decompression drilling of the femoral head.

PubMed

Beckmann, J; Goetz, J; Baethis, H; Kalteis, T; Grifka, J; Perlick, L

2006-08-01

Osteonecrosis of the femoral head is a local destructive disease with progression into devastating stages. Left untreated it mostly leads to severe secondary osteoarthrosis and early endoprosthetic joint replacement. Core decompression by exact drilling into the ischemic areas can be performed in early stages according to Ficat or ARCO. Computer-aided surgery might enhance the precision of the drilling and lower the radiation exposure time of both staff and patients. The aim of this study was to evaluate the precision of the fluoroscopically based VectorVision navigation system in an in vitro model. Thirty sawbones were prepared with a defect filled up with a radiopaque gypsum sphere mimicking the osteonecrosis. Twenty sawbones were drilled by guidance of an intraoperative navigation system VectorVision (BrainLAB, Munich, Germany) and 10 sawbones by fluoroscopic control only. No gypsum sphere was missed. There was a statistically significant difference regarding the three-dimensional deviation (Euclidian norm) as well as maximum deviation in x-, y- or z-direction (maximum norm) to the desired mid-point of the lesion, with a mean of 0.51 and 0.4 mm in the navigated group and 1.1 and 0.88 mm in the control group, respectively. Furthermore, significant difference was found in the number of drilling corrections as well as the radiation time needed: no second drilling or correction of drilling direction was necessary in the navigated group compared to 1.4 in the control group. The radiation time needed was less than 1 s compared to 3.1 s, respectively. The fluoroscopy-based VectorVision navigation system shows a high feasibility of computer-guided drilling with a clear reduction of radiation exposure time and can therefore be integrated into clinical routine. The additional time needed is acceptable regarding the simultaneous reduction of radiation time.

Successful Translation of Fluorescence Navigation During Oncologic Surgery: A Consensus Report.

PubMed

Rosenthal, Eben L; Warram, Jason M; de Boer, Esther; Basilion, James P; Biel, Merrill A; Bogyo, Matthew; Bouvet, Michael; Brigman, Brian E; Colson, Yolonda L; DeMeester, Steven R; Gurtner, Geoffrey C; Ishizawa, Takeaki; Jacobs, Paula M; Keereweer, Stijn; Liao, Joseph C; Nguyen, Quyen T; Olson, James M; Paulsen, Keith D; Rieves, Dwaine; Sumer, Baran D; Tweedle, Michael F; Vahrmeijer, Alexander L; Weichert, Jamey P; Wilson, Brian C; Zenn, Michael R; Zinn, Kurt R; van Dam, Gooitzen M

2016-01-01

Navigation with fluorescence guidance has emerged in the last decade as a promising strategy to improve the efficacy of oncologic surgery. To achieve routine clinical use, the onus is on the surgical community to objectively assess the value of this technique. This assessment may facilitate both Food and Drug Administration approval of new optical imaging agents and reimbursement for the imaging procedures. It is critical to characterize fluorescence-guided procedural benefits over existing practices and to elucidate both the costs and the safety risks. This report is the result of a meeting of the International Society of Image Guided Surgery (www.isigs.org) on February 6, 2015, in Miami, Florida, and reflects a consensus of the participants' opinions. Our objective was to critically evaluate the imaging platform technology and optical imaging agents and to make recommendations for successful clinical trial development of this highly promising approach in oncologic surgery. © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Total knee arthroplasty with a computer-navigated saw: a pilot study.

PubMed

Garvin, Kevin L; Barrera, Andres; Mahoney, Craig R; Hartman, Curtis W; Haider, Hani

2013-01-01

Computer-aided surgery aims to improve implant alignment in TKA but has only been adopted by a minority for routine use. A novel approach, navigated freehand bone cutting (NFC), is intended to achieve wider acceptance by eliminating the need for cumbersome, implant-specific mechanical jigs and avoiding the expense of navigation. We determined cutting time, surface quality, implant fit, and implant alignment after NFC of synthetic femoral specimens and the feasibility and alignment of a complete TKA performed with NFC technology in cadaveric specimens. Seven surgeons prepared six synthetic femoral specimens each, using our custom NFC system. Cutting times, quality of bone cuts, and implant fit and alignment were assessed quantitatively by CT surface scanning and computational measurements. Additionally, a single surgeon performed a complete TKA on two cadaveric specimens using the NFC system, with cutting time and implant alignment analyzed through plain radiographs and CT. For the synthetic specimens, femoral coronal alignment was within ± 2° of neutral in 94% of the specimens. Sagittal alignment was within 0° to 5° of flexion in all specimens. Rotation was within ± 1° of the epicondylar axis in 97% of the specimens. The mean time to make cuts improved from 13 minutes for the first specimen to 9 minutes for the fourth specimen. TKA was performed in two cadaveric specimens without complications and implants were well aligned. TKA is feasible with NFC, which eliminates the need for implant-specific instruments. We observed a fast learning curve. NFC has the potential to improve TKA alignment, reduce operative time, and reduce the number of instruments in surgery. Fewer instruments and less sterilization could reduce costs associated with TKA.

Image-guided removal of supratentorial cavernomas in critical brain areas: application of neuronavigation and intraoperative magnetic resonance imaging.

PubMed

Gralla, J; Ganslandt, O; Kober, H; Buchfelder, M; Fahlbusch, R; Nimsky, C

2003-04-01

In a retrospective study the postoperative results of 26 patients operated on for supratentorial cavernous hemangiomas either deep-seated or near eloquent brain areas are summarized. An exact surgical approach to these lesions is essential to prevent neurological deterioration. Three different navigation systems were used and compared according to their clinical applicability. Complete removal of the lesion was obtained in all patients of this series. In six cases (23 %) functional data from magnetoencephalography or functional magnetic resonance imaging were integrated into the navigational setup. In 14 cases (54 %) intraoperative magnetic resonance imaging was performed. The follow-up time was 3 - 26 months (mean: 10 months). In the postoperative course one patient (3.8 %) developed a hemiparesis, another one developed quadrantopia. Nineteen patients presented with preoperative seizure history, 16 of these (84 %) had no further or rare seizures after surgery. The better results in seizure control were achieved in those patients with shorter duration of seizure history before surgery. The study indicates that the application of neuronavigation allows surgery on supratentorial cavernous hemangiomas in critical brain areas with low morbidity. The intraoperative visualization of eloquent cortex areas by integration of functional data allows a fast identification and exemption of eloquent brain areas, preventing neurological deterioration. Furthermore, the intraoperative MR resection control ensures a complete resection and illustrates the minimal invasive approach.

A novel graphical user interface for ultrasound-guided shoulder arthroscopic surgery

NASA Astrophysics Data System (ADS)

Tyryshkin, K.; Mousavi, P.; Beek, M.; Pichora, D.; Abolmaesumi, P.

2007-03-01

This paper presents a novel graphical user interface developed for a navigation system for ultrasound-guided computer-assisted shoulder arthroscopic surgery. The envisioned purpose of the interface is to assist the surgeon in determining the position and orientation of the arthroscopic camera and other surgical tools within the anatomy of the patient. The user interface features real time position tracking of the arthroscopic instruments with an optical tracking system, and visualization of their graphical representations relative to a three-dimensional shoulder surface model of the patient, created from computed tomography images. In addition, the developed graphical interface facilitates fast and user-friendly intra-operative calibration of the arthroscope and the arthroscopic burr, capture and segmentation of ultrasound images, and intra-operative registration. A pilot study simulating the computer-aided shoulder arthroscopic procedure on a shoulder phantom demonstrated the speed, efficiency and ease-of-use of the system.

A patient-mount navigated intervention system for spinal diseases and its clinical trial on percutaneous pulsed radiofrequency stimulation of dorsal root ganglion.

PubMed

Yang, Chi-Lin; Yang, Been-Der; Lin, Mu-Lien; Wang, Yao-Hung; Wang, Jaw-Lin

2010-10-01

Development of a patient-mount navigated intervention (PaMNI) system for spinal diseases. An in vivo clinical human trial was conducted to validate this system. To verify the feasibility of the PaMNI system with the clinical trial on percutaneous pulsed radiofrequency stimulation of dorsal root ganglion (PRF-DRG). Two major image guiding techniques, i.e., computed tomography (CT)-guided and fluoro-guided, were used for spinal intervention. The CT-guided technique provides high spatial resolution, and is claimed to be more accurate than the fluoro-guided technique. Nevertheless, the CT-guided intervention usually reaches higher radiograph exposure than the fluoro-guided counterpart. Some navigated intervention systems were developed to reduce the radiation of CT-guided intervention. Nevertheless, these systems were not popularly used due to the longer operation time, a new protocol for surgeons, and the availability of such a system. The PaMNI system includes 3 components, i.e., a patient-mount miniature tracking unit, an auto-registered reference frame unit, and a user-friendly image processing unit. The PRF-DRG treatment was conducted to find the clinical feasibility of this system. The in vivo clinical trial showed that the accuracy, visual analog scale evaluation after surgery, and radiograph exposure of the PaMNI-guided technique are comparable to the one of conventional fluoro-guided technique, while the operation time is increased by 5 minutes. Combining the virtues of fluoroscopy and CT-guided techniques, our navigation system is operated like a virtual fluoroscopy with augmented CT images. This system elevates the performance of CT-guided intervention and reduces surgeons' radiation exposure risk to a minimum, while keeping low radiation dose to patients like its fluoro-guided counterpart. The clinical trial of PRF-DRG treatment showed the clinical feasibility and efficacy of this system.

Augmented Reality Based Navigation for Computer Assisted Hip Resurfacing: A Proof of Concept Study.

PubMed

Liu, He; Auvinet, Edouard; Giles, Joshua; Rodriguez Y Baena, Ferdinando

2018-05-23

Implantation accuracy has a great impact on the outcomes of hip resurfacing such as recovery of hip function. Computer assisted orthopedic surgery has demonstrated clear advantages for the patients, with improved placement accuracy and fewer outliers, but the intrusiveness, cost, and added complexity have limited its widespread adoption. To provide seamless computer assistance with improved immersion and a more natural surgical workflow, we propose an augmented-reality (AR) based navigation system for hip resurfacing. The operative femur is registered by processing depth information from the surgical site with a commercial depth camera. By coupling depth data with robotic assistance, obstacles that may obstruct the femur can be tracked and avoided automatically to reduce the chance of disruption to the surgical workflow. Using the registration result and the pre-operative plan, intra-operative surgical guidance is provided through a commercial AR headset so that the user can perform the operation without additional physical guides. To assess the accuracy of the navigation system, experiments of guide hole drilling were performed on femur phantoms. The position and orientation of the drilled holes were compared with the pre-operative plan, and the mean errors were found to be approximately 2 mm and 2°, results which are in line with commercial computer assisted orthopedic systems today.

Real-time continuous image-guided surgery: Preclinical investigation in glossectomy.

PubMed

Tabanfar, Reza; Qiu, Jimmy; Chan, Harley; Aflatouni, Niousha; Weersink, Robert; Hasan, Wael; Irish, Jonathan C

2017-10-01

To develop, validate, and study the efficacy of an intraoperative real-time continuous image-guided surgery (RTC-IGS) system for glossectomy. Prospective study. We created a RTC-IGS system and surgical simulator for glossectomy, enabling definition of a surgical target preoperatively, real-time cautery tracking, and display of a surgical plan intraoperatively. System performance was evaluated by a group of otolaryngology residents, fellows, medical students, and staff under a reproducible setting by using realistic tongue phantoms. Evaluators were grouped into a senior and a junior group based on surgical experience, and guided and unguided tumor resections were performed. National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores and a Likert scale were used to measure workloads and impressions of the system, respectively. Efficacy was studied by comparing surgical accuracy, time, collateral damage, and workload between RTC-IGS and non-navigated resections. The senior group performed more accurately (80.9% ± 3.7% vs. 75.2% ± 5.5%, P = .28), required less time (5.0 ± 1.3 minutes vs. 7.3 ± 1.2 minutes, P = .17), and experienced lower workload (43 ± 2.0 vs. 64.4 ± 1.3 NASA-TLX score, P = .08), suggesting a trend of construct validity. Impressions were favorable, with participants reporting the system is a valuable practice tool (4.0/5 ± 0.3) and increases confidence (3.9/5 ± 0.4). Use of RTC-IGS improved both groups' accuracy, with the junior group improving from 64.4% ± 5.4% to 75.2% ± 5.5% (P = .01) and the senior group improving from 76.1% ± 4.5% to 80.9% ± 3.7% (P = .16). We created an RTC-IGS system and surgical simulator and demonstrated a trend of construct validity. Our navigated simulator allows junior trainees to practice glossectomies outside the operating room. In all evaluators, navigation assistance resulted in increased surgical accuracy. NA Laryngoscope, 127:E347-E353, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

A clinical pilot study of a modular video-CT augmentation system for image-guided skull base surgery

NASA Astrophysics Data System (ADS)

Liu, Wen P.; Mirota, Daniel J.; Uneri, Ali; Otake, Yoshito; Hager, Gregory; Reh, Douglas D.; Ishii, Masaru; Gallia, Gary L.; Siewerdsen, Jeffrey H.

2012-02-01

Augmentation of endoscopic video with preoperative or intraoperative image data [e.g., planning data and/or anatomical segmentations defined in computed tomography (CT) and magnetic resonance (MR)], can improve navigation, spatial orientation, confidence, and tissue resection in skull base surgery, especially with respect to critical neurovascular structures that may be difficult to visualize in the video scene. This paper presents the engineering and evaluation of a video augmentation system for endoscopic skull base surgery translated to use in a clinical study. Extension of previous research yielded a practical system with a modular design that can be applied to other endoscopic surgeries, including orthopedic, abdominal, and thoracic procedures. A clinical pilot study is underway to assess feasibility and benefit to surgical performance by overlaying CT or MR planning data in realtime, high-definition endoscopic video. Preoperative planning included segmentation of the carotid arteries, optic nerves, and surgical target volume (e.g., tumor). An automated camera calibration process was developed that demonstrates mean re-projection accuracy (0.7+/-0.3) pixels and mean target registration error of (2.3+/-1.5) mm. An IRB-approved clinical study involving fifteen patients undergoing skull base tumor surgery is underway in which each surgery includes the experimental video-CT system deployed in parallel to the standard-of-care (unaugmented) video display. Questionnaires distributed to one neurosurgeon and two otolaryngologists are used to assess primary outcome measures regarding the benefit to surgical confidence in localizing critical structures and targets by means of video overlay during surgical approach, resection, and reconstruction.

Depth and lateral deviations in guided implant surgery: an RCT comparing guided surgery with mental navigation or the use of a pilot-drill template.

PubMed

Vercruyssen, M; Coucke, W; Naert, I; Jacobs, R; Teughels, W; Quirynen, M

2015-11-01

To assess the accuracy of guided surgery compared with mental navigation or the use of a pilot-drill template in fully edentulous patients. Sixty consecutive patients (72 jaws), requiring four to six implants (maxilla or mandible), were randomly assigned to one of the following treatment modalities: Materialise Universal(®) mucosa, Materialise Universal(®) bone, Facilitate(™) mucosa, Facilitate(™) bone, mental navigation, or a pilot-drill template. Accuracy was assessed by matching the planning CT with a postoperative CBCT. Deviations were registered in a vertical (depth) and horizontal (lateral) plane. The latter further subdivided into BL (bucco-lingual) and MD (mesio-distal) deviations. The overall mean vertical deviation for the guided surgery groups was 0.9 mm ± 0.8 (range: 0.0-3.7) and 0.9 mm ± 0.6 (range: 0.0-2.9) in a horizontal direction. For the non-guided groups, this was 1.7 mm ± 1.3 (range: 0.0-6.4) and 2.1 mm ± 1.4 (range 0.0-8.5), respectively (P < 0.05). The overall mean deviation for the guided surgery groups in MD direction was 0.6 mm ± 0.5 (range: 0.0-2.5) and 0.5 mm ± 0.5 (range: 0.0-2.9) in BL direction. For the non-guided groups, this was 1.8 mm ± 1.4 (range: 0.0-8.3) and 0.7 mm ± 0.6 (range 0.0-2.9), respectively. The deviation in MD direction was significantly higher in the non-guided groups (P = 0.0002). The most important inaccuracy with guided surgery is in vertical direction (depth). The inaccuracy in MD or BL direction is clearly less. For non-guided surgery, the inaccuracy is significantly higher. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Synframe: a preliminary report.

PubMed

Aebi, M; Steffen, T

2000-02-01

Both endoscopic lumbar spinal surgery and the non-standardized and unstable retractor systems for the lumbar spine presently on the market have disadvantages and limitations in relation to the minimally invasive surgical concept, which have been gradually recognized in the last few years. In an attempt to resolve some of these issues, we have developed a highly versatile retractor system, which allows access to and surgery at the lumbar, thoracic and even cervical spine. This retractor system - Synframe - is based on a ring concept allowing 360 degrees access to a surgical opening in anterior as well as posterior surgery. The ring is concentrically laid over the surgical opening for the approach and is used as a carrier for retractor arms, which are instrumented with either different sizes or types of blades and/or different sizes of Hohmann hooks. In posterior surgery, nerve root retractors can also be installed. This ring also functions as a carrier for fiberoptic illumination devices and different sizes of endoscopes, used to transmit the surgical procedure out of the depth of the surgical exposure for both teaching purposes and for the surgical team when it has no longer direct visual access to the procedure. The ring is stable, being fixed onto the operating table, allowing precise minimally open approaches and surgical procedures under direct vision with optimal illumination. This ring system also opens perspectives for an integrated minimally open surgical concept, where the ring may be used as a reference platform in computer-navigated surgery.

Toward Intraoperative Image-Guided Transoral Robotic Surgery

PubMed Central

Liu, Wen P.; Reaugamornrat, Sureerat; Deguet, Anton; Sorger, Jonathan M.; Siewerdsen, Jeffrey H.; Richmon, Jeremy; Taylor, Russell H.

2014-01-01

This paper presents the development and evaluation of video augmentation on the stereoscopic da Vinci S system with intraoperative image guidance for base of tongue tumor resection in transoral robotic surgery (TORS). Proposed workflow for image-guided TORS begins by identifying and segmenting critical oropharyngeal structures (e.g., the tumor and adjacent arteries and nerves) from preoperative computed tomography (CT) and/or magnetic resonance (MR) imaging. These preoperative planned data can be deformably registered to the intraoperative endoscopic view using mobile C-arm cone-beam computed tomography (CBCT) [1, 2]. Augmentation of TORS endoscopic video defining surgical targets and critical structures has the potential to improve navigation, spatial orientation, and confidence in tumor resection. Experiments in animal specimens achieved statistically significant improvement in target localization error when comparing the proposed image guidance system to simulated current practice. PMID:25525474

Navigated versus conventional total knee arthroplasty: A prospective study at three years follow-up.

PubMed

Martín-Hernández, C; Sanz-Sainz, M; Revenga-Giertych, C; Hernández-Vaquero, D; Fernández-Carreira, J M; Albareda-Albareda, J; Castillo-Palacios, A; Ranera-Garcia, M

2018-03-28

Computer-assisted surgery application in total knee arthroplasty (TKA) has shown more accurate implant alignment compared with conventional instrumentation and is associated with more homogeneous alignment results. Although longer implant survival and superior clinical outcomes should be expected from navigated TKA, currently available evidence does not support this hypothesis. The aim of this study was to compare navigated TKA with conventional TKA regarding clinical and radiological outcomes after a 3-year follow-up under the hypothesis that navigated TKA would provide better outcomes than conventional TKA. In a prospective multicentre study, 119 patients underwent navigated TKA and 80 patients received conventional instrumentation. Patients were evaluated at the baseline and at postoperative months 3, 12, 24, and 36. Analysis included the American Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-12 (SF12) Health Survey, and radiographic assessment. All clinical scores improved significantly for all patients during the follow-up but were significantly better in the navigation group. The percentage of patients showing a mechanical axis between 3° of varus and 3° of valgus was significantly higher in the ATR group (93%) than in the conventional TKA group (71%) (P<.01). The use of computer-assisted surgery in TKA provides more accurate mechanical alignment and superior short-term functional outcomes compared to conventional TKA. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Navigation programs, are they helpful for perioperative care with thyroid cancer patients?

PubMed

Park, K A; Oh, Y J; Kim, K M; Eum, S Y; Cho, M H; Son, Y H; Park, S H; Woo, K M; Lee, Y S; Kim, S; Chang, H-S; Park, C S

2017-07-01

The purpose of this study was to develop and evaluate a navigation program for patients with thyroid cancer. The navigation program was developed following an analysis of the unmet needs of patients who underwent surgery for thyroid cancer. Ninety-nine patients in the control group received usual care, and 95 in the navigation group were managed with a navigation program during the perioperative period. The effectiveness of the navigation program was assessed by administering a questionnaire to both groups. Overall satisfaction scores were significantly higher in the navigation than in the control group (p = .025), as were satisfaction scores on the continuity of information (p < .001), the continuity of management (p = .002), the continuity of relationships with healthcare providers (p<.001), and patient empowerment (p < .001). The newly developed navigation program for patients with thyroid cancer was effective in raising satisfaction levels and in actively managing the disease during the perioperative period. © 2016 John Wiley & Sons Ltd.

Associations between clinical outcome and navigated transcranial magnetic stimulation characteristics in patients with motor-eloquent brain lesions: a combined navigated transcranial magnetic stimulation-diffusion tensor imaging fiber tracking approach.

PubMed

Sollmann, Nico; Wildschuetz, Noémie; Kelm, Anna; Conway, Neal; Moser, Tobias; Bulubas, Lucia; Kirschke, Jan S; Meyer, Bernhard; Krieg, Sandro M

2018-03-01

OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging fiber tracking (DTI FT) based on nTMS data are increasingly used for preoperative planning and resection guidance in patients suffering from motor-eloquent brain tumors. The present study explores whether nTMS-based DTI FT can also be used for individual preoperative risk assessment regarding surgery-related motor impairment. METHODS Data derived from preoperative nTMS motor mapping and subsequent nTMS-based tractography in 86 patients were analyzed. All patients suffered from high-grade glioma (HGG), low-grade glioma (LGG), or intracranial metastasis (MET). In this context, nTMS-based DTI FT of the corticospinal tract (CST) was performed at a range of fractional anisotropy (FA) levels based on an individualized FA threshold ([FAT]; tracking with 50%, 75%, and 100% FAT), which was defined as the highest FA value allowing for visualization of fibers (100% FAT). Minimum lesion-to-CST distances were measured, and fiber numbers of the reconstructed CST were assessed. These data were then correlated with the preoperative, postoperative, and follow-up status of motor function and the resting motor threshold (rMT). RESULTS At certain FA levels, a statistically significant difference in lesion-to-CST distances was observed between patients with HGG who had no impairment and those who developed surgery-related transient or permanent motor deficits (75% FAT: p = 0.0149; 100% FAT: p = 0.0233). In this context, no patient with a lesion-to-CST distance ≥ 12 mm suffered from any new surgery-related permanent paresis (50% FAT and 75% FAT). Furthermore, comparatively strong negative correlations were observed between the rMT and lesion-to-CST distances of patients with surgery-related transient paresis (Spearman correlation coefficient [r s ]; 50% FAT: r s = -0.8660; 75% FAT: r s = -0.8660) or surgery-related permanent paresis (50% FAT: r s = -0.7656; 75% FAT: r s = -0.6763). CONCLUSIONS This is one of the first studies to show a direct correlation between imaging, clinical status, and neurophysiological markers for the integrity of the motor system in patients with brain tumors. The findings suggest that nTMS-based DTI FT might be suitable for individual risk assessment in patients with HGG, in addition to being a surgery-planning tool. Importantly, necessary data for risk assessment were obtained without significant additional efforts, making this approach potentially valuable for direct clinical use.

PC-based control unit for a head-mounted operating microscope for augmented-reality visualization in surgical navigation

NASA Astrophysics Data System (ADS)

Figl, Michael; Birkfellner, Wolfgang; Watzinger, Franz; Wanschitz, Felix; Hummel, Johann; Hanel, Rudolf A.; Ewers, Rolf; Bergmann, Helmar

2002-05-01

Two main concepts of Head Mounted Displays (HMD) for augmented reality (AR) visualization exist, the optical and video-see through type. Several research groups have pursued both approaches for utilizing HMDs for computer aided surgery. While the hardware requirements for a video see through HMD to achieve acceptable time delay and frame rate seem to be enormous the clinical acceptance of such a device is doubtful from a practical point of view. Starting from previous work in displaying additional computer-generated graphics in operating microscopes, we have adapted a miniature head mounted operating microscope for AR by integrating two very small computer displays. To calibrate the projection parameters of this so called Varioscope AR we have used Tsai's Algorithm for camera calibration. Connection to a surgical navigation system was performed by defining an open interface to the control unit of the Varioscope AR. The control unit consists of a standard PC with a dual head graphics adapter to render and display the desired augmentation of the scene. We connected this control unit to a computer aided surgery (CAS) system by the TCP/IP interface. In this paper we present the control unit for the HMD and its software design. We tested two different optical tracking systems, the Flashpoint (Image Guided Technologies, Boulder, CO), which provided about 10 frames per second, and the Polaris (Northern Digital, Ontario, Canada) which provided at least 30 frames per second, both with a time delay of one frame.

New orthopaedic implant management tool for computer-assisted planning, navigation, and simulation: from implant CAD files to a standardized XML-based implant database.

PubMed

Sagbo, S; Blochaou, F; Langlotz, F; Vangenot, C; Nolte, L-P; Zheng, G

2005-01-01

Computer-Assisted Orthopaedic Surgery (CAOS) has made much progress over the last 10 years. Navigation systems have been recognized as important tools that help surgeons, and various such systems have been developed. A disadvantage of these systems is that they use non-standard formalisms and techniques. As a result, there are no standard concepts for implant and tool management or data formats to store information for use in 3D planning and navigation. We addressed these limitations and developed a practical and generic solution that offers benefits for surgeons, implant manufacturers, and CAS application developers. We developed a virtual implant database containing geometrical as well as calibration information for orthopedic implants and instruments, with a focus on trauma. This database has been successfully tested for various applications in the client/server mode. The implant information is not static, however, because manufacturers periodically revise their implants, resulting in the deletion of some implants and the introduction of new ones. Tracking these continuous changes and keeping CAS systems up to date is a tedious task if done manually. This leads to additional costs for system development, and some errors are inevitably generated due to the huge amount of information that has to be processed. To ease management with respect to implant life cycle, we developed a tool to assist end-users (surgeons, hospitals, CAS system providers, and implant manufacturers) in managing their implants. Our system can be used for pre-operative planning and intra-operative navigation, and also for any surgical simulation involving orthopedic implants. Currently, this tool allows addition of new implants, modification of existing ones, deletion of obsolete implants, export of a given implant, and also creation of backups. Our implant management system has been successfully tested in the laboratory with very promising results. It makes it possible to fill the current gap that exists between the CAS system and implant manufacturers, hospitals, and surgeons.

History of computer-assisted orthopedic surgery (CAOS) in sports medicine.

PubMed

Jackson, Douglas W; Simon, Timothy M

2008-06-01

Computer-assisted orthopedic surgery and navigation applications have a history rooted in the desire to link imaging technology with real-time anatomic landmarks. Although applications are still evolving in the clinical and research setting, computer-assisted orthopedic surgery has already demonstrated in certain procedures its potential for improving the surgeon's accuracy, reproducibility (once past the learning curve), and in reducing outlier outcomes. It is also being used as an educational tool to assist less experienced surgeons in interpreting measurements and precision placements related to well defined anatomic landmarks. It also can assist experienced surgeons, in real-time, plan their bony cuts, tunnel placement, and with ligament balancing. Presently, the additional time, the expense to acquire the needed software and hardware, and restricted reimbursement have slowed the widespread use of navigation. Its current applications have been primarily in joint replacement surgery, spine surgery, and trauma. It has not been widely used in the clinical setting for sports medicine procedures. Sports medicine applications such as individualizing tunnel placement in ligament surgery, opening wedge osteotomy with and without accompanying ligament reconstruction, and balancing and tensioning of the ligaments during the procedure (allowing real-time corrections if necessary) are currently being evaluated and being used on a limited clinical basis.

Coronal in vivo forward-imaging of rat brain morphology with an ultra-small optical coherence tomography fiber probe

NASA Astrophysics Data System (ADS)

Xie, Yijing; Bonin, Tim; Löffler, Susanne; Hüttmann, Gereon; Tronnier, Volker; Hofmann, Ulrich G.

2013-02-01

A well-established navigation method is one of the key conditions for successful brain surgery: it should be accurate, safe and online operable. Recent research shows that optical coherence tomography (OCT) is a potential solution for this application by providing a high resolution and small probe dimension. In this study a fiber-based spectral-domain OCT system utilizing a super-luminescent-diode with the center wavelength of 840 nm providing 14.5 μm axial resolution was used. A composite 125 μm diameter detecting probe with a gradient index (GRIN) fiber fused to a single mode fiber was employed. Signals were reconstructed into grayscale images by horizontally aligning A-scans from the same trajectory with different depths. The reconstructed images can display brain morphology along the entire trajectory. For scans of typical white matter, the signals showed a higher reflection of light intensity with lower penetration depth as well as a steeper attenuation rate compared to the scans typical for gray matter. Micro-structures such as axon bundles (70 μm) in the caudate nucleus are visible in the reconstructed images. This study explores the potential of OCT to be a navigation modality in brain surgery.

Augmented reality (AR) and virtual reality (VR) applied in dentistry.

PubMed

Huang, Ta-Ko; Yang, Chi-Hsun; Hsieh, Yu-Hsin; Wang, Jen-Chyan; Hung, Chun-Cheng

2018-04-01

The OSCE is a reliable evaluation method to estimate the preclinical examination of dental students. The most ideal assessment for OSCE is used the augmented reality simulator to evaluate. This literature review investigated a recently developed in virtual reality (VR) and augmented reality (AR) starting of the dental history to the progress of the dental skill. As result of the lacking of technology, it needs to depend on other device increasing the success rate and decreasing the risk of the surgery. The development of tracking unit changed the surgical and educational way. Clinical surgery is based on mature education. VR and AR simultaneously affected the skill of the training lesson and navigation system. Widely, the VR and AR not only applied in the dental training lesson and surgery, but also improved all field in our life. Copyright © 2018. Published by Elsevier Taiwan.

Real-time simulation for intra-operative navigation in robotic surgery. Using a mass spring system for a basic study of organ deformation.

PubMed

Kawamura, Kazuya; Kobayashi, Yo; Fujie, Masakatsu G

2007-01-01

Medical technology has advanced with the introduction of robot technology, making previous medical treatments that were very difficult far more possible. However, operation of a surgical robot demands substantial training and continual practice on the part of the surgeon because it requires difficult techniques that are different from those of traditional surgical procedures. We focused on a simulation technology based on the physical characteristics of organs. In this research, we proposed the development of surgical simulation, based on a physical model, for intra-operative navigation by a surgeon. In this paper, we describe the design of our system, in particular our organ deformation calculator. The proposed simulation system consists of an organ deformation calculator and virtual slave manipulators. We obtained adequate experimental results of a target node at a nearby point of interaction, because this point ensures better accuracy for our simulation model. The next research step would be to focus on a surgical environment in which internal organ models would be integrated into a slave simulation system.

Posterior internal fixation plus vertebral bone implantation under navigational aid for thoracolumbar fracture treatment

PubMed Central

ZHOU, WEI; KONG, WEIQING; ZHAO, BIZHEN; FU, YISHAN; ZHANG, TAO; XU, JIANGUANG

2013-01-01

The aim of this study was to investigate the method of posterior thoracolumbar vertebral pedicle screw reduction and fixation combined with vertebral bone implantation via the affected vertebral body under navigational aid for the treatment of thoracolumbar fractures. The efficacy of the procedure was also measured. Between June 2005 and March 2011, posterior thoracolumbar vertebral pedicle screw reduction and fixation plus artificial bone implantation via the affected vertebral pedicle under navigational aid was used to treat 30 patients with thoracolumbar fractures, including 18 males and 12 females, ranging in age from 21 to 57 years. Compared with the values prior to surgery, intraspinal occupation, vertebral height ratio and Cobb angle at the follow-up were significantly improved. At the long-term follow-up, the postoperative Cobb angle loss was <1° and the anterior vertebral body height loss was <2 mm. Posterior thoracolumbar vertebral pedicle screw reduction and fixation combined with vertebral bone implantation via the affected vertebral body under navigational aid may increase the accuracy and safety of surgery, and it is an ideal method of internal implantation. Bone implantation via the affected vertebral body may increase vertebral stability. PMID:23935737

[Endoscopic sinus surgery in flowing water].

PubMed

Noda, K; Doi, K; Noiri, T; Koizuka, I; Kubo, T

2000-05-01

A balloon has been developed that completely fills the choana, preventing water from leaking into the pharynx even when the water is entering into the nasal cavity at a rate of 1000 ml per minute. The balloon enables endoscopic sinus surgery (ESS) to be safely performed in "flowing water". This surgical technique is similar to that used in transurethral resections of the prostate because the tip of the endoscope is kept clean, and blood, debris and resected tissues are continuously removed by the water flow. In addition, the water pressure helps to suppress bleeding. This technique enables ESS to be performed with greater ease and efficiency. We have performed ESS in flowing water on 38 patients with chronic sinusitis under local anaesthesia. No complications, such as water leakage into the pharynx, were encountered, and only a few patients felt discomfort from the insertion of the balloon. Even if the balloon had burst, an emergency could have been easily prevented by withdrawing the endoscope from the nasal cavity and stopping the flow of water. Ultrasonography (USG) was used to examine the water-filled nasal cavity during surgery (SSD-2000 and Micro Tip Radial (ASU-101); Aloka, Ltd., Japan). Using USG, the middle turbinate, the inferior turbinate and the nasal septum could be visualized in a single coronal image. When the sensor was in the posterior ethmoid sinus, the orbit and its optic nerve could also be visualized. Since this surgery is performed under local anesthesia, eye movements can rapidly alter the position of the optic nerve. Thus, visualization of the optic nerve's exact position is extremely important. Unfortunately, USG is not very useful for localizing structures and guiding the surgeon to distant tumors or cysts located behind thick bones, since ultrasound can not penetrate hard masses or bones. In this situation, navigation systems are more reliable than USG. Nevertheless, USG is often useful for depicting surgical sites, especially during a crisis, if the medial wall of the orbit is thin or if the skull base has been broken, exposing the dura. USG can also provide early warning of an impending complication. USG also has several practical advantages over navigation systems: the cost of USG is much lower, preparation for surgery is unnecessary, visual information can be obtained in real time, and measurement accuracy (estimated to be about 2 mm for navigation systems) is not a consideration. Thus, USG can be easily used to avoid complications in most surgeries for chronic sinusitis. Flowing water also allows the nasal eavity to be completely washed and sterilized at the end of the surgery. This not only prevents post-operative infection, but enables sinus function to be more quickly recovered. In addition, the pressure from the balloon also prevents post-operative nasal hemorrhaging. This allows patients to be safely discharged from the hospital at an earlier time. The balloon can also be used for non-surgical purposes. For example, emergent epistaxis can be easily stopped by the insertion of this balloon, even if the doctor is not an otorhinolaryngologist. In addition, the balloon's soft pressure allows it to be left in the nose for long periods without any complications. We conclude that this simple balloon, which we have named the "Noda Balloon", is extremely useful for nasal treatments.

[Application of computer-assisted 3D imaging simulation for surgery].

PubMed

Matsushita, S; Suzuki, N

1994-03-01

This article describes trends in application of various imaging technology in surgical planning, navigation, and computer aided surgery. Imaging information is essential factor for simulation in medicine. It includes three dimensional (3D) image reconstruction, neuro-surgical navigation, creating substantial model based on 3D imaging data and etc. These developments depend mostly on 3D imaging technique, which is much contributed by recent computer technology. 3D imaging can offer new intuitive information to physician and surgeon, and this method is suitable for mechanical control. By utilizing simulated results, we can obtain more precise surgical orientation, estimation, and operation. For more advancement, automatic and high speed recognition of medical imaging is being developed.

A New Navigation System of Renal Puncture for Endoscopic Combined Intrarenal Surgery: Real-time Virtual Sonography-guided Renal Access.

PubMed

Hamamoto, Shuzo; Unno, Rei; Taguchi, Kazumi; Ando, Ryosuke; Hamakawa, Takashi; Naiki, Taku; Okada, Shinsuke; Inoue, Takaaki; Okada, Atsushi; Kohri, Kenjiro; Yasui, Takahiro

2017-11-01

To evaluate the clinical utility of a new navigation technique for percutaneous renal puncture using real-time virtual sonography (RVS) during endoscopic combined intrarenal surgery. Thirty consecutive patients who underwent endoscopic combined intrarenal surgery for renal calculi, between April 2014 and July 2015, were divided into the RVS-guided puncture (RVS; n = 15) group and the ultrasonography-guided puncture (US; n = 15) group. In the RVS group, renal puncture was repeated until precise piercing of a papilla was achieved under direct endoscopic vision, using the RVS system to synchronize the real-time US image with the preoperative computed tomography image. In the US group, renal puncture was performed under US guidance only. In both groups, 2 urologists worked simultaneously to fragment the renal calculi after inserting the miniature percutaneous tract. The mean sizes of the renal calculi in the RVS and the US group were 33.5 and 30.5 mm, respectively. A lower mean number of puncture attempts until renal access through the calyx was needed for the RVS compared with the US group (1.6 vs 3.4 times, respectively; P = .001). The RVS group had a lower mean postoperative hemoglobin decrease (0.93 vs 1.39 g/dL, respectively; P = .04), but with no between-group differences with regard to operative time, tubeless rate, and stone-free rate. None of the patients in the RVS group experienced postoperative complications of a Clavien score ≥2, with 3 patients experiencing such complications in the US group. RVS-guided renal puncture was effective, with a lower incidence of bleeding-related complications compared with US-guided puncture. Copyright © 2017 Elsevier Inc. All rights reserved.

3D-printed navigation template in proximal femoral osteotomy for older children with developmental dysplasia of the hip

PubMed Central

Zheng, Pengfei; Xu, Peng; Yao, Qingqiang; Tang, Kai; Lou, Yue

2017-01-01

To explore the feasibility of 3D-printed navigation template in proximal femoral varus rotation and shortening osteotomy for older children with developmental dysplasia of the hip (DDH). Between June 2014 and May 2015, navigation templates were designed and used for 12 DDH patients. Surgical information and outcomes were compared to 13 patients undergoing the same surgery but without navigation template. In template-guided patient group, operation time (21.08 min vs. 46.92 min), number of X-ray exposures (3.92 vs. 6.69), and occurrence of femoral epiphysis damage (0 vs. 0.92) were significantly decreased (P < 0.05). Furthermore, after 12–18 months follow-up, 66.7% and 16.7% of the hips in template-guided group were rated as excellent or good, respectively, according to the McKay criteria; 83.3% and 16.7% by using the Severin criteria respectively. By contrast, 46.2% and 23.1% of the hips in traditional operation group were classed as excellent or good, respectively, using the McKay criteria; 46.2% and 30.8% by using the Severin criteria respectively. The template-guided group achieved a better outcome; however, there was no significant difference. Application of the navigation template for older DDH children can reduce the operation time, radiation exposure, and epiphysis damage, which also simplifies surgery and improves precision. PMID:28322290

[Cost analysis for navigation in knee endoprosthetics].

PubMed

Cerha, O; Kirschner, S; Günther, K-P; Lützner, J

2009-12-01

Total knee arthroplasty (TKA) is one of the most frequent procedures in orthopaedic surgery. The outcome depends on a range of factors including alignment of the leg and the positioning of the implant in addition to patient-associated factors. Computer-assisted navigation systems can improve the restoration of a neutral leg alignment. This procedure has been established especially in Europe and North America. The additional expenses are not reimbursed in the German DRG system (Diagnosis Related Groups). In the present study a cost analysis of computer-assisted TKA compared to the conventional technique was performed. The acquisition expenses of various navigation systems (5 and 10 year depreciation), annual costs for maintenance and software updates as well as the accompanying costs per operation (consumables, additional operating time) were considered. The additional operating time was determined on the basis of a meta-analysis according to the current literature. Situations with 25, 50, 100, 200 and 500 computer-assisted TKAs per year were simulated. The amount of the incremental costs of the computer-assisted TKA depends mainly on the annual volume and the additional operating time. A relevant decrease of the incremental costs was detected between 50 and 100 procedures per year. In a model with 100 computer-assisted TKAs per year an additional operating time of 14 mins and a 10 year depreciation of the investment costs, the incremental expenses amount to 300-395 depending on the navigation system. Computer-assisted TKA is associated with additional costs. From an economical point of view an amount of more than 50 procedures per year appears to be favourable. The cost-effectiveness could be estimated if long-term results will show a reduction of revisions or a better clinical outcome.

[Clinical application of accurate placement of lumbar pedicle screws using three-dimensional printing navigational templates under Quadrant system].

PubMed

Chen, Xuanhuang; Yu, Zhengxi; Wu, Changfu; Li, Xing; Chen, Xu; Zhang, Guodong; Zheng, Zugao; Lin, Haibin

2017-02-01

To explore the feasibility and the effectiveness of the accurate placement of lumbar pedicle screws using three-dimensional (3D) printing navigational templates in Quadrant minimally invasive system. The L 1-5 spines of 12 adult cadavers were scanned using CT. The 3D models of the lumbar spines were established. The screw trajectory was designed to pass through the central axis of the pedicle by using Mimics software. The navigational template was designed and 3D-printed according to the bony surface where the soft tissues could be removed. The placed screws were scanned using CT to create the 3D model again after operation. The 3D models of the designed trajectory and the placed screws were registered to evaluate the placed screws coincidence rate. Between November 2014 and November 2015, 31 patients with lumbar instability accepted surgery assisted with 3D-printing navigation module under Quadrant minimally invasive system. There were 14 males and 17 females, aged from 42 to 60 years, with an average of 45.2 years. The disease duration was 6-13 months (mean, 8.8 months). Single segment was involved in 15 cases, two segments in 13 cases, and three segments in 3 cases. Preoperative visual analogue scale (VAS) was 7.59±1.04; Oswestry disability index (ODI) was 76.21±5.82; and the Japanese Orthopaedic Association (JOA) score was 9.21±1.64. A total of 120 screws were placed in 12 cadavers specimens. The coincidence rate of placed screw was 100%. A total of 162 screws were implanted in 31 patients. The operation time was 65-147 minutes (mean, 102.23 minutes); the intraoperative blood loss was 50-116 mL (mean, 78.20 mL); and the intraoperative radiation exposure time was 8-54 seconds (mean, 42 seconds). At 3-7 days after operation, CT showed that the coincidence rate of the placed screws was 98.15% (159/162). At 4 weeks after operation, VAS, ODI, and JOA score were 2.24±0.80, 29.17±2.50, and 23.43±1.14 respectively, showing significant differences when compared with preoperative ones ( t =14.842, P =0.006; t =36.927, P =0.002; t =-36.031, P =0.001). Thirty-one patients were followed up 8-24 months (mean, 18.7 months). All incision healed by first intention, and no complication occurred. During the follow-up, X-ray film and CT showed that pedicle screw was accurately placed without loosening or breakage, and with good fusion of intervertebral bone graft. 3D-printing navigational templates in Quadrant minimally invasive system can help lumbar surgery gain minimal invasion, less radiation, and accurate placement.

Language mapping with navigated transcranial magnetic stimulation in pediatric and adult patients undergoing epilepsy surgery: Comparison with extraoperative direct cortical stimulation.

PubMed

Lehtinen, Henri; Mäkelä, Jyrki P; Mäkelä, Teemu; Lioumis, Pantelis; Metsähonkala, Liisa; Hokkanen, Laura; Wilenius, Juha; Gaily, Eija

2018-06-01

Navigated transcranial magnetic stimulation (nTMS) is becoming increasingly popular in noninvasive preoperative language mapping, as its results correlate well enough with those obtained by direct cortical stimulation (DCS) during awake surgery in adult patients with tumor. Reports in the context of epilepsy surgery or extraoperative DCS in adults are, however, sparse, and validation of nTMS with DCS in children is lacking. Furthermore, little is known about the risk of inducing epileptic seizures with nTMS in pediatric epilepsy patients. We provide the largest validation study to date in an epilepsy surgery population. We compared language mapping with nTMS and extraoperative DCS in 20 epilepsy surgery patients (age range 9-32 years; 14 children and adolescents). In comparison with DCS, sensitivity of nTMS was 68%, specificity 76%, positive predictive value 27%, and negative predictive value 95%. Age, location of ictal-onset zone near or within DCS-mapped language areas or severity of cognitive deficits had no significant effect on these values. None of our patients had seizures during nTMS. Our study suggests that nTMS language mapping is clinically useful and safe in epilepsy surgery patients, including school-aged children and patients with extensive cognitive dysfunction. Similar to in tumor surgery, mapping results in the frontal region are most reliable. False negative findings may be slightly more likely in epilepsy than in tumor surgery patients. Mapping results should always be verified by other methods in individual patients.

Intraoperative computed tomography with an integrated navigation system in stabilization surgery for complex craniovertebral junction malformation.

PubMed

Yu, Xinguang; Li, Lianfeng; Wang, Peng; Yin, Yiheng; Bu, Bo; Zhou, Dingbiao

2014-07-01

This study was designed to report our preliminary experience with stabilization procedures for complex craniovertebral junction malformation (CVJM) using intraoperative computed tomography (iCT) with an integrated neuronavigation system (NNS). To evaluate the workflow, feasibility and clinical outcome of stabilization procedures using iCT image-guided navigation for complex CVJM. The stabilization procedures in CVJM are complex because of the area's intricate geometry and bony structures, its critical relationship to neurovascular structures and the intricate biomechanical issues involved. A sliding gantry 40-slice computed tomography scanner was installed in a preexisting operating room. The images were transferred directly from the scanner to the NNS using an automated registration system. On the basis of the analysis of intraoperative computed tomographic images, 23 cases (11 males, 12 females) with complicated CVJM underwent navigated stabilization procedures to allow more control over screw placement. The age of these patients were 19-52 years (mean: 33.5 y). We performed C1-C2 transarticular screw fixation in 6 patients to produce atlantoaxial arthrodesis with better reliability. Because of a high-riding transverse foramen on at least 1 side of the C2 vertebra and an anomalous vertebral artery position, 7 patients underwent C1 lateral mass and C2 pedicle screw fixation. Ten additional patients were treated with individualized occipitocervical fixation surgery from the hypoplasia of C1 or constraints due to C2 bone structure. In total, 108 screws were inserted into 23 patients using navigational assistance. The screws comprised 20 C1 lateral mass screws, 26 C2, 14 C3, or 4 C4 pedicle screws, 32 occipital screws, and 12 C1-C2 transarticular screws. There were no vascular or neural complications except for pedicle perforations that were detected in 2 (1.9%) patients and were corrected intraoperatively without any persistent nerves or vessel damage. The overall accuracy of the image guidance system was 98.1%. The duration of interruption during the surgical process for the iCT was 8±1.5 minutes. All patients were clinically evaluated using Nurick grade criteria and for neurological deficits 3 months after surgery. Twenty-one patients (91.3%) improved by at least 1 Nurick grade, whereas the grade remained unchanged in 2 (8.7%) patients. Craniovertebral stability and solid bone fusion was achieved in all patients. NNS was found to correlate well with the intraoperative findings, and the recalibration was uneventful in all cases and had an accuracy of 1.8 mm (range, 0.6-2.2 mm). iCT scanning with integrated NNS was found to be both feasible and beneficial in the stabilization procedures for complex CVJM. In this unusual patient population, the technique seemed to be of value for negotiating complex anatomy and for achieving more control over screw placement.

Surgical orthodontics.

PubMed

Strohl, Alexis M; Vitkus, Lauren

2017-08-01

The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.

Robotic digital subtraction angiography systems within the hybrid operating room.

PubMed

Murayama, Yuichi; Irie, Koreaki; Saguchi, Takayuki; Ishibashi, Toshihiro; Ebara, Masaki; Nagashima, Hiroyasu; Isoshima, Akira; Arakawa, Hideki; Takao, Hiroyuki; Ohashi, Hiroki; Joki, Tatsuhiro; Kato, Masataka; Tani, Satoshi; Ikeuchi, Satoshi; Abe, Toshiaki

2011-05-01

Fully equipped high-end digital subtraction angiography (DSA) within the operating room (OR) environment has emerged as a new trend in the fields of neurosurgery and vascular surgery. To describe initial clinical experience with a robotic DSA system in the hybrid OR. A newly designed robotic DSA system (Artis zeego; Siemens AG, Forchheim, Germany) was installed in the hybrid OR. The system consists of a multiaxis robotic C arm and surgical OR table. In addition to conventional neuroendovascular procedures, the system was used as an intraoperative imaging tool for various neurosurgical procedures such as aneurysm clipping and spine instrumentation. Five hundred one neurosurgical procedures were successfully conducted in the hybrid OR with the robotic DSA. During surgical procedures such as aneurysm clipping and arteriovenous fistula treatment, intraoperative 2-/3-dimensional angiography and C-arm-based computed tomographic images (DynaCT) were easily performed without moving the OR table. Newly developed virtual navigation software (syngo iGuide; Siemens AG) can be used in frameless navigation and in access to deep-seated intracranial lesions or needle placement. This newly developed robotic DSA system provides safe and precise treatment in the fields of endovascular treatment and neurosurgery.

Optical augmented reality assisted navigation system for neurosurgery teaching and planning

NASA Astrophysics Data System (ADS)

Wu, Hui-Qun; Geng, Xing-Yun; Wang, Li; Zhang, Yuan-Peng; Jiang, Kui; Tang, Le-Min; Zhou, Guo-Min; Dong, Jian-Cheng

2013-07-01

This paper proposed a convenient navigation system for neurosurgeon's pre-operative planning and teaching with augmented reality (AR) technique, which maps the three-dimensional reconstructed virtual anatomy structures onto a skull model. This system included two parts, a virtual reality system and a skull model scence. In our experiment, a 73 year old right-handed man initially diagnosed with astrocytoma was selected as an example to vertify our system. His imaging data from different modalities were registered and the skull soft tissue, brain and inside vessels as well as tumor were reconstructed. Then the reconstructed models were overlayed on the real scence. Our findings showed that the reconstructed tissues were augmented into the real scence and the registration results were in good alignment. The reconstructed brain tissue was well distributed in the skull cavity. The probe was used by a neurosurgeon to explore the surgical pathway which could be directly posed into the tumor while not injuring important vessels. In this way, the learning cost for students and patients' education about surgical risks reduced. Therefore, this system could be a selective protocol for image guided surgery(IGS), and is promising for neurosurgeon's pre-operative planning and teaching.

[Interest of non invasive navigation in total knee arthroplasty].

PubMed

Zorman, D; Leclercq, G; Cabanas, J Juanos; Jennart, H

2015-01-01

During surgery of total knee arthroplasty, we use a computerized non invasive navigation (Brainlab Victor Vision CT-free) to assess the accuracy of the bone cuts (navigation expresse). The purpose of this study is to evaluate non invasive navigation when a total knee arthroplasty is achieved by conventional instrumentation. The study is based on forty total knee arthroplasties. The accuracy of the tibial and distal femoral bone cuts, checked by non invasive navigation, is evaluated prospectively. In our clinical series, we have obtained, with the conventional instrumentation, a correction of the mechanical axis only in 90 % of cases (N = 36). With non invasive navigation, we improved the positioning of implants and obtained in all cases the desired axiometry in the frontal plane. Although operative time is increased by about 15 minutes, the non invasive navigation does not induce intraoperative or immediate postoperative complications. Despite the cost of this technology, we believe that the reliability of the procedure is enhanced by a simple and reproducible technique.

Navigation system for robot-assisted intra-articular lower-limb fracture surgery.

PubMed

Dagnino, Giulio; Georgilas, Ioannis; Köhler, Paul; Morad, Samir; Atkins, Roger; Dogramadzi, Sanja

2016-10-01

In the surgical treatment for lower-leg intra-articular fractures, the fragments have to be positioned and aligned to reconstruct the fractured bone as precisely as possible, to allow the joint to function correctly again. Standard procedures use 2D radiographs to estimate the desired reduction position of bone fragments. However, optimal correction in a 3D space requires 3D imaging. This paper introduces a new navigation system that uses pre-operative planning based on 3D CT data and intra-operative 3D guidance to virtually reduce lower-limb intra-articular fractures. Physical reduction in the fractures is then performed by our robotic system based on the virtual reduction. 3D models of bone fragments are segmented from CT scan. Fragments are pre-operatively visualized on the screen and virtually manipulated by the surgeon through a dedicated GUI to achieve the virtual reduction in the fracture. Intra-operatively, the actual position of the bone fragments is provided by an optical tracker enabling real-time 3D guidance. The motion commands for the robot connected to the bone fragment are generated, and the fracture physically reduced based on the surgeon's virtual reduction. To test the system, four femur models were fractured to obtain four different distal femur fracture types. Each one of them was subsequently reduced 20 times by a surgeon using our system. The navigation system allowed an orthopaedic surgeon to virtually reduce the fracture with a maximum residual positioning error of [Formula: see text] (translational) and [Formula: see text] (rotational). Correspondent physical reductions resulted in an accuracy of 1.03 ± 0.2 mm and [Formula: see text], when the robot reduced the fracture. Experimental outcome demonstrates the accuracy and effectiveness of the proposed navigation system, presenting a fracture reduction accuracy of about 1 mm and [Formula: see text], and meeting the clinical requirements for distal femur fracture reduction procedures.

Image overlay navigation by markerless surface registration in gastrointestinal, hepatobiliary and pancreatic surgery.

PubMed

Sugimoto, Maki; Yasuda, Hideki; Koda, Keiji; Suzuki, Masato; Yamazaki, Masato; Tezuka, Tohru; Kosugi, Chihiro; Higuchi, Ryota; Watayo, Yoshihisa; Yagawa, Yohsuke; Uemura, Shuichiro; Tsuchiya, Hironori; Azuma, Takeshi

2010-09-01

We applied a new concept of "image overlay surgery" consisting of the integration of virtual reality (VR) and augmented reality (AR) technology, in which dynamic 3D images were superimposed on the patient's actual body surface and evaluated as a reference for surgical navigation in gastrointestinal, hepatobiliary and pancreatic surgery. We carried out seven surgeries, including three cholecystectomies, two gastrectomies and two colectomies. A Macintosh and a DICOM workstation OsiriX were used in the operating room for image analysis. Raw data of the preoperative patient information obtained via MDCT were reconstructed to volume rendering and projected onto the patient's body surface during the surgeries. For accurate registration, OsiriX was first set to reproduce the patient body surface, and the positional coordinates of the umbilicus, left and right nipples, and the inguinal region were fixed as physiological markers on the body surface to reduce the positional error. The registration process was non-invasive and markerlesss, and was completed within 5 min. Image overlay navigation was helpful for 3D anatomical understanding of the surgical target in the gastrointestinal, hepatobiliary and pancreatic anatomies. The surgeon was able to minimize movement of the gaze and could utilize the image assistance without interfering with the forceps operation, reducing the gap from the VR. Unexpected organ injury could be avoided in all procedures. In biliary surgery, the projected virtual cholangiogram on the abdominal wall could advance safely with identification of the bile duct. For early gastric and colorectal cancer, the small tumors and blood vessels, which usually could not be found on the gastric serosa by laparoscopic view, were simultaneously detected on the body surface by carbon dioxide-enhanced MDCT. This provided accurate reconstructions of the tumor and involved lymph node, directly linked with optimization of the surgical procedures. Our non-invasive markerless registration using physiological markers on the body surface reduced logistical efforts. The image overlay technique is a useful tool when highlighting hidden structures, giving more information.

Game theory: applications for surgeons and the operating room environment.

PubMed

McFadden, David W; Tsai, Mitchell; Kadry, Bassam; Souba, Wiley W

2012-11-01

Game theory is an economic system of strategic behavior, often referred to as the "theory of social situations." Very little has been written in the medical literature about game theory or its applications, yet the practice of surgery and the operating room environment clearly involves multiple social situations with both cooperative and non-cooperative behaviors. A comprehensive review was performed of the medical literature on game theory and its medical applications. Definitive resources on the subject were also examined and applied to surgery and the operating room whenever possible. Applications of game theory and its proposed dilemmas abound in the practicing surgeon's world, especially in the operating room environment. The surgeon with a basic understanding of game theory principles is better prepared for understanding and navigating the complex Operating Room system and optimizing cooperative behaviors for the benefit all stakeholders. Copyright © 2012 Mosby, Inc. All rights reserved.

78 FR 68861 - Certain Navigation Products, Including GPS Devices, Navigation and Display Systems, Radar Systems...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-15

... Devices, Navigation and Display Systems, Radar Systems, Navigational Aids, Mapping Systems and Related... navigation products, including GPS devices, navigation and display systems, radar systems, navigational aids..., radar systems, navigational aids, mapping systems and related software by reason of infringement of one...

Construct and face validity of a virtual reality-based camera navigation curriculum.

PubMed

Shetty, Shohan; Panait, Lucian; Baranoski, Jacob; Dudrick, Stanley J; Bell, Robert L; Roberts, Kurt E; Duffy, Andrew J

2012-10-01

Camera handling and navigation are essential skills in laparoscopic surgery. Surgeons rely on camera operators, usually the least experienced members of the team, for visualization of the operative field. Essential skills for camera operators include maintaining orientation, an effective horizon, appropriate zoom control, and a clean lens. Virtual reality (VR) simulation may be a useful adjunct to developing camera skills in a novice population. No standardized VR-based camera navigation curriculum is currently available. We developed and implemented a novel curriculum on the LapSim VR simulator platform for our residents and students. We hypothesize that our curriculum will demonstrate construct and face validity in our trainee population, distinguishing levels of laparoscopic experience as part of a realistic training curriculum. Overall, 41 participants with various levels of laparoscopic training completed the curriculum. Participants included medical students, surgical residents (Postgraduate Years 1-5), fellows, and attendings. We stratified subjects into three groups (novice, intermediate, and advanced) based on previous laparoscopic experience. We assessed face validity with a questionnaire. The proficiency-based curriculum consists of three modules: camera navigation, coordination, and target visualization using 0° and 30° laparoscopes. Metrics include time, target misses, drift, path length, and tissue contact. We analyzed data using analysis of variance and Student's t-test. We noted significant differences in repetitions required to complete the curriculum: 41.8 for novices, 21.2 for intermediates, and 11.7 for the advanced group (P < 0.05). In the individual modules, coordination required 13.3 attempts for novices, 4.2 for intermediates, and 1.7 for the advanced group (P < 0.05). Target visualization required 19.3 attempts for novices, 13.2 for intermediates, and 8.2 for the advanced group (P < 0.05). Participants believe that training improves camera handling skills (95%), is relevant to surgery (95%), and is a valid training tool (93%). Graphics (98%) and realism (93%) were highly regarded. The VR-based camera navigation curriculum demonstrates construct and face validity for our training population. Camera navigation simulation may be a valuable tool that can be integrated into training protocols for residents and medical students during their surgery rotations. Copyright © 2012 Elsevier Inc. All rights reserved.

Intraoperative computed tomography.

PubMed

Tonn, J C; Schichor, C; Schnell, O; Zausinger, S; Uhl, E; Morhard, D; Reiser, M

2011-01-01

Intraoperative computed tomography (iCT) has gained increasing impact among modern neurosurgical techniques. Multislice CT with a sliding gantry in the OR provides excellent diagnostic image quality in the visualization of vascular lesions as well as bony structures including skull base and spine. Due to short acquisition times and a high spatial and temporal resolution, various modalities such as iCT-angiography, iCT-cerebral perfusion and the integration of intraoperative navigation with automatic re-registration after scanning can be performed. This allows a variety of applications, e.g. intraoperative angiography, intraoperative cerebral perfusion studies, update of cerebral and spinal navigation, stereotactic procedures as well as resection control in tumour surgery. Its versatility promotes its use in a multidisciplinary setting. Radiation exposure is comparable to standard CT systems outside the OR. For neurosurgical purposes, however, new hardware components (e.g. a radiolucent headholder system) had to be developed. Having a different range of applications compared to intraoperative MRI, it is an attractive modality for intraoperative imaging being comparatively easy to install and cost efficient.

Quantitative Analysis of Transnasal Anterior Skull Base Approach: Report of Technology for Intraoperative Assessment of Instrument Motion.

PubMed

Berens, Angelique M; Harbison, Richard Alex; Li, Yangming; Bly, Randall A; Aghdasi, Nava; Ferreira, Manuel; Hannaford, Blake; Moe, Kris S

2017-08-01

To develop a method to measure intraoperative surgical instrument motion. This model will be applicable to the study of surgical instrument kinematics including surgical training, skill verification, and the development of surgical warning systems that detect aberrant instrument motion that may result in patient injury. We developed an algorithm to automate derivation of surgical instrument kinematics in an endoscopic endonasal skull base surgery model. Surgical instrument motion was recorded during a cadaveric endoscopic transnasal approach to the pituitary using a navigation system modified to record intraoperative time-stamped Euclidian coordinates and Euler angles. Microdebrider tip coordinates and angles were referenced to the cadaver's preoperative computed tomography scan allowing us to assess surgical instrument kinematics over time. A representative cadaveric endoscopic endonasal approach to the pituitary was performed to demonstrate feasibility of our algorithm for deriving surgical instrument kinematics. Technical feasibility of automatically measuring intraoperative surgical instrument motion and deriving kinematics measurements was demonstrated using standard navigation equipment.

Intraoperative evaluation of total knee replacement: kinematic assessment with a navigation system.

PubMed

Casino, Daniela; Zaffagnini, Stefano; Martelli, Sandra; Lopomo, Nicola; Bignozzi, Simone; Iacono, Francesco; Russo, Alessandro; Marcacci, Maurilio

2009-04-01

Interest in the kinematics of reconstructed knees has increased since it was shown that the alteration of knee motion could lead to abnormal wear and damage to soft tissues. We performed intraoperative kinematic measurements using a navigation system to study knee kinematics before and after posterior substituting rotating platform total knee arthroplasty (TKA). We verified intraoperatively (1) if varus/valgus (VV) laxity and anterior/posterior (AP) laxity were restored after TKA; (2) if TKA induced abnormal femoral rollback; and (3) how tibial axial rotation was influenced by TKA throughout the range of flexion. We found that TKA improved alignment in preoperative osteoarthritic varus knees which became neutral after surgery and maintained a neutral alignment in neutral knees. The VV stability at 0 degrees was restored while AP laxity at 90 degrees significantly increased after TKA. Following TKA, the femur had an abnormal anterior translation up to 60 degrees of flexion, followed by a small rollback of 12 +/- 5 mm. TKA influenced the tibia rotation pattern during flexion, but not the total amount of internal/external rotation throughout whole range of flexion, which was preserved after TKA (6 degrees +/- 5 degrees ). This study showed that the protocol proposed might be useful to adjust knee stability at time zero and that knee kinematic outcome during total knee replacement can be monitored by a navigation system.

Health Care Worker Fatigue.

PubMed

Gardner, Lea Anne; Dubeck, Deborah

2016-08-01

The Pennsylvania Patient Safety Reporting System is a confidential, statewide Internet reporting system to which all Pennsylvania hospitals, outpatient-surgery facilities, birthing centers, and abortion facilities must file information on incidents and serious events.Safety Monitor is a column from Pennsylvania's Patient Safety Authority, the authority that informs nurses on issues that can affect patient safety and presents strategies they can easily integrate into practice. For more information on the authority, visit www.patientsafetyauthority.org. For the original article discussed in this column or for other articles on patient safety, click on "Patient Safety Advisories" and then "Advisory Library" in the left-hand navigation menu.

Indocyanine green SPY elite-assisted sentinel lymph node biopsy in cutaneous melanoma.

PubMed

Korn, Jason M; Tellez-Diaz, Alejandra; Bartz-Kurycki, Marisa; Gastman, Brian

2014-04-01

Sentinel lymph node biopsy is the standard of care for intermediate-depth and high-risk thin melanomas. Recently, indocyanine green and near-infrared imaging have been used to aid in sentinel node biopsy. The present study aimed to determine the feasibility of sentinel lymph node biopsy with indocyanine green SPY Elite navigation and to critically evaluate the technique compared with the standard modalities. A retrospective review of 90 consecutive cutaneous melanoma patients who underwent sentinel lymph node biopsy was performed. Two cohorts were formed: group A, which had sentinel lymph node biopsy performed with blue dye and radioisotope; and group B, which had sentinel lymph node biopsy performed with radioisotope and indocyanine green SPY Elite navigation. The cohorts were compared to assess for differences in localization rates, sensitivity and specificity of sentinel node identification, and length of surgery. The sentinel lymph node localization rate was 79.4 percent using the blue dye method, 98.0 percent using the indocyanine green fluorescence method, and 97.8 percent using the radioisotope/handheld gamma probe method. Indocyanine green fluorescence detected more sentinel lymph nodes than the vital dye method alone (p = 0.020). A trend toward a reduction in length of surgery was noted in the SPY Elite cohort. Sentinel lymph node mapping and localization in cutaneous melanoma with the indocyanine green SPY Elite navigation system is technically feasible and may offer several advantages over current modalities, including higher sensitivity and specificity, decreased number of lymph nodes sampled, decreased operative time, and potentially lower false-negative rates. Diagnostic, II.

O-arm with navigation versus C-arm: a review of screw placement over 3 years at a major trauma center.

PubMed

Verma, S K; Singh, P K; Agrawal, D; Sinha, S; Gupta, D; Satyarthee, G D; Sharma, B S

2016-12-01

There is a relatively high incidence of screw misplacement during spinal instrumentation due to distortion of normal anatomy following spinal trauma. The O-arm is the next-generation spinal navigation tool that provides intraoperative 3-D imaging and navigation for spine surgeries. To evaluate and compare the use of O-arm as compared to C-arm for spinal trauma in a Level I trauma center in India. In this retrospective study over 3 years (July 2010-April 2013), All patients of spinal injury who underwent spinal instrumentation were divided into O-arm group and C-arm group. Accuracy of screw placement was assessed during each surgery in both groups. A total of 587 patients were evaluated during the study period. There were 278 patients in O-arm group and 309 patients in C-arm group. Both groups were well matched in mean age (27.7 vs. 28.9 years), ASIA grades, and level of injury. The number of screws placed was significantly higher in the C-arm group as compared to the O-arm group (2173 vs. 1720). However, the O-arm group had significantly less screw malplacement rate of 0.93% (n = 16) as compared to malplacement rate in C-arm group of 8.79% (n = 191, p < 0.05). Use of O-arm imaging system ensures accurate screw placement and dramatically decreases screw malplacement rate, thus providing better patient safety. Its use is especially beneficial in academic and teaching centers where novice surgeons can attain results equivalent to that of experts in spinal instrumentation.

Multi-degree-of-freedom ultrasonic micromotor for guidewire and catheter navigation: The NeuroGlide actuator

NASA Astrophysics Data System (ADS)

Yun, Cheol-Ho; Yeo, Leslie Y.; Friend, James R.; Yan, Bernard

2012-04-01

A 240-μm diameter ultrasonic micromotor is presented as a potential solution for an especially difficult task in minimally invasive neurosurgery, navigating a guidewire to an injury in the neurovasculature as the first step of surgery. The peak no-load angular velocity and maximum torque were 600 rad/s and 1.6 nN-m, respectively, and we obtained rotation about all three axes. By using a burst drive scheme, open-loop position and speed control were achieved. The construction method and control scheme proposed in this study remove most of the current limitations in minimally invasive, catheter-based actuation, enabling minimally invasive vascular surgery concepts to be pursued for a broad variety of applications.

Robotically assisted velocity-sensitive triggered focused ultrasound surgery

NASA Astrophysics Data System (ADS)

Maier, Florian; Brunner, Alexander; Jenne, Jürgen W.; Krafft, Axel J.; Semmler, Wolfhard; Bock, Michael

2012-11-01

Magnetic Resonance (MR) guided Focused Ultrasound Surgery (FUS) of abdominal organs is challenging due to breathing motion and limited patient access in the MR environment. In this work, an experimental robotically assisted FUS setup was combined with a MR-based navigator technique to realize motion-compensated sonications and online temperature imaging. Experiments were carried out in a static phantom, during periodic manual motion of the phantom without triggering, and with triggering to evaluate the triggering method. In contrast to the non-triggered sonication, the results of the triggered sonication show a confined symmetric temperature distribution. In conclusion, the velocity sensitive navigator can be employed for triggered FUS to compensate for periodic motion. Combined with the robotic FUS setup, flexible treatment of abdominal targets might be realized.

Computer animation for minimally invasive surgery: computer system requirements and preferred implementations

NASA Astrophysics Data System (ADS)

Pieper, Steven D.; McKenna, Michael; Chen, David; McDowall, Ian E.

1994-04-01

We are interested in the application of computer animation to surgery. Our current project, a navigation and visualization tool for knee arthroscopy, relies on real-time computer graphics and the human interface technologies associated with virtual reality. We believe that this new combination of techniques will lead to improved surgical outcomes and decreased health care costs. To meet these expectations in the medical field, the system must be safe, usable, and cost-effective. In this paper, we outline some of the most important hardware and software specifications in the areas of video input and output, spatial tracking, stereoscopic displays, computer graphics models and libraries, mass storage and network interfaces, and operating systems. Since this is a fairly new combination of technologies and a new application, our justification for our specifications are drawn from the current generation of surgical technology and by analogy to other fields where virtual reality technology has been more extensively applied and studied.

[epiDRB--a new minimally invasive concept for referencing in the field of computer-assisted orthopaedic surgery].

PubMed

Ohnsorge, J A K; Weisskopf, M; Siebert, C H

2005-01-01

Optoelectronic navigation for computer-assisted orthopaedic surgery (CAOS) is based on a firm connection of bone with passive reflectors or active light-emitting diodes in a specific three-dimensional pattern. Even a so-called "minimally-invasive" dynamic reference base (DRB) requires fixation with screws or clamps via incision of the skin. Consequently an originally percutaneous intervention would unnecessarily be extended to an open procedure. Thus, computer-assisted navigation is rarely applied. Due to their tree-like design most DRB's interfere with the surgeon's actions and therefore are at permanent risk to be accidentally dislocated. Accordingly, the optic communication between the camera and the operative site may repeatedly be interrupted. The aim of the research was the development of a less bulky, more comfortable, stable and safely trackable device that can be fixed truly percutaneously. With engineering support of the industrial partner the radiolucent epiDRB was developed. It can be fixed with two or more pins and gains additional stability from its epicutaneous position. The intraoperative applicability and reliability was experimentally tested. Its low centre of gravity and its flat design allow the device to be located directly in the area of interest. Thanks to its epicutaneous position and its particular shape the epiDRB may perpetually be tracked by the navigation system without hindering the surgeon's actions. Hence, the risk of being displaced by accident is minimised and the line of sight remains unaffected. With the newly developed epiDRB computer-assisted navigation becomes easier and safer to handle even in punctures and other percutaneous procedures at the spine as much as at the extremities without an unproportionate amount of additional trauma. Due to the special design referencing of more than one vertebral body is possible at one time, thus decreasing radiation exposure and increasing efficiency.

Imageless navigation system does not improve component rotational alignment in total knee arthroplasty.

PubMed

Cheng, Tao; Zhang, Guoyou; Zhang, Xianlong

2011-12-01

The aim of computer-assisted surgery is to improve accuracy and limit the range of surgical variability. However, a worldwide debate exists regarding the importance and usefulness of computer-assisted navigation for total knee arthroplasty (TKA). The main purpose of this study is to summarize and compare the radiographic outcomes of TKA performed using imageless computer-assisted navigation compared with conventional techniques. An electronic search of PubMed, EMBASE, Web of Science, and Cochrane library databases was made, in addition to manual search of major orthopedic journals. A meta-analysis of 29 quasi-randomized/randomized controlled trials (quasi-RCTs/RCTs) and 11 prospective comparative studies was conducted through a random effects model. Additional a priori sources of clinical heterogeneity were evaluated by subgroup analysis with regard to radiographic methods. When the outlier cut-off value of lower limb axis was defined as ±2° or ±3° from the neutral, the postoperative full-length radiographs demonstrated that the risk ratio was 0.54 or 0.39, respectively, which were in favor of the navigated group. When the cut-off value used for the alignment in the coronal and sagittal plane was 2° or 3°, imageless navigation significantly reduced the outlier rate of the femoral and tibial components compared with the conventional group. Notably, computed tomography scans demonstrated no statistically significant differences between the two groups regarding the outliers in the rotational alignment of the femoral and tibial components; however, there was strong statistical heterogeneity. Our results indicated that imageless computer-assisted navigation systems improve lower limb axis and component orientation in the coronal and sagittal planes, but not the rotational alignment in TKA. Further multiple-center clinical trials with long-term follow-up are needed to determine differences in the clinical and functional outcomes of knee arthroplasties performed using computer-assisted techniques. Copyright © 2011 Elsevier Inc. All rights reserved.

The expert surgical assistant. An intelligent virtual environment with multimodal input.

PubMed

Billinghurst, M; Savage, J; Oppenheimer, P; Edmond, C

1996-01-01

Virtual Reality has made computer interfaces more intuitive but not more intelligent. This paper shows how an expert system can be coupled with multimodal input in a virtual environment to provide an intelligent simulation tool or surgical assistant. This is accomplished in three steps. First, voice and gestural input is interpreted and represented in a common semantic form. Second, a rule-based expert system is used to infer context and user actions from this semantic representation. Finally, the inferred user actions are matched against steps in a surgical procedure to monitor the user's progress and provide automatic feedback. In addition, the system can respond immediately to multimodal commands for navigational assistance and/or identification of critical anatomical structures. To show how these methods are used we present a prototype sinus surgery interface. The approach described here may easily be extended to a wide variety of medical and non-medical training applications by making simple changes to the expert system database and virtual environment models. Successful implementation of an expert system in both simulated and real surgery has enormous potential for the surgeon both in training and clinical practice.

Recent advances in 3D computed tomography techniques for simulation and navigation in hepatobiliary pancreatic surgery.

PubMed

Uchida, Masafumi

2014-04-01

A few years ago it could take several hours to complete a 3D image using a 3D workstation. Thanks to advances in computer science, obtaining results of interest now requires only a few minutes. Many recent 3D workstations or multimedia computers are equipped with onboard 3D virtual patient modeling software, which enables patient-specific preoperative assessment and virtual planning, navigation, and tool positioning. Although medical 3D imaging can now be conducted using various modalities, including computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasonography (US) among others, the highest quality images are obtained using CT data, and CT images are now the most commonly used source of data for 3D simulation and navigation image. If the 2D source image is bad, no amount of 3D image manipulation in software will provide a quality 3D image. In this exhibition, the recent advances in CT imaging technique and 3D visualization of the hepatobiliary and pancreatic abnormalities are featured, including scan and image reconstruction technique, contrast-enhanced techniques, new application of advanced CT scan techniques, and new virtual reality simulation and navigation imaging. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

3D-Printed Simulation Device for Orbital Surgery.

PubMed

Lichtenstein, Juergen Thomas; Zeller, Alexander Nicolai; Lemound, Juliana; Lichtenstein, Thorsten Enno; Rana, Majeed; Gellrich, Nils-Claudius; Wagner, Maximilian Eberhard

Orbital surgery is a challenging procedure because of its complex anatomy. Training could especially benefit from dedicated study models. The currently available devices lack sufficient anatomical representation and realistic soft tissue properties. Hence, we developed a 3D-printed simulation device for orbital surgery with tactual (haptic) correct simulation of all relevant anatomical structures. Based on computed tomography scans collected from patients treated in a third referral center, the hard and soft tissue were segmented and virtually processed to generate a 3D-model of the orbit. Hard tissue was then physically realized by 3D-printing. The soft tissue was manufactured by a composite silicone model of the nucleus and the surrounding tissue over a negative mold model also generated by 3D-printing. The final model was evaluated by a group of 5 trainees in oral and maxillofacial surgery (1) and a group of 5 consultants (2). All participants were asked to reconstruct an isolated orbital floor defect with a titanium implant. A stereotactic navigation system was available to all participants. Their experience was evaluated for haptic realism, correct representation of surgical approach, general handling of model, insertion of implant into the orbit, placement and fixation of implant, and usability of navigated control. The items were evaluated via nonparametric statistics (1 [poor]-5 [good]). Group 1 gave an average mark of 4.0 (±0.9) versus 4.6 (±0.6) by group 2. The haptics were rated as 3.6 (±1.1) [1] and 4.2 (±0.8) [2]. The surgical approach was graded 3.7 (±1.2) [1] and 4.0 (±1.0) [2]. Handling of the models was rated 3.5 (±1.1) [1] and 4 (±0.7) [2]. The insertion of the implants was marked as 3.7 (±0.8) [1] and 4.2 (±0.8) [2]. Fixation of the implants was also perceived to be realistic with 3.6 (±0.9) [1] and 4.2 (±0.45) [2]. Lastly, surgical navigation was rated 3.8 (±0.8) [1] and 4.6 (±0.56) [2]. In this project, all relevant hard and soft tissue characteristics of orbital anatomy could be realized. Moreover, it was possible to demonstrate that the entire workflow of an orbital procedure may be simulated. Hence, using this model training expenses may be reduced and patient security could be enhanced. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Incidence and risk factors for the misplacement of pedicle screws in scoliosis surgery assisted by O-arm navigation-analysis of a large series of one thousand, one hundred and forty five screws.

PubMed

Jin, Mengran; Liu, Zhen; Qiu, Yong; Yan, Huang; Han, Xiao; Zhu, Zezhang

2017-04-01

To assess the accuracy of O-arm-navigation-based pedicle screw placement in scoliosis surgery and identify the potential risk factors for the misplacement of pedicle screws. One hundred forty four scoliosis patients treated with O-arm-navigation-based pedicle screw instrumentation were enrolled, and 1145 pedicle screws implanted in the apical region of the curves were retrospectively reviewed for accuracy according to post-operative CT images. The potential risk factors and independent predictive factor(s) for the misplaced screws were identified statistically. The overall malpositioning rate of pedicle screw was 9.8%; 54.5% of which were misplaced laterally. Univariate and multivariate logistic regression analysis of clinical and surgical treatment variables indicated that patients with congenital scoliosis (CS) [OR: 1.489 (95% CI: 1.002-2.213; P = 0.035)] and neurofibromatosis type I (NF-1) [OR: 1.785 (95% CI: 1267-2.045; P = 0.026)], middle-thoracic spine [OR: 1.661 (95% CI: 1.107-2.481; P = 0.021)], the concave pedicles [OR: 1.527 (95% CI: 1.020-2.285; P = 0.019)], and the segments three levels away from the tracker [OR: 3.522 (95% CI: 2.357-5.263; P = 0.001)] were independently associated with pedicle screw misplacement. O-arm-assisted navigation does improve the accuracy and safety of pedicle screw placement in scoliosis surgery. However, unavoidable screw malpositioning remained, which occurred significantly more often in patients with CS and NF-1, in middle-thoracic spine, in the concave pedicles, and in the segments three levels away from the tracker.

A true minimally invasive approach for cochlear implantation: high accuracy in cranial base navigation through flat-panel-based volume computed tomography.

PubMed

Majdani, Omid; Bartling, Soenke H; Leinung, Martin; Stöver, Timo; Lenarz, Minoo; Dullin, Christian; Lenarz, Thomas

2008-02-01

High-precision intraoperative navigation using high-resolution flat-panel volume computed tomography makes feasible the possibility of minimally invasive cochlear implant surgery, including cochleostomy. Conventional cochlear implant surgery is typically performed via mastoidectomy with facial recess to identify and avoid damage to vital anatomic landmarks. To accomplish this procedure via a minimally invasive approach--without performing mastoidectomy--in a precise fashion, image-guided technology is necessary. With such an approach, surgical time and expertise may be reduced, and hearing preservation may be improved. Flat-panel volume computed tomography was used to scan 4 human temporal bones. A drilling channel was planned preoperatively from the mastoid surface to the round window niche, providing a margin of safety to all functional important structures (e.g., facial nerve, chorda tympani, incus). Postoperatively, computed tomographic imaging and conventional surgical exploration of the drilled route to the cochlea were performed. All 4 specimens showed a cochleostomy located at the scala tympani anterior inferior to the round window. The chorda tympani was damaged in 1 specimen--this was preoperatively planned as a narrow facial recess was encountered. Using flat-panel volume computed tomography for image-guided surgical navigation, we were able to perform minimally invasive cochlear implant surgery defined as a narrow, single-channel mastoidotomy with cochleostomy. Although this finding is preliminary, it is technologically achievable.

Screw Placement Accuracy for Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery: A Study on 3-D Neuronavigation-Guided Surgery

PubMed Central

Torres, Jorge; James, Andrew R.; Alimi, Marjan; Tsiouris, Apostolos John; Geannette, Christian; Härtl, Roger

2012-01-01

Purpose The aim of this study was to assess the impact of 3-D navigation for pedicle screw placement accuracy in minimally invasive transverse lumbar interbody fusion (MIS-TLIF). Methods A retrospective review of 52 patients who had MIS-TLIF assisted with 3D navigation is presented. Clinical outcomes were assessed with the Oswestry Disability Index (ODI), Visual Analog Scales (VAS), and MacNab scores. Radiographic outcomes were assessed using X-rays and thin-slice computed tomography. Result The mean age was 56.5 years, and 172 screws were implanted with 16 pedicle breaches (91.0% accuracy rate). Radiographic fusion rate at a mean follow-up of 15.6 months was 87.23%. No revision surgeries were required. The mean improvement in the VAS back pain, VAS leg pain, and ODI at 11.3 months follow-up was 4.3, 4.5, and 26.8 points, respectively. At last follow-up the mean postoperative disc height gain was 4.92 mm and the mean postoperative disc angle gain was 2.79 degrees. At L5–S1 level, there was a significant correlation between a greater disc space height gain and a lower VAS leg score. Conclusion Our data support that application of 3-D navigation in MIS-TLIF is associated with a high level of accuracy in the pedicle screw placement. PMID:24353961

Medical robotics.

PubMed

Ferrigno, Giancarlo; Baroni, Guido; Casolo, Federico; De Momi, Elena; Gini, Giuseppina; Matteucci, Matteo; Pedrocchi, Alessandra

2011-01-01

Information and communication technology (ICT) and mechatronics play a basic role in medical robotics and computer-aided therapy. In the last three decades, in fact, ICT technology has strongly entered the health-care field, bringing in new techniques to support therapy and rehabilitation. In this frame, medical robotics is an expansion of the service and professional robotics as well as other technologies, as surgical navigation has been introduced especially in minimally invasive surgery. Localization systems also provide treatments in radiotherapy and radiosurgery with high precision. Virtual or augmented reality plays a role for both surgical training and planning and for safe rehabilitation in the first stage of the recovery from neurological diseases. Also, in the chronic phase of motor diseases, robotics helps with special assistive devices and prostheses. Although, in the past, the actual need and advantage of navigation, localization, and robotics in surgery and therapy has been in doubt, today, the availability of better hardware (e.g., microrobots) and more sophisticated algorithms(e.g., machine learning and other cognitive approaches)has largely increased the field of applications of these technologies,making it more likely that, in the near future, their presence will be dramatically increased, taking advantage of the generational change of the end users and the increasing request of quality in health-care delivery and management.

A comparison of CT-based navigation techniques for minimally invasive lumbar pedicle screw placement.

PubMed

Wood, Martin; Mannion, Richard

2011-02-01

A comparison of 2 surgical techniques. To determine the relative accuracy of minimally invasive lumbar pedicle screw placement using 2 different CT-based image-guided techniques. Three-dimensional intraoperative fluoroscopy systems have recently become available that provide the ability to use CT-quality images for navigation during image-guided minimally invasive spinal surgery. However, the cost of this equipment may negate any potential benefit in navigational accuracy. We therefore assess the accuracy of pedicle screw placement using an intraoperative 3-dimensional fluoroscope for guidance compared with a technique using preoperative CT images merged to intraoperative 2-dimensional fluoroscopy. Sixty-seven patients undergoing minimally invasive placement of lumbar pedicle screws (296 screws) using a navigated, image-guided technique were studied and the accuracy of pedicle screw placement assessed. Electromyography (EMG) monitoring of lumbar nerve roots was used in all. Group 1: 24 patients in whom a preoperative CT scan was merged with intraoperative 2-dimensional fluoroscopy images on the image-guidance system. Group 2: 43 patients using intraoperative 3-dimensional fluoroscopy images as the source for the image guidance system. The frequencies of pedicle breach and EMG warnings (indicating potentially unsafe screw placement) in each group were recorded. The rate of pedicle screw misplacement was 6.4% in group 1 vs 1.6% in group 2 (P=0.03). There were no cases of neurologic injury from suboptimal placement of screws. Additionally, the incidence of EMG warnings was significantly lower in group 2 (3.7% vs. 10% (P=0.03). The use of an intraoperative 3-dimensional fluoroscopy system with an image-guidance system results in greater accuracy of pedicle screw placement than the use of preoperative CT scans, although potentially dangerous placement of pedicle screws can be prevented by the use of EMG monitoring of lumbar nerve roots.

Minimally invasive scoliosis surgery assisted by O-arm navigation for Lenke Type 5C adolescent idiopathic scoliosis: a comparison with standard open approach spinal instrumentation.

PubMed

Zhu, Weiguo; Sun, Weixiang; Xu, Leilei; Sun, Xu; Liu, Zhen; Qiu, Yong; Zhu, Zezhang

2017-04-01

OBJECTIVE Recently, minimally invasive scoliosis surgery (MISS) was introduced for the correction of adult scoliosis. Multiple benefits including a good deformity correction rate and fewer complications have been demonstrated. However, few studies have reported on the use of MISS for the management of adolescent idiopathic scoliosis (AIS). The purpose of this study was to investigate the outcome of posterior MISS assisted by O-arm navigation for the correction of Lenke Type 5C AIS. METHODS The authors searched a database for all patients with AIS who had been treated with either MISS or PSF between November 2012 and January 2014. Levels of fusion, density of implants, operation time, and estimated blood loss (EBL) were recorded. Coronal and sagittal parameters were evaluated before surgery, immediately after surgery, and at the last follow-up. The accuracy of pedicle screw placement was assessed according to postoperative axial CT images in both groups. The 22-item Scoliosis Research Society questionnaire (SRS-22) results and complications were collected during follow-up. RESULTS The authors retrospectively reviewed the records of 45 patients with Lenke Type 5C AIS, 15 who underwent posterior MISS under O-arm navigation and 30 who underwent posterior spinal fusion (PSF). The 2 treatment groups were matched in terms of baseline characteristics. Comparison of radiographic parameters revealed no obvious difference between the 2 groups immediately after surgery or at the final follow-up; however, the MISS patients had significantly less EBL (p < 0.001) and longer operation times (p = 0.002). The evaluation of pain and self-image using the SRS-22 showed significantly higher scores in the MISS group (p = 0.013 and 0.046, respectively) than in the PSF group. Postoperative CT showed high accuracy in pedicle placement in both groups. No deep wound infection, pseudarthrosis, additional surgery, implant failure, or neurological complications were recorded in either group. CONCLUSIONS Minimally invasive scoliosis surgery is an effective and safe alternative to open surgery for patients with Lenke Type 5C AIS. Compared with results of the open approach, the outcomes of MISS are promising, with reduced morbidity. Before the routine use of MISS, however, long-term data are needed.

30 Years of Neurosurgical Robots: Review and Trends for Manipulators and Associated Navigational Systems.

PubMed

Smith, James Andrew; Jivraj, Jamil; Wong, Ronnie; Yang, Victor

2016-04-01

This review provides an examination of contemporary neurosurgical robots and the developments that led to them. Improvements in localization, microsurgery and minimally invasive surgery have made robotic neurosurgery viable, as seen by the success of platforms such as the CyberKnife and neuromate. Neurosurgical robots can now perform specific surgical tasks such as skull-base drilling and craniotomies, as well as pedicle screw and cochlear electrode insertions. Growth trends in neurosurgical robotics are likely to continue but may be tempered by concerns over recent surgical robot recalls, commercially-driven surgeon training, and studies that show operational costs for surgical robotic procedures are often higher than traditional surgical methods. We point out that addressing performance issues related to navigation-related registration is an active area of research and will aid in improving overall robot neurosurgery performance and associated costs.

Matching CT and ultrasound data of the liver by landmark constrained image registration

NASA Astrophysics Data System (ADS)

Olesch, Janine; Papenberg, Nils; Lange, Thomas; Conrad, Matthias; Fischer, Bernd

2009-02-01

In navigated liver surgery the key challenge is the registration of pre-operative planing and intra-operative navigation data. Due to the patients individual anatomy the planning is based on segmented, pre-operative CT scans whereas ultrasound captures the actual intra-operative situation. In this paper we derive a novel method based on variational image registration methods and additional given anatomic landmarks. For the first time we embed the landmark information as inequality hard constraints and thereby allowing for inaccurately placed landmarks. The yielding optimization problem allows to ensure the accuracy of the landmark fit by simultaneous intensity based image registration. Following the discretize-then-optimize approach the overall problem is solved by a generalized Gauss-Newton-method. The upcoming linear system is attacked by the MinRes solver. We demonstrate the applicability of the new approach for clinical data which lead to convincing results.

Three-Dimensional Anatomic Evaluation of the Anterior Cruciate Ligament for Planning Reconstruction

PubMed Central

Hoshino, Yuichi; Kim, Donghwi; Fu, Freddie H.

2012-01-01

Anatomic study related to the anterior cruciate ligament (ACL) reconstruction surgery has been developed in accordance with the progress of imaging technology. Advances in imaging techniques, especially the move from two-dimensional (2D) to three-dimensional (3D) image analysis, substantially contribute to anatomic understanding and its application to advanced ACL reconstruction surgery. This paper introduces previous research about image analysis of the ACL anatomy and its application to ACL reconstruction surgery. Crucial bony landmarks for the accurate placement of the ACL graft can be identified by 3D imaging technique. Additionally, 3D-CT analysis of the ACL insertion site anatomy provides better and more consistent evaluation than conventional “clock-face” reference and roentgenologic quadrant method. Since the human anatomy has a complex three-dimensional structure, further anatomic research using three-dimensional imaging analysis and its clinical application by navigation system or other technologies is warranted for the improvement of the ACL reconstruction. PMID:22567310

Economic evaluation comparing intraoperative cone beam CT-based navigation and conventional fluoroscopy for the placement of spinal pedicle screws: a patient-level data cost-effectiveness analysis.

PubMed

Dea, Nicolas; Fisher, Charles G; Batke, Juliet; Strelzow, Jason; Mendelsohn, Daniel; Paquette, Scott J; Kwon, Brian K; Boyd, Michael D; Dvorak, Marcel F S; Street, John T

2016-01-01

Pedicle screws are routinely used in contemporary spinal surgery. Screw misplacement may be asymptomatic but is also correlated with potential adverse events. Computer-assisted surgery (CAS) has been associated with improved screw placement accuracy rates. However, this technology has substantial acquisition and maintenance costs. Despite its increasing usage, no rigorous full economic evaluation comparing this technology to current standard of care has been reported. Medical costs are exploding in an unsustainable way. Health economic theory requires that medical equipment costs be compared with expected benefits. To answer this question for computer-assisted spinal surgery, we present an economic evaluation looking specifically at symptomatic misplaced screws leading to reoperation secondary to neurologic deficits or biomechanical concerns. The study design was an observational case-control study from prospectively collected data of consecutive patients treated with the aid of CAS (treatment group) compared with a matched historical cohort of patients treated with conventional fluoroscopy (control group). The patient sample consisted of consecutive patients treated surgically at a quaternary academic center. The primary effectiveness measure studied was the number of reoperations for misplaced screws within 1 year of the index surgery. Secondary outcome measures included were total adverse event rate and postoperative computed tomography usage for pedicle screw examination. A patient-level data cost-effectiveness analysis from the hospital perspective was conducted to determine the value of a navigation system coupled with intraoperative 3-D imaging (O-arm Imaging and the StealthStation S7 Navigation Systems, Medtronic, Louisville, CO, USA) in adult spinal surgery. The capital costs for both alternatives were reported as equivalent annual costs based on the annuitization of capital expenditures method using a 3% discount rate and a 7-year amortization period. Annual maintenance costs were also added. Finally, reoperation costs using a micro-costing approach were calculated for both groups. An incremental cost-effectiveness ratio was calculated and reported as cost per reoperation avoided. Based on reoperation costs in Canada and in the United States, a minimal caseload was calculated for the more expensive alternative to be cost saving. Sensitivity analyses were also conducted. A total of 5,132 pedicle screws were inserted in 502 patients during the study period: 2,682 screws in 253 patients in the treatment group and 2,450 screws in 249 patients in the control group. Overall accuracy rates were 95.2% for the treatment group and 86.9% for the control group. Within 1 year post treatment, two patients (0.8%) required a revision surgery in the treatment group compared with 15 patients (6%) in the control group. An incremental cost-effectiveness ratio of $15,961 per reoperation avoided was calculated for the CAS group. Based on a reoperation cost of $12,618, this new technology becomes cost saving for centers performing more than 254 instrumented spinal procedures per year. Computer-assisted spinal surgery has the potential to reduce reoperation rates and thus to have serious cost-effectiveness and policy implications. High acquisition and maintenance costs of this technology can be offset by equally high reoperation costs. Our cost-effectiveness analysis showed that for high-volume centers with a similar case complexity to the studied population, this technology is economically justified. Copyright © 2015 Elsevier Inc. All rights reserved.

Total knee arthroplasty with computer-assisted navigation more closely replicates normal knee biomechanics than conventional surgery.

PubMed

McClelland, Jodie A; Webster, Kate E; Ramteke, Alankar A; Feller, Julian A

2017-06-01

Computer-assisted navigation in total knee arthroplasty (TKA) reduces variability and may improve accuracy in the postoperative static alignment. The effect of navigation on alignment and biomechanics during more dynamic movements has not been investigated. This study compared knee biomechanics during level walking of 121 participants: 39 with conventional TKA, 42 with computer-assisted navigation TKA and 40 unimpaired control participants. Standing lower-limb alignment was significantly closer to ideal in participants with navigation TKA. During gait, when differences in walking speed were accounted for, participants with conventional TKA had less knee flexion during stance and swing than controls (P<0.01), but there were no differences between participants with navigation TKA and controls for the same variables. Both groups of participants with TKA had lower knee adduction moments than controls (P<0.01). In summary, there were fewer differences in the biomechanics of computer-assisted navigation TKA patients compared to controls than for patients with conventional TKA. Computer-assisted navigation TKA may restore biomechanics during walking that are closer to normal than conventional TKA. Copyright © 2017 Elsevier B.V. All rights reserved.

Image-Based Navigation for Functional Endoscopic Sinus Surgery Using Structure From Motion.

PubMed

Leonard, Simon; Reiter, Austin; Sinha, Ayushi; Ishii, Masaru; Taylor, Russel H; Hager, Gregory D

2016-01-01

Functional Endoscopic Sinus Surgery (FESS) is a challenging procedure for otolaryngologists and is the main surgical approach for treating chronic sinusitis, to remove nasal polyps and open up passageways. To reach the source of the problem and to ultimately remove it, the surgeons must often remove several layers of cartilage and tissues. Often, the cartilage occludes or is within a few millimeters of critical anatomical structures such as nerves, arteries and ducts. To make FESS safer, surgeons use navigation systems that register a patient to his/her CT scan and track the position of the tools inside the patient. Current navigation systems, however, suffer from tracking errors greater than 1 mm, which is large when compared to the scale of the sinus cavities, and errors of this magnitude prevent from accurately overlaying virtual structures on the endoscope images. In this paper, we present a method to facilitate this task by 1) registering endoscopic images to CT data and 2) overlaying areas of interests on endoscope images to improve the safety of the procedure. First, our system uses structure from motion (SfM) to generate a small cloud of 3D points from a short video sequence. Then, it uses iterative closest point (ICP) algorithm to register the points to a 3D mesh that represents a section of a patients sinuses. The scale of the point cloud is approximated by measuring the magnitude of the endoscope's motion during the sequence. We have recorded several video sequences from five patients and, given a reasonable initial registration estimate, our results demonstrate an average registration error of 1.21 mm when the endoscope is viewing erectile tissues and an average registration error of 0.91 mm when the endoscope is viewing non-erectile tissues. Our implementation SfM + ICP can execute in less than 7 seconds and can use as few as 15 frames (0.5 second of video). Future work will involve clinical validation of our results and strengthening the robustness to initial guesses and erectile tissues.

Image-based navigation for functional endoscopic sinus surgery using structure from motion

NASA Astrophysics Data System (ADS)

Leonard, Simon; Reiter, Austin; Sinha, Ayushi; Ishii, Masaru; Taylor, Russell H.; Hager, Gregory D.

2016-03-01

Functional Endoscopic Sinus Surgery (FESS) is a challenging procedure for otolaryngologists and is the main surgical approach for treating chronic sinusitis, to remove nasal polyps and open up passageways. To reach the source of the problem and to ultimately remove it, the surgeons must often remove several layers of cartilage and tissues. Often, the cartilage occludes or is within a few millimeters of critical anatomical structures such as nerves, arteries and ducts. To make FESS safer, surgeons use navigation systems that register a patient to his/her CT scan and track the position of the tools inside the patient. Current navigation systems, however, suffer from tracking errors greater than 1 mm, which is large when compared to the scale of the sinus cavities, and errors of this magnitude prevent from accurately overlaying virtual structures on the endoscope images. In this paper, we present a method to facilitate this task by 1) registering endoscopic images to CT data and 2) overlaying areas of interests on endoscope images to improve the safety of the procedure. First, our system uses structure from motion (SfM) to generate a small cloud of 3D points from a short video sequence. Then, it uses iterative closest point (ICP) algorithm to register the points to a 3D mesh that represents a section of a patients sinuses. The scale of the point cloud is approximated by measuring the magnitude of the endoscope's motion during the sequence. We have recorded several video sequences from five patients and, given a reasonable initial registration estimate, our results demonstrate an average registration error of 1.21 mm when the endoscope is viewing erectile tissues and an average registration error of 0.91 mm when the endoscope is viewing non-erectile tissues. Our implementation SfM + ICP can execute in less than 7 seconds and can use as few as 15 frames (0.5 second of video). Future work will involve clinical validation of our results and strengthening the robustness to initial guesses and erectile tissues.

Caring for class III obese patients.

PubMed

Gardner, Lea Anne

2013-11-01

The Pennsylvania Patient Safety Reporting System is a confidential, statewide Internet reporting system to which all Pennsylvania hospitals, outpatient-surgery facilities, and birthing centers, as well as some abortion facilities, must file information on medical errors.Safety Monitor is a column from Pennsylvania's Patient Safety Authority, the authority that informs nurses on issues that can affect patient safety and presents strategies they can easily integrate into practice. For more information on the authority, visit www.patientsafetyauthority.org. For the original article discussed in this column or for other articles on patient safety, click on "Patient Safety Advisories" and then "Advisory Library" in the left-hand navigation menu.

Single-Incision Multiport/Single Port Laparoscopic Abdominal Surgery (SILAP): A Prospective Multicenter Observational Quality Study.

PubMed

Mantke, Rene; Diener, Markus; Kropf, Siegfried; Otto, Ronny; Manger, Thomas; Vestweber, Boris; Mirow, Lutz; Winde, Günther; Lippert, Hans

2016-09-07

Increasing experience with minimally invasive surgery and the development of new instruments has resulted in a tendency toward reducing the number of abdominal skin incisions. Retrospective and randomized prospective studies could show the feasibility of single-incision surgery without any increased risk to the patient. However, large prospective multicenter observational datasets do not currently exist. This prospective multicenter observational quality study will provide a relevant dataset reflecting the feasibility and safety of single-incision surgery. This study focuses on external validity, clinical relevance, and the patients' perspective. Accordingly, the single-incision multiport/single port laparoscopic abdominal surgery (SILAP) study will supplement the existing evidence, which does not currently allow evidence-based surgical decision making. The SILAP study is an international prospective multicenter observational quality study. Mortality, morbidity, complications during surgery, complications postoperatively, patient characteristics, and technical aspects will be monitored. We expect more than 100 surgical centers to participate with 5000 patients with abdominal single-incision surgery during the study period. Funding was obtained in 2012. Enrollment began on January 01, 2013, and will be completed on December 31, 2018. As of January 2016, 2119 patients have been included, 106 German centers are registered, and 27 centers are very active (>5 patients per year). This prospective multicenter observational quality study will provide a relevant dataset reflecting the feasibility and safety of single-incision surgery. An international enlargement and recruitment of centers outside of Germany is meaningful. German Clinical Trials Register: DRKS00004594; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004594 (Archived by WebCite at http://www.webcitation.org/6jK6ZVyUs).

[Using the CAS (computer-assisted surgery) system in arthroscopic cruciate ligament surgery--adaptation and application in clinical practice].

PubMed

Bernsmann, K; Rosenthal, A; Sati, M; Ansari, B; Wiese, M

2001-01-01

The anterior cruciate ligament (ACL) is of great importance for the knee joint function. In the case of a complete ligament injury there is hardly any chance for complete recovery. The clear advantages of an operative reconstruction by replacing the ACL has been shown in many trails. The accurate placement of the graft's insertions has a significant effect on the mid- and probably long-term outcome of this procedure. Reviewing the literature, there are poor long-term results of ACL replacement in 5 to 52% of all cases, depending on the score system. One of the main reasons for unacceptable results is graft misplacement. This led to the construction of a CAS system for ACL replacement. The system assists this surgical procedure by navigating the exact position of the drilling holes. The Potential deformation quantity of the transplant can be controlled by this system in real time. 40 computer-assisted ACL replacements have been performed under active use of the CAS system. The short-term results are encouraging, no special complications have been seen so far. Prospective long-term follow-up studies are ongoing. ACL reconstruction by manual devices has many sources of error. The CAS system is able to give the surgeon reasonable views that are unachieveable by conventional surgery. He is therefore able to control a source of error and to optimise the results. The feasibility of this device in clinical routine use has been proven.

[Impact of digital technology on clinical practices: perspectives from surgery].

PubMed

Zhang, Y; Liu, X J

2016-04-09

Digital medical technologies or computer aided medical procedures, refer to imaging, 3D reconstruction, virtual design, 3D printing, navigation guided surgery and robotic assisted surgery techniques. These techniques are integrated into conventional surgical procedures to create new clinical protocols that are known as "digital surgical techniques". Conventional health care is characterized by subjective experiences, while digital medical technologies bring quantifiable information, transferable data, repeatable methods and predictable outcomes into clinical practices. Being integrated into clinical practice, digital techniques facilitate surgical care by improving outcomes and reducing risks. Digital techniques are becoming increasingly popular in trauma surgery, orthopedics, neurosurgery, plastic and reconstructive surgery, imaging and anatomic sciences. Robotic assisted surgery is also evolving and being applied in general surgery, cardiovascular surgery and orthopedic surgery. Rapid development of digital medical technologies is changing healthcare and clinical practices. It is therefore important for all clinicians to purposefully adapt to these technologies and improve their clinical outcomes.

Development of a femoral template for computer-assisted tunnel placement in anatomical double-bundle ACL reconstruction.

PubMed

Luites, J W H; Wymenga, A B; Blankevoort, L; Kooloos, J M G; Verdonschot, N

2011-01-01

Femoral graft placement is an important factor in the success of anterior cruciate ligament (ACL) reconstruction. In addition to improving the accuracy of femoral tunnel placement, Computer Assisted Surgery (CAS) can be used to determine the anatomic location. This is achieved by using a 3D femoral template which indicates the position of the anatomical ACL center based on endoscopically measurable landmarks. This study describes the development and application of this method. The template is generated through statistical shape analysis of the ACL insertion, with respect to the anteromedial (AM) and posterolateral (PL) bundles. The ligament insertion data, together with the osteocartilage edge on the lateral notch, were mapped onto a cylinder fitted to the intercondylar notch surface (n = 33). Anatomic variation, in terms of standard variation of the positions of the ligament centers in the template, was within 2.2 mm. The resulting template was programmed in a computer-assisted navigation system for ACL replacement and its accuracy and precision were determined on 31 femora. It was found that with the navigation system the AM and PL tunnels could be positioned with an accuracy of 2.5 mm relative to the anatomic insertion centers; the precision was 2.4 mm. This system consists of a template that can easily be implemented in 3D computer navigation software. Requiring no preoperative images and planning, the system provides adequate accuracy and precision to position the entrance of the femoral tunnels for anatomical single- or double-bundle ACL reconstruction.

The application of surgical navigation system using optical molecular imaging technology in orthotopic breast cancer and metastasis studies

NASA Astrophysics Data System (ADS)

Chi, Chongwei; Zhang, Qian; Kou, Deqiang; Ye, Jinzuo; Mao, Yamin; Qiu, Jingdan; Wang, Jiandong; Yang, Xin; Du, Yang; Tian, Jie

2014-02-01

Currently, it has been an international focus on intraoperative precise positioning and accurate resection of tumor and metastases. The methods such as X-rays, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have played an important role in preoperative accurate diagnosis. However, most of them are inapplicable for intraoperative surgery. We have proposed a surgical navigation system based on optical molecular imaging technology for intraoperative detection of tumors and metastasis. This system collects images from two CCD cameras for real-time fluorescent and color imaging. For image processing, the template matching algorithm is used for multispectral image fusion. For the application of tumor detection, the mouse breast cancer cell line 4T1-luc, which shows highly metastasis, was used for tumor model establishment and a model of matrix metalloproteinase (MMP) expressing breast cancer. The tumor-bearing nude mice were given tail vein injection of MMP 750FAST (PerkinElmer, Inc. USA) probe and imaged with both bioluminescence and fluorescence to assess in vivo binding of the probe to the tumor and metastases sites. Hematoxylin and eosin (H&E) staining was performed to confirm the presence of tumor and metastasis. As a result, one tumor can be observed visually in vivo. However liver metastasis has been detected under surgical navigation system and all were confirmed by histology. This approach helps surgeons to find orthotopic tumors and metastasis during intraoperative resection and visualize tumor borders for precise positioning. Further investigation is needed for future application in clinics.

Real-time navigation system for sentinel lymph node biopsy in breast cancer patients using projection mapping with indocyanine green fluorescence.

PubMed

Takada, Masahiro; Takeuchi, Megumi; Suzuki, Eiji; Sato, Fumiaki; Matsumoto, Yoshiaki; Torii, Masae; Kawaguchi-Sakita, Nobuko; Nishino, Hiroto; Seo, Satoru; Hatano, Etsuro; Toi, Masakazu

2018-05-09

Inability to visualize indocyanine green fluorescence images in the surgical field limits the application of current near-infrared fluorescence imaging (NIR) systems for real-time navigation during sentinel lymph node (SLN) biopsy in breast cancer patients. The aim of this study was to evaluate the usefulness of the Medical Imaging Projection System (MIPS), which uses active projection mapping, for SLN biopsy. A total of 56 patients (59 procedures) underwent SLN biopsy using the MIPS between March 2016 and November 2017. After SLN biopsy using the MIPS, residual SLNs were removed using a conventional NIR camera and/or radioisotope method. The primary endpoint of this study was identification rate of SLNs using the MIPS. In all procedures, at least one SLN was detected by the MIPS, giving an SLN identification rate of 100% [95% confidence interval (CI) 94-100%]. SLN biopsy was successfully performed without operating lights in all procedures. In total, 3 positive SLNs were excised using MIPS, but were not included in the additional SLNs excised by other methods. The median number of SLNs excised using the MIPS was 3 (range 1-7). Of procedures performed after preoperative systemic therapy, the median number of SLNs excised using the MIPS was 3 (range 2-6). The MIPS is effective in detecting SLNs in patients with breast cancer, providing continuous and accurate projection of fluorescence signals in the surgical field, without need for operating lights, and could be useful in real-time navigation surgery for SLN biopsy.

Magnetic navigation for thoracic aortic stent-graft deployment using ultrasound image guidance.

PubMed

Luo, Zhe; Cai, Junfeng; Wang, Su; Zhao, Qiang; Peters, Terry M; Gu, Lixu

2013-03-01

We propose a system for thoracic aortic stent-graft deployment that employs a magnetic tracking system (MTS) and intraoperative ultrasound (US). A preoperative plan is first performed using a general public utilities-accelerated cardiac modeling method to determine the target position of the stent-graft. During the surgery, an MTS is employed to track sensors embedded in the catheter, cannula, and the US probe, while a fiducial landmark based registration is used to map the patient's coordinate to the image coordinate. The surgical target is tracked in real time via a calibrated intraoperative US image. Under the guidance of the MTS integrated with the real-time US images, the stent-graft can be deployed to the target position without the use of ionizing radiation. This navigation approach was validated using both phantom and animal studies. In the phantom study, we demonstrate a US calibration accuracy of 1.5 ± 0.47 mm, and a deployment error of 1.4 ± 0.16 mm. In the animal study, we performed experiments on five porcine subjects and recorded fiducial, target, and deployment errors of 2.5 ± 0.32, 4.2 ± 0.78, and 2.43 ± 0.69 mm, respectively. These results demonstrate that delivery and deployment of thoracic stent-graft under MTS-guided navigation using US imaging is feasible and appropriate for clinical application.

The evolution and future of minimalism in neurological surgery.

PubMed

Liu, Charles Y; Wang, Michael Y; Apuzzo, Michael L J

2004-11-01

The evolution of the field of neurological surgery has been marked by a progressive minimalism. This has been evident in the development of an entire arsenal of modern neurosurgical enterprises, including microneurosurgery, neuroendoscopy, stereotactic neurosurgery, endovascular techniques, radiosurgical systems, intraoperative and navigational devices, and in the last decade, cellular and molecular adjuvants. In addition to reviewing the major developments and paradigm shifts in the cyclic reinvention of the field as it currently stands, this paper attempts to identify forces and developments that are likely to fuel the irresistible escalation of minimalism into the future. These forces include discoveries in computational science, imaging, molecular science, biomedical engineering, and information processing as they relate to the theme of minimalism. These areas are explained in the light of future possibilities offered by the emerging field of nanotechnology with molecular engineering.

Biological fiducial point based registration for multiple brain tissues reconstructed from different imaging modalities

NASA Astrophysics Data System (ADS)

Wu, Huiqun; Zhou, Gangping; Geng, Xingyun; Zhang, Xiaofeng; Jiang, Kui; Tang, Lemin; Zhou, Guomin; Dong, Jiancheng

2013-10-01

With the development of computer aided navigation system, more and more tissues shall be reconstructed to provide more useful information for surgical pathway planning. In this study, we aimed to propose a registration framework for different reconstructed tissues from multi-modalities based on some fiducial points on lateral ventricles. A male patient with brain lesion was admitted and his brain scans were performed by different modalities. Then, the different brain tissues were segmented in different modality with relevant suitable algorithms. Marching cubes were calculated for three dimensional reconstructions, and then the rendered tissues were imported to a common coordinate system for registration. Four pairs of fiducial markers were selected to calculate the rotation and translation matrix using least-square measure method. The registration results were satisfied in a glioblastoma surgery planning as it provides the spatial relationship between tumors and surrounding fibers as well as vessels. Hence, our framework is of potential value for clinicians to plan surgery.

[The operating room of the future].

PubMed

Broeders, I A; Niessen, W; van der Werken, C; van Vroonhoven, T J

2000-01-29

Advances in computer technology will revolutionize surgical techniques in the next decade. The operating room (OR) of the future will be connected with a laboratory where clinical specialists and researchers prepare image-guided interventions and explore the possibilities of these techniques. The virtual reality is linked to the actual situation in the OR with the aid of navigation instruments. During complicated operations the images prepared preoperatively will be corrected during the operation on the basis of the information obtained peroperatively. MRI currently offers maximal possibilities for image-guided surgery of soft tissues. Simpler techniques such as fluoroscopy and echography will become increasingly integrated in computer-assisted peroperative navigation. The development of medical robot systems will make possible microsurgical procedures by the endoscopic route. Tele-manipulation systems will also play a part in the training of surgeons. Design and construction of the OR will be adapted to the surgical technology, and include an information and control unit where preoperative and peroperative data come together and from where the surgeon operates the instruments. Concepts for the future OR should be regularly adjusted to allow for new surgical technology.

Reducing barriers to breast cancer care through Avon patient navigation programs.

PubMed

Stanley, Sandte; Arriola, Kimberly Jacob; Smith, Shakiyla; Hurlbert, Marc; Ricci, Carolyn; Escoffery, Cam

2013-01-01

Avon Foundation for Women grantees provide breast cancer services through patient navigation (PN) in an effort to alleviate barriers to care among underserved women. To gain a better understanding of how PN programs function, this study explores variations in the use of navigators, types of services offered, description of clients they serve, tracking of treatment completion, and evaluation mechanisms. Fifty-six Avon PN programs funded since 2008 throughout the United States were contacted. An online survey was distributed to the grantees of which 44 (81%) complete responses were collected and analyzed. Clients were racially and ethnically diverse, mostly in the 40- to 64-year old age range (64%) and 91.6% with an average income of less than $30 000. Women were either uninsured (50.7%) or receiving Medicaid (32.4%). PN programs were both community and hospital-based (22.5%); many hospitals (35.2%) were described as safety nets (eg, provide a significant level of care to low-income, uninsured, vulnerable populations). On-site services included breast screening (eg, mammography and breast ultrasound) and treatment (eg, breast surgery and radiation therapy). Some barriers to care identified by the programs included transportation, access to appointments, language, and financial issues (eg, cost of screening and treatment specifically for those uninsured). More than 39% of programs provided care across the cancer continuum. Many Avon PN programs incorporated navigation services that span the cancer care continuum. They addressed disparities by offering navigation and on-site medical services to reduce multiple systems barriers and social issues related to breast care.

Internet Presentation of Departments of Pediatric Surgery in Germany and Their Compliance with Recommended Criteria for Promoting Services and Offering Professional Information for Patients.

PubMed

Farhat, Naim; Zoeller, Christoph; Petersen, Claus; Ure, Benno

2016-08-01

Introduction The presentation of health institutions in the internet is highly variable concerning marketing features and medical information. We aimed to investigate the structure and the kind of information provided on the Web sites of all departments of pediatric surgery in Germany. Furthermore, we aimed to identify the degree to which these Web sites comply with internet marketing recommendations for generating business. Method The Web sites of all pediatric surgery units referred to as departments on the official Web site of the German Society of Pediatric Surgery (GSPS) were assessed. The search engine Google was used by entering the terms "pediatric surgery" and the name of the city. Besides general data eight content characteristics focusing on ranking, accessibility, use of social media, multilingual sites, navigation options, selected images, contact details, and medical information were evaluated according to published recommendations. Results A total of 85 departments of pediatric surgery were included. On Google search results 44 (52%) ranked number one and 34 (40%) of the department's homepages were accessible directly through the homepage link of the GSPS. A link to own digital and/or social media was offered on 11 (13%) homepages. Nine sites were multilingual. The most common navigation bar item was clinical services on 74 (87%) homepages. Overall, 76 (89%) departments presented their doctors and 17 (20%) presented other staff members with images of doctors on 53 (62%) and contact data access from the homepage on 68 (80%) Web sites. On 25 (29%) Web sites information on the medical conditions treated were presented, on 17 (20%) details of treating concepts, and on 4 (5%) numbers of patients with specific conditions treated in the own department per year. Conclusion We conclude that numerous of the investigated online presentations do not comply with recommended criteria for offering professional information for patients and for promoting services. Only less than one-third of the departments of pediatric surgery in Germany offer information about the medical conditions they treat. Features, which may influence the decision of patients and parents such as ranking, accessibility, use of social media, multilingual sites, navigation options, selected images, and contact information were differently lacking on many Web sites. Georg Thieme Verlag KG Stuttgart · New York.

33 CFR 62.51 - Western Rivers Marking System.

Code of Federal Regulations, 2012 CFR

2012-07-01

....51 Section 62.51 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.51 Western Rivers Marking System. (a) A variation of the standard U.S. aids to navigation system described above is employed...

33 CFR 62.51 - Western Rivers Marking System.

Code of Federal Regulations, 2013 CFR

2013-07-01

....51 Section 62.51 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.51 Western Rivers Marking System. (a) A variation of the standard U.S. aids to navigation system described above is employed...

33 CFR 62.51 - Western Rivers Marking System.

Code of Federal Regulations, 2014 CFR

2014-07-01

....51 Section 62.51 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.51 Western Rivers Marking System. (a) A variation of the standard U.S. aids to navigation system described above is employed...

The Application of Surgical Navigation in the Treatment of Temporomandibular Joint Ankylosis.

PubMed

Sun, Guowen; Lu, Mingxing; Hu, Qingang

2015-11-01

The purpose of this study was to assess the safety and the accuracy of surgical navigation technology in the resection of severe ankylosis of the mandibular condyle with the middle cranial fossa. The computed tomography scan data were transferred to a Windows-based computer workstation, and the patient's individual anatomy was assessed in multiplanar views at the workstation. In the operation, the patient and the virtual image were matched by individual registration with the reference points which were set on the skull bone surface and the teeth. Then, the real-time navigation can be performed. The acquisition of the data sets was uncomplicated, and image quality was sufficient to assess the operative result in 2 cases. Both of the operations were performed successfully with the guidance of real-time navigation. The application of surgical navigation has enhanced the safety and the accuracy of the surgery for bony ankylosis of temporomandibular joint. The use of surgical navigation resulted in the promotion of accurate and safe surgical excision of the ankylosed skull base tissue.

A novel concept for smart trepanation.

PubMed

Follmann, Axel; Korff, Alexander; Fuertjes, Tobias; Kunze, Sandra C; Schmieder, Kirsten; Radermacher, Klaus

2012-01-01

Trepanation of the skull is a common procedure in craniofacial and neurosurgical interventions, allowing access to the innermost cranial structures. Despite a careful advancement, injury of the dura mater represents a frequent complication during these cranial openings. The technology of computer-assisted surgery offers different support systems such as navigated tools and surgical robots. This article presents a novel technical approach toward an image- and sensor-based synergistic control of the cutting depth of a manually guided soft-tissue-preserving saw. Feasibility studies in a laboratory setup modeling relevant skull tissue parameters demonstrate that errors due to computed tomography or magnetic resonance image segmentation and registration, optical tracking, and mechanical tolerances of up to 2.5 mm, imminent to many computer-assisted surgery systems, can be compensated for by the cutting tool characteristics without damaging the dura. In conclusion, the feasibility of a computer-controlled trepanation system providing a safer and efficient trepanation has been demonstrated. Injuries of the dura mater can be avoided, and the bone cutting gap can be reduced to 0.5 mm with potential benefits for the reintegration of the bone flap.

Minimally invasive abdominal surgery: lux et veritas past, present, and future.

PubMed

Harrell, Andrew G; Heniford, B Todd

2005-08-01

Laparoscopic surgery has developed out of multiple technology innovations and the desire to see beyond the confines of the human body. As the instrumentation became more advanced, the application of this technique followed. By revisiting the historical developments that now define laparoscopic surgery, we can possibly foresee its future. A Medline search was performed of all the English-language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. Minimally invasive surgery is becoming important in almost every facet of abdominal surgery. Optical improvements, miniaturization, and robotic technology continue to define the frontier of minimally invasive surgery. Endoluminal resection surgery, image-guided surgical navigation, and remotely controlled robotics are not far from becoming reality. These and advances yet to be described will change laparoscopic surgery just as the electric light bulb did over 100 years ago.

Early Experience with Combining Awake Craniotomy and Intraoperative Navigable Ultrasound for Resection of Eloquent Region Gliomas.

PubMed

Moiyadi, Aliasgar; Shetty, Prakash

2017-03-01

Introduction  Optimal resection of tumors in eloquent locations requires a combination of intraoperative imaging and functional monitoring during surgery. Combining awake surgery with intraoperative magnetic resonanceis logistically challenging. Navigable ultrasound (US) is a useful alternative in such cases. Methods  A total of 22 subjects with eloquent tumors were operated on (1 intended biopsy and 21 intended radical resections) using combined modality three-dimensional (3D) US and awake craniotomy with intraoperative clinical monitoring. We describe the technical details for these cases specifically addressing the feasibility of combining the two modalities. Results  US was used for resection control in 18 cases. There were technical limitations in three cases. Transient intraoperative worsening was encountered in eight, necessitating premature termination of the procedure. All patients tolerated the awake procedure well. Mean duration of the surgery was 3.2 hours. Radical resections were obtained in 14 of 18 where this was intended and in 12 of the 13 where there was no adverse intraoperative monitoring event prompting premature termination of the resection. Conclusions  Combining awake surgery with 3DUS is feasible and beneficial. It does not entail any additional surgical workflow modification or patient discomfort. This combined modality intraoperative monitoring can be beneficial for eloquent region tumors. Georg Thieme Verlag KG Stuttgart · New York.

Fluorescence cholangiography during laparoscopic cholecystectomy in a patient with situs inversus totalis: a case report and literature review.

PubMed

Rungsakulkij, Narongsak; Tangtawee, Pongsatorn

2017-04-20

Situs inversus totalis is a rare autosomal disorder in which the patient's affected visceral organs are a perfect mirror image of their normal positions. Surgery in these patients is technically challenging. Minimally invasive surgery such as laparoscopic cholecystectomy is the standard treatment for symptomatic cholelithiasis, but it can be difficult to perform. Laparoscopic cholecystectomy in patients with situs inversus totalis may be even more technically challenging. Fluorescence cholangiography is a new innovation in the field of navigation surgery. This procedure is safe and easy to perform, its findings are easy to interpret, and it does not require a learning curve or radiographs. It can be used in real time during surgery to identify extrahepatic biliary structures. We herein report a case of situs inversus totalis in a Thai patient with a history of biliary pancreatitis. He underwent laparoscopic cholecystectomy with intraoperative fluorescence cholangiography. The operation was successfully completed without complications. To the best of our knowledge, this is the first case report of the use of fluorescence cholangiography during laparoscopic cholecystectomy in a patient with situs inversus. Fluorescence cholangiographyis a new navigational surgical technique with which to identify extrahepatic biliary structures. It can be used as an adjunct technique during laparoscopic cholecystectomy to avoid biliary tract injury in difficult cases.

Computer-assisted abdominal surgery: new technologies.

PubMed

Kenngott, H G; Wagner, M; Nickel, F; Wekerle, A L; Preukschas, A; Apitz, M; Schulte, T; Rempel, R; Mietkowski, P; Wagner, F; Termer, A; Müller-Stich, Beat P

2015-04-01

Computer-assisted surgery is a wide field of technologies with the potential to enable the surgeon to improve efficiency and efficacy of diagnosis, treatment, and clinical management. This review provides an overview of the most important new technologies and their applications. A MEDLINE database search was performed revealing a total of 1702 references. All references were considered for information on six main topics, namely image guidance and navigation, robot-assisted surgery, human-machine interface, surgical processes and clinical pathways, computer-assisted surgical training, and clinical decision support. Further references were obtained through cross-referencing the bibliography cited in each work. Based on their respective field of expertise, the authors chose 64 publications relevant for the purpose of this review. Computer-assisted systems are increasingly used not only in experimental studies but also in clinical studies. Although computer-assisted abdominal surgery is still in its infancy, the number of studies is constantly increasing, and clinical studies start showing the benefits of computers used not only as tools of documentation and accounting but also for directly assisting surgeons during diagnosis and treatment of patients. Further developments in the field of clinical decision support even have the potential of causing a paradigm shift in how patients are diagnosed and treated.

Navigation within the heart and vessels in clinical practice.

PubMed

Beyar, Rafael

2010-02-01

The field of interventional cardiology has developed at an unprecedented pace on account of the visual and imaging power provided by constantly improving biomedical technologies. Transcatheter-based technology is now routinely used for coronary revascularization and noncoronary interventions using balloon angioplasty, stents, and many other devices. In the early days of interventional practice, the operating physician had to manually navigate catheters and devices under fluoroscopic imaging and was exposed to radiation, with its comcomitant necessity for wearing heavy lead aprons for protection. Until recently, very little has changed in the way procedures have been carried out in the catheterization laboratory. The technological capacity to remotely manipulate devices, using robotic arms and computational tools, has been developed for surgery and other medical procedures. This has brought to practice the powerful combination of the abilities afforded by imaging, navigational tools, and remote control manipulation. This review covers recent developments in navigational tools for catheter positioning, electromagnetic mapping, magnetic resonance imaging (MRI)-based cardiac electrophysiological interventions, and navigation tools through coronary arteries.

A SINS/SRS/GNS Autonomous Integrated Navigation System Based on Spectral Redshift Velocity Measurements.

PubMed

Wei, Wenhui; Gao, Zhaohui; Gao, Shesheng; Jia, Ke

2018-04-09

In order to meet the requirements of autonomy and reliability for the navigation system, combined with the method of measuring speed by using the spectral redshift information of the natural celestial bodies, a new scheme, consisting of Strapdown Inertial Navigation System (SINS)/Spectral Redshift (SRS)/Geomagnetic Navigation System (GNS), is designed for autonomous integrated navigation systems. The principle of this SINS/SRS/GNS autonomous integrated navigation system is explored, and the corresponding mathematical model is established. Furthermore, a robust adaptive central difference particle filtering algorithm is proposed for this autonomous integrated navigation system. The simulation experiments are conducted and the results show that the designed SINS/SRS/GNS autonomous integrated navigation system possesses good autonomy, strong robustness and high reliability, thus providing a new solution for autonomous navigation technology.

Navigation for space shuttle approach and landing using an inertial navigation system augmented by data from a precision ranging system or a microwave scan beam landing guidance system

NASA Technical Reports Server (NTRS)

Mcgee, L. A.; Smith, G. L.; Hegarty, D. M.; Merrick, R. B.; Carson, T. M.; Schmidt, S. F.

1970-01-01

A preliminary study has been made of the navigation performance which might be achieved for the high cross-range space shuttle orbiter during final approach and landing by using an optimally augmented inertial navigation system. Computed navigation accuracies are presented for an on-board inertial navigation system augmented (by means of an optimal filter algorithm) with data from two different ground navigation aids; a precision ranging system and a microwave scanning beam landing guidance system. These results show that augmentation with either type of ground navigation aid is capable of providing a navigation performance at touchdown which should be adequate for the space shuttle. In addition, adequate navigation performance for space shuttle landing is obtainable from the precision ranging system even with a complete dropout of precision range measurements as much as 100 seconds before touchdown.

Ultra-minimally invasive local immune cell therapy and regenerative therapy by multi-piercing surgery for abdominal solid tumor: therapeutic simulation by natural orifice translumenal endoscopic surgery-assisted needlescopic surgery using 3-mm diameter robots.

PubMed

Ohdaira, Takeshi; Tsutsumi, Norifumi; Xu, Hao; Mori, Megumu; Uemura, Munenori; Ieiri, Satoshi; Hashizume, Makoto

2011-07-01

We have invented multi-piercing surgery (MPS) which could potentially solve the triangular formation loss and device clashing which occur in single-port surgery (SPS), as well as restricted visual field, organ damage by needle-type instruments, and impaired removal of a resected organ from the body which occur in needlescopic surgery (NS). MPS is natural orifice translumenal endoscopic surgery (NOTES)-assisted NS. We used 3-mm diameter robots as needle-type instruments for MPS to examine the possibility of local immune cell therapy and regenerative therapy using stem cells for pancreatic cancer. In MPS using two robots, the therapeutic cell suspension was injected into a target region of pancreas in two pigs. Both retention of a capsule of liquid cell suspension and invasive level were evaluated. Triangular formation could be ensured. The use of small-diameter robots allowed (1) the surgical separation of the pancreas and the retroperitoneum, and (2) the formation of the capsule containing the immune cell and stem cell suspension. The endoscope for NOTES provided a clear visual field and also assisted the removal of a resected organ from the body. The visual field of the endoscope could be oriented well by using an electromagnetic navigation system. MPS using small-diameter robots could potentially solve the issues inherent in SPS and NS and could allow minimally invasive local immune cell and stem cell therapy.

Influence of nurse navigation on wait times for breast cancer care in a Canadian regional cancer center.

PubMed

Baliski, Christopher; McGahan, Colleen E; Liberto, Caitlyn M; Broughton, Sandra; Ellard, Susan; Taylor, Marianne; Bates, Janet; Lai, Anky

2014-05-01

The wait times for breast cancer care in our region do not meet acceptable benchmarks. We implemented the Interior Breast Rapid Access Investigation and Diagnosis (IB-RAPID) nurse navigation program to address this issue. The IB-RAPID prospective database was reviewed for patients entering the program between April 1, 2011 and April 30, 2012 (2011/2012 cohort), and was compared with patients from the same area in 2010. The main end point was the time between the 1st diagnostic imaging test and the surgery. Multiple linear regression was performed to investigate factors influencing the wait times. The wait times decreased with the introduction of IB-RAPID (59 vs 48 days; median). Stage of disease, total number of biopsies, and magnetic resonance imaging (MRI) use influenced wait times. MRI significantly delayed surgical intervention in both groups with those not having an MRI having a shorter wait time to surgery (68.5 vs 57.6 days; mean) in 2011/2012. The implementation of nurse navigation for patients with breast cancer appears to be effective at reducing the wait times for surgical treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

Combining 5-Aminolevulinic Acid Fluorescence and Intraoperative Magnetic Resonance Imaging in Glioblastoma Surgery: A Histology-Based Evaluation.

PubMed

Hauser, Sonja B; Kockro, Ralf A; Actor, Bertrand; Sarnthein, Johannes; Bernays, René-Ludwig

2016-04-01

Glioblastoma resection guided by 5-aminolevulinic acid (5-ALA) fluorescence and intraoperative magnetic resonance imaging (iMRI) may improve surgical results and prolong survival. To evaluate 5-ALA fluorescence combined with subsequent low-field iMRI for resection control in glioblastoma surgery. Fourteen patients with suspected glioblastoma suitable for complete resection of contrast-enhancing portions were enrolled. The surgery was carried out using 5-ALA-induced fluorescence and frameless navigation. Areas suspicious for tumor underwent biopsy. After complete resection of fluorescent tissue, low-field iMRI was performed. Areas suspicious for tumor remnant underwent biopsy under navigation guidance and were resected. The histological analysis was blinded. In 13 of 14 cases, the diagnosis was glioblastoma multiforme. One lymphoma and 1 case without fluorescence were excluded. In 11 of 12 operations, residual contrast enhancement on iMRI was found after complete resection of 5-ALA fluorescent tissue. In 1 case, the iMRI enhancement was in an eloquent area and did not undergo a biopsy. The 28 biopsies of areas suspicious for tumor on iMRI in the remaining 10 cases showed tumor in 39.3%, infiltration zone in 25%, reactive central nervous system tissue in 32.1%, and normal brain in 3.6%. Ninety-three fluorescent and 24 non-fluorescent tissue samples collected before iMRI contained tumor in 95.7% and 87.5%, respectively. 5-ALA fluorescence-guided resection may leave some glioblastoma tissue undetected. MRI might detect areas suspicious for tumor even after complete resection of all fluorescent tissue; however, due to the limited accuracy of iMRI in predicting tumor remnant (64.3%), resection of this tissue has to be considered with caution in eloquent regions.

INL Autonomous Navigation System

DOE Office of Scientific and Technical Information (OSTI.GOV)

2005-03-30

The INL Autonomous Navigation System provides instructions for autonomously navigating a robot. The system permits high-speed autonomous navigation including obstacle avoidance, waypoing navigation and path planning in both indoor and outdoor environments.

On the feasibility of MRI-guided navigation to demarcate breast cancer for breast-conserving surgery.

PubMed

Alderliesten, Tanja; Loo, Claudette; Paape, Anita; Muller, Sara; Rutgers, Emiel; Peeters, Marie-Jeanne Vrancken; Gilhuijs, Kenneth

2010-06-01

The aim of this study was to investigate the feasibility of image-guided navigation approaches to demarcate breast cancer on the basis of preacquired magnetic resonance (MR) imaging in supine patient orientation. Strategies were examined to minimize the uncertainty in the instrument-tip position, based on the hypothesis that the release of instrument pressure returns the breast tissue to its predeformed state. For this purpose, four sources of uncertainty were taken into account: (1) U(ligaments): Uncertainty in the reproducibility of the internal mammary gland geometry during repeat patient setup in supine orientation; (2) U(r_breathing): Residual uncertainty in registration of the breast after compensation for breathing motion using an external marker; (3) U(reconstruction): Uncertainty in the reconstructed location of the tip of the needle using an optical image-navigation system (phantom experiments, n = 50); and (4) U(deformation): Uncertainty in displacement of breast tumors due to needle-induced tissue deformations (patients, n = 21). A Monte Carlo study was performed to establish the 95% confidence interval (CI) of the combined uncertainties. This region of uncertainty was subsequently visualized around the reconstructed needle tip as an additional navigational aid in the preacquired MR images. Validation of the system was performed in five healthy volunteers (localization of skin markers only) and in two patients. In the patients, the navigation system was used to monitor ultrasound-guided radioactive seed localization of breast cancer. Nearest distances between the needle tip and the tumor boundary in the ultrasound images were compared to those in the concurrently reconstructed MR images. Both U(reconstruction) and U(deformation) were normally distributed with 0.1 +/- 1.2 mm (mean +/- 1 SD) and 0.1 +/- 0.8 mm, respectively. Taking prior estimates for U(ligaments) (0.0 +/- 1.5 mm) and U(r_breathing) (-0.1 +/- 0.6 mm) into account, the combined impact resulted in 3.9 mm uncertainty in the position of the needle tip (95% CI) after release of pressure. The volunteer study showed a targeting accuracy comparable to that in the phantom experiments: 2.9 +/- 1.3 versus 2.7 +/- 1.1 mm, respectively. In the patient feasibility study, the deviations were within the 3.9 mm CI. Image-guided navigation to demarcate breast cancer on the basis of preacquired MR images in supine orientation appears feasible if patient breathing is tracked during the navigation procedure, positional uncertainty is visualized and pressure on the localization instrument is released prior to verification of its position.

A SINS/SRS/GNS Autonomous Integrated Navigation System Based on Spectral Redshift Velocity Measurements

PubMed Central

Wei, Wenhui; Gao, Zhaohui; Gao, Shesheng; Jia, Ke

2018-01-01

In order to meet the requirements of autonomy and reliability for the navigation system, combined with the method of measuring speed by using the spectral redshift information of the natural celestial bodies, a new scheme, consisting of Strapdown Inertial Navigation System (SINS)/Spectral Redshift (SRS)/Geomagnetic Navigation System (GNS), is designed for autonomous integrated navigation systems. The principle of this SINS/SRS/GNS autonomous integrated navigation system is explored, and the corresponding mathematical model is established. Furthermore, a robust adaptive central difference particle filtering algorithm is proposed for this autonomous integrated navigation system. The simulation experiments are conducted and the results show that the designed SINS/SRS/GNS autonomous integrated navigation system possesses good autonomy, strong robustness and high reliability, thus providing a new solution for autonomous navigation technology. PMID:29642549

Intraoperative magnetic resonance imaging during surgery for pituitary adenomas: pros and cons.

PubMed

Buchfelder, Michael; Schlaffer, Sven-Martin

2012-12-01

Surgery for pituitary adenomas still remains a mainstay in their treatment, despite all advances in sophisticated medical treatments and radiotherapy. Total tumor excision is often attempted, but there are limitations in the intraoperative assessment of the radicalism of tumor resection by the neurosurgeon. Standard postoperative imaging is usually performed with a few months delay from the surgical intervention. The purpose of this report is to review briefly the facilities and kinds of intraoperative magnetic resonance imaging for all physician and surgeons involved in the management of pituitary adenomas on the basis of current literature. To date, there are several low- and high-field magnetic resonance imaging systems available for intraoperative use and depiction of the extent of tumor removal during surgery. Recovery of vision and the morphological result of surgery can be largely predicted from the intraoperative images. A variety of studies document that depiction of residual tumor allows targeted attack of the remnant and extent the resection. Intraoperative magnetic resonance imaging offers an immediate feedback to the surgeon and is a perfect quality control for pituitary surgery. It is also used as a basis of datasets for intraoperative navigation which is particularly useful in any kind of anatomical variations and repeat operations in which primary surgery has distorted the normal anatomy. However, setting up the technology is expensive and some systems even require extensive remodeling of the operation theatre. Intraoperative imaging prolongs the operation, but may also depict evolving problems, such as hematomas in the tumor cavity. There are several artifacts in intraoperative MR images possible that must be considered. The procedures are not associated with an increased complication rate.

Concepts and Preliminary Data Toward the Realization of Image-guided Liver Surgery

PubMed Central

Cash, David M.; Miga, Michael I.; Glasgow, Sean C.; Dawant, Benoit M.; Clements, Logan W.; Cao, Zhujiang; Galloway, Robert L.; Chapman, William C.

2013-01-01

Image-guided surgery provides navigational assistance to the surgeon by displaying the surgical probe position on a set of preoperative tomograms in real time. In this study, the feasibility of implementing image-guided surgery concepts into liver surgery was examined during eight hepatic resection procedures. Preoperative tomographic image data were acquired and processed. Accompanying intraoperative data on liver shape and position were obtained through optically tracked probes and laser range scanning technology. The preoperative and intraoperative representations of the liver surface were aligned using the iterative closest point surface matching algorithm. Surface registrations resulted in mean residual errors from 2 to 6 mm, with errors of target surface regions being below a stated goal of 1 cm. Issues affecting registration accuracy include liver motion due to respiration, the quality of the intraoperative surface data, and intraoperative organ deformation. Respiratory motion was quantified during the procedures as cyclical, primarily along the cranial–caudal direction. The resulting registrations were more robust and accurate when using laser range scanning to rapidly acquire thousands of points on the liver surface and when capturing unique geometric regions on the liver surface, such as the inferior edge. Finally, finite element models recovered much of the observed intraoperative deformation, further decreasing errors in the registration. Image-guided liver surgery has shown the potential to provide surgeons with important navigation aids that could increase the accuracy of targeting lesions and the number of patients eligible for surgical resection. PMID:17458587

Preoperative planning of thoracic surgery with use of three-dimensional reconstruction, rapid prototyping, simulation and virtual navigation.

PubMed

Heuts, Samuel; Sardari Nia, Peyman; Maessen, Jos G

2016-01-01

For the past decades, surgeries have become more complex, due to the increasing age of the patient population referred for thoracic surgery, more complex pathology and the emergence of minimally invasive thoracic surgery. Together with the early detection of thoracic disease as a result of innovations in diagnostic possibilities and the paradigm shift to personalized medicine, preoperative planning is becoming an indispensable and crucial aspect of surgery. Several new techniques facilitating this paradigm shift have emerged. Pre-operative marking and staining of lesions are already a widely accepted method of preoperative planning in thoracic surgery. However, three-dimensional (3D) image reconstructions, virtual simulation and rapid prototyping (RP) are still in development phase. These new techniques are expected to become an important part of the standard work-up of patients undergoing thoracic surgery in the future. This review aims at graphically presenting and summarizing these new diagnostic and therapeutic tools.

A Multidisciplinary Patient Navigation Program Improves Compliance With Adjuvant Breast Cancer Therapy in a Public Hospital.

PubMed

Castaldi, Maria; Safadjou, Saman; Elrafei, Tarek; McNelis, John

Cancer health disparities affecting low-income and minority patients have been well documented to lead to poor outcomes. This report examines the impact of patient navigation on adherence to prescribed adjuvant breast cancer treatment. A multidisciplinary patient navigation program was initiated at a public safety net hospital to improve compliance with 3 National Quality Forum measures: (1) administration of combination chemotherapy for women with Stage (defined by the American Joint Committee on Cancer [AJCC]) T1c, II, or III hormone receptor-negative breast cancer within 120 days; (2) administration of endocrine therapy for women with AJCC Stage T1c, II, or III hormone receptor-positive breast cancer within 365 days; and (3) radiation therapy for women receiving breast-conserving surgery within one year. Implementation of a multidisciplinary patient navigation program reduced time to treatment and improved compliance with adjuvant therapy for breast cancer in an underserved minority community.

Optimizing MR imaging-guided navigation for focused ultrasound interventions in the brain

NASA Astrophysics Data System (ADS)

Werner, B.; Martin, E.; Bauer, R.; O'Gorman, R.

2017-03-01

MR imaging during transcranial MR imaging-guided Focused Ultrasound surgery (tcMRIgFUS) is challenging due to the complex ultrasound transducer setup and the water bolus used for acoustic coupling. Achievable image quality in the tcMRIgFUS setup using the standard body coil is significantly inferior to current neuroradiologic standards. As a consequence, MR image guidance for precise navigation in functional neurosurgical interventions using tcMRIgFUS is basically limited to the acquisition of MR coordinates of salient landmarks such as the anterior and posterior commissure for aligning a stereotactic atlas. Here, we show how improved MR image quality provided by a custom built MR coil and optimized MR imaging sequences can support imaging-guided navigation for functional tcMRIgFUS neurosurgery by visualizing anatomical landmarks that can be integrated into the navigation process to accommodate for patient specific anatomy.

Surgery of language-eloquent tumors in patients not eligible for awake surgery: the impact of a protocol based on navigated transcranial magnetic stimulation on presurgical planning and language outcome, with evidence of tumor-induced intra-hemispheric plasticity.

PubMed

Raffa, Giovanni; Quattropani, Maria C; Scibilia, Antonino; Conti, Alfredo; Angileri, Filippo Flavio; Esposito, Felice; Sindorio, Carmela; Cardali, Salvatore Massimiliano; Germanò, Antonino; Tomasello, Francesco

2018-05-01

Awake surgery and intraoperative monitoring represent the gold standard for surgery of brain tumors located in the perisylvian region of the dominant hemisphere due to their ability to map and preserve the language network during surgery. Nevertheless, in some cases awake surgery is not feasible. This could increase the risk of postoperative language deficit. Navigated transcranial magnetic stimulation (nTMS) and nTMS-based DTI fiber tracking (DTI-FT) provide a preoperative mapping and reconstruction of the cortico-subcortical language network. This can be used to plan and guide the surgical strategy to preserve the language function. The objective if this study is to describe the impact of a non-invasive preoperative protocol for mapping the language network through the nTMS and nTMS-based DTI-FT in patients not eligible for awake surgery and thereby operated under general anesthesia for suspected language-eloquent brain tumors. We reviewed clinical data of patients not eligible for awake surgery and operated under general anaesthesia between 2015 and 2016. All patients underwent nTMS language cortical mapping and nTMS-based DTI-FT of subcortical language fascicles. The nTMS findings were used to plan and guide the maximal safe resection of the tumor. The impact on postoperative language outcome and the accuracy of the nTMS-based mapping in predicting language deficits were evaluated. Twenty patients were enrolled in the study. The nTMS-based reconstruction of the language network was successful in all patients. Interestingly, we observed a significant association between tumor localization and the cortical distribution of the nTMS errors (p = 0.004), thereby suggesting an intra-hemispheric plasticity of language cortical areas, probably induced by the tumor itself. The nTMS mapping disclosed the true-eloquence of lesions in 12 (60%) of all suspected cases. In the remaining 8 cases (40%) the suspected eloquence of the lesion was disproved. The nTMS-based findings guided the planning and surgery through the visual feedback of navigation. This resulted in a slight reduction of the postoperative language performance at discharge that was completely recovered after one month from surgery. The accuracy of the nTMS-based protocol in predicting postoperative permanent deficits was significantly high, especially for false-eloquent lesions (p = 0.04; sensitivity 100%, specificity 57.14%, negative predictive value 100%, positive predicitive value 50%). The nTMS-based preoperative mapping allows for a reliable visualization of the language network, being also able to identify an intra-hemispheric tumor-induced cortical plasticity. It allows for a customized surgical strategy that could preserve post-operative language function. This approach should be considered as a support for neurosurgeons whenever approaching patients affected by suspected language-eloquent tumors but not eligible for awake surgery. Copyright © 2018 Elsevier B.V. All rights reserved.

Image-guided surgery.

PubMed

Wagner, A; Ploder, O; Enislidis, G; Truppe, M; Ewers, R

1996-04-01

Interventional video tomography (IVT), a new imaging modality, achieves virtual visualization of anatomic structures in three dimensions for intraoperative stereotactic navigation. Partial immersion into a virtual data space, which is orthotopically coregistered to the surgical field, enhances, by means of a see-through head-mounted display (HMD), the surgeon's visual perception and technique by providing visual access to nonvisual data of anatomy, physiology, and function. The presented cases document the potential of augmented reality environments in maxillofacial surgery.

[Ten years retrospective review of the application of digital medical technology in general surgery in China].

PubMed

Fang, C H; Lau, Y Y; Zhou, W P; Cai, W

2017-12-01

Digital medical technology is a powerful tool which has forcefully promoted the development of general surgery in China. In this article, we reviews the application status of three-dimensional visualization and three-dimensional printing technology in general surgery, introduces the development situation of surgical navigation guided by optical and electromagnetic technology and preliminary attempt to combined with mixed reality applied to complicated hepatectomy, looks ahead the development direction of digital medicine in the era of artificial intelligence and big data on behalf of surgical robot and radiomics. Surgeons should proactively master these advanced techniques and accelerate the innovative development of general surgery in China.

Navigation in endoscopic sinus surgery: the first Indian experience.

PubMed

Rai, Devinder; Munjal, Manish; Rai, Varun

2013-08-01

Although the use of image guidance surgery (IGS) is standard practice in developed countries, it has not been in use in Indian Otolaryngology ever since its clinical inception in 1994. Some clinically interesting applications, relevant indications, practical tips and results in the Indian context are presented. Usage technique and data presentation. Indications based on AAO-HNS 2002 guidelines seem valid, and though the accuracy parameters remain still guarded, in line with the best technology available, based on the evidences of scattered reports and expert opinions, the use of navigation can be recommended as state of the art. IGS provides reliable information to a sinus surgeon in difficult circumstances. Its adaptation fortunately does not require a significant learning curve as it does not change the methodology of the surgical procedure. It can be an excellent teaching tool, but its use does not replace proper surgical training.

Navigated transcranial magnetic stimulation in preoperative planning for the treatment of motor area cavernous angiomas

PubMed Central

Paiva, Wellingson Silva; Fonoff, Erich Talamoni; Marcolin, Marco Antonio; Bor-Seng-Shu, Edson; Figueiredo, Eberval Gadelha; Teixeira, Manoel Jacobsen

2013-01-01

Since the introduction of microscopic techniques, radical surgery for cavernous angiomas has become a recommended treatment option. However, the treatment of motor area cavernous angioma represents a great challenge for the surgical team. Here, we describe an approach guided by frameless neuronavigation and preoperative functional mapping with transcranial magnetic stimulation (TMS), for surgical planning. We used TMS to map the motor cortex and its relationship with the angioma. We achieved complete resection of the lesions in the surgeries, while avoiding areas of motor response identified during the preoperative mapping. We verified the complete control of seizures (Engel class 1A) in the patients with previous refractory epilepsy. Postsurgery, one patient was seizure-free without medication, and two patients required only one medication for seizure control. Thus, navigated TMS appears to be a useful tool, in preoperative planning for cavernous angiomas of the motor area. PMID:24353424

Hand gesture guided robot-assisted surgery based on a direct augmented reality interface.

PubMed

Wen, Rong; Tay, Wei-Liang; Nguyen, Binh P; Chng, Chin-Boon; Chui, Chee-Kong

2014-09-01

Radiofrequency (RF) ablation is a good alternative to hepatic resection for treatment of liver tumors. However, accurate needle insertion requires precise hand-eye coordination and is also affected by the difficulty of RF needle navigation. This paper proposes a cooperative surgical robot system, guided by hand gestures and supported by an augmented reality (AR)-based surgical field, for robot-assisted percutaneous treatment. It establishes a robot-assisted natural AR guidance mechanism that incorporates the advantages of the following three aspects: AR visual guidance information, surgeon's experiences and accuracy of robotic surgery. A projector-based AR environment is directly overlaid on a patient to display preoperative and intraoperative information, while a mobile surgical robot system implements specified RF needle insertion plans. Natural hand gestures are used as an intuitive and robust method to interact with both the AR system and surgical robot. The proposed system was evaluated on a mannequin model. Experimental results demonstrated that hand gesture guidance was able to effectively guide the surgical robot, and the robot-assisted implementation was found to improve the accuracy of needle insertion. This human-robot cooperative mechanism is a promising approach for precise transcutaneous ablation therapy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

[Standardization and modeling of surgical processes].

PubMed

Strauss, G; Schmitz, P

2016-12-01

Due to the technological developments around the operating room, surgery in the twenty-first century is undergoing a paradigm shift. Which technologies have already been integrated into the surgical routine? How can a favorable cost-benefit balance be achieved by the implementation of new software-based assistance systems? This article presents the state of the art technology as exemplified by a semi-automated operation system for otorhinolaryngology surgery. The main focus is on systems for implementation of digital handbooks and navigational functions in situ. On the basis of continuous development in digital imaging, decisions may by facilitated by individual patient models thus allowing procedures to be optimized. The ongoing digitization and linking of all relevant information enable a high level of standardization in terms of operating procedures. This may be used by assistance systems as a basis for complete documentation and high process reliability. Automation of processes in the operating room results in an increase in quality, precision and standardization so that the effectiveness and efficiency of treatment can be improved; however, care must be taken that detrimental consequences, such as loss of skills and placing too much faith in technology must be avoided by adapted training concepts.

Relative navigation requirements for automatic rendezvous and capture systems

NASA Technical Reports Server (NTRS)

Kachmar, Peter M.; Polutchko, Robert J.; Chu, William; Montez, Moises

1991-01-01

This paper will discuss in detail the relative navigation system requirements and sensor trade-offs for Automatic Rendezvous and Capture. Rendezvous navigation filter development will be discussed in the context of navigation performance requirements for a 'Phase One' AR&C system capability. Navigation system architectures and the resulting relative navigation performance for both cooperative and uncooperative target vehicles will be assessed. Relative navigation performance using rendezvous radar, star tracker, radiometric, laser and GPS navigation sensors during appropriate phases of the trajectory will be presented. The effect of relative navigation performance on the Integrated AR&C system performance will be addressed. Linear covariance and deterministic simulation results will be used. Evaluation of relative navigation and IGN&C system performance for several representative relative approach profiles will be presented in order to demonstrate the full range of system capabilities. A summary of the sensor requirements and recommendations for AR&C system capabilities for several programs requiring AR&C will be presented.

Apollo Onboard Navigation Techniques

NASA Technical Reports Server (NTRS)

Interbartolo, Michael

2009-01-01

This viewgraph presentation reviews basic navigation concepts, describes coordinate systems and identifies attitude determination techniques including Primary Guidance, Navigation and Control System (PGNCS) IMU management and Command and Service Module Stabilization and Control System/Lunar Module (LM) Abort Guidance System (AGS) attitude management. The presentation also identifies state vector determination techniques, including PGNCS coasting flight navigation, PGNCS powered flight navigation and LM AGS navigation.

33 CFR 62.1 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM General § 62.1 Purpose. (a) The Coast Guard administers the U.S. Aids to Navigation System. The system consists of Federal aids to navigation operated by the Coast Guard, aids to...

33 CFR 62.1 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM General § 62.1 Purpose. (a) The Coast Guard administers the U.S. Aids to Navigation System. The system consists of Federal aids to navigation operated by the Coast Guard, aids to...

33 CFR 62.1 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM General § 62.1 Purpose. (a) The Coast Guard administers the U.S. Aids to Navigation System. The system consists of Federal aids to navigation operated by the Coast Guard, aids to...

33 CFR 62.1 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM General § 62.1 Purpose. (a) The Coast Guard administers the U.S. Aids to Navigation System. The system consists of Federal aids to navigation operated by the Coast Guard, aids to...

33 CFR 62.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM General § 62.1 Purpose. (a) The Coast Guard administers the U.S. Aids to Navigation System. The system consists of Federal aids to navigation operated by the Coast Guard, aids to...

Intraoperative radiation exposure in spinal scoliosis surgery for pediatric patients using the O-arm® imaging system.

PubMed

Kobayashi, Kazuyoshi; Ando, Kei; Ito, Kenyu; Tsushima, Mikito; Morozumi, Masayoshi; Tanaka, Satoshi; Machino, Masaaki; Ota, Kyotaro; Ishiguro, Naoki; Imagama, Shiro

2018-05-01

The O-arm ® navigation system allows intraoperative CT imaging that can facilitate highly accurate instrumentation surgery, but radiation exposure is higher than with X-ray radiography. This is a particular concern in pediatric surgery. The purpose of this study is to examine intraoperative radiation exposure in pediatric spinal scoliosis surgery using O-arm. The subjects were 38 consecutive patients (mean age 12.9 years, range 10-17) with scoliosis who underwent spinal surgery with posterior instrumentation using O-arm. The mean number of fused vertebral levels was 11.0 (6-15). O-arm was performed before and after screw insertion, using an original protocol for the cervical, thoracic, and lumbar spine doses. The average scanning range was 6.9 (5-9) intervertebral levels per scan, with 2-7 scans per patient (mean 4.0 scans). Using O-arm, the dose per scan was 92.5 (44-130) mGy, and the mean total dose was 401 (170-826) mGy. This dose was 80.2% of the mean preoperative CT dose of 460 (231-736) mGy (P = 0.11). The total exposure dose and number of scans using intraoperative O-arm correlated strongly and significantly with the number of fused levels; however, there was no correlation with the patient's height. As the fused range became wider, several scans were required for O-arm, and the total radiation exposure became roughly the same as that in preoperative CT. Use of O-arm in our original protocol can contribute to reduction in radiation exposure.

Point-cloud-to-point-cloud technique on tool calibration for dental implant surgical path tracking

NASA Astrophysics Data System (ADS)

Lorsakul, Auranuch; Suthakorn, Jackrit; Sinthanayothin, Chanjira

2008-03-01

Dental implant is one of the most popular methods of tooth root replacement used in prosthetic dentistry. Computerize navigation system on a pre-surgical plan is offered to minimize potential risk of damage to critical anatomic structures of patients. Dental tool tip calibrating is basically an important procedure of intraoperative surgery to determine the relation between the hand-piece tool tip and hand-piece's markers. With the transferring coordinates from preoperative CT data to reality, this parameter is a part of components in typical registration problem. It is a part of navigation system which will be developed for further integration. A high accuracy is required, and this relation is arranged by point-cloud-to-point-cloud rigid transformations and singular value decomposition (SVD) for minimizing rigid registration errors. In earlier studies, commercial surgical navigation systems from, such as, BrainLAB and Materialize, have flexibility problem on tool tip calibration. Their systems either require a special tool tip calibration device or are unable to change the different tool. The proposed procedure is to use the pointing device or hand-piece to touch on the pivot and the transformation matrix. This matrix is calculated every time when it moves to the new position while the tool tip stays at the same point. The experiment acquired on the information of tracking device, image acquisition and image processing algorithms. The key success is that point-to-point-cloud requires only 3 post images of tool to be able to converge to the minimum errors 0.77%, and the obtained result is correct in using the tool holder to track the path simulation line displayed in graphic animation.

Transnasal endoscopic resection of a nasopharyngeal pleomorphic adenoma: a rare case report.

PubMed

Martínez-Capoccioni, Gabriel; Martín-Martín, Carlos; Espinosa-Restrepo, Federico

2012-08-01

Pleomorphic adenoma (PA) is the most common benign tumor of the major and minor salivary glands, but rarely found in the nasopharynx. A PA originating from the left lateral wall of the nasopharynx was found in a 52-year-old female who presented with nasal obstruction, left-side otalgia, aural fullness, tinnitus and subjective hearing loss. It was successfully removed by transnasal endoscopic surgery (TES) and navigator system assessed our location, due to the proximity of critical anatomic structures such as the left internal carotid. We believe that the TES for primary and recurrent nasopharyngeal benign tumors is feasible and safe in properly selected patients, due to superior functional and cosmetic results and a low complication rate. Tumor characteristics and location should be taken into account when selecting cases for the right procedure for this lesions; transnasal endoscopic surgery is safe and preferable, carrying less potential morbidity compared to open procedures.

A multicenter prospective cohort study on camera navigation training for key user groups in minimally invasive surgery.

PubMed

Graafland, Maurits; Bok, Kiki; Schreuder, Henk W R; Schijven, Marlies P

2014-06-01

Untrained laparoscopic camera assistants in minimally invasive surgery (MIS) may cause suboptimal view of the operating field, thereby increasing risk for errors. Camera navigation is often performed by the least experienced member of the operating team, such as inexperienced surgical residents, operating room nurses, and medical students. The operating room nurses and medical students are currently not included as key user groups in structured laparoscopic training programs. A new virtual reality laparoscopic camera navigation (LCN) module was specifically developed for these key user groups. This multicenter prospective cohort study assesses face validity and construct validity of the LCN module on the Simendo virtual reality simulator. Face validity was assessed through a questionnaire on resemblance to reality and perceived usability of the instrument among experts and trainees. Construct validity was assessed by comparing scores of groups with different levels of experience on outcome parameters of speed and movement proficiency. The results obtained show uniform and positive evaluation of the LCN module among expert users and trainees, signifying face validity. Experts and intermediate experience groups performed significantly better in task time and camera stability during three repetitions, compared to the less experienced user groups (P < .007). Comparison of learning curves showed significant improvement of proficiency in time and camera stability for all groups during three repetitions (P < .007). The results of this study show face validity and construct validity of the LCN module. The module is suitable for use in training curricula for operating room nurses and novice surgical trainees, aimed at improving team performance in minimally invasive surgery. © The Author(s) 2013.

Applications of 3D orbital computer-assisted surgery (CAS).

PubMed

Scolozzi, P

2017-09-01

The purpose of the present report is to describe the indications for use of 3D orbital computer-assisted surgery (CAS). We analyzed the clinical and radiological data of all patients with orbital deformities treated using intra-operative navigation and CAD/CAM techniques at the Hôpitaux Universitaires de Genève, Switzerland, between 2009 and 2016. We recorded age and gender, orbital deformity, technical and surgical procedure and postoperative complications. One hundred and three patients were included. Mean age was 39.5years (range, 5 to 84years) and 85 (87.5%) were men. Of the 103 patients, 96 had intra-operative navigation (34 for primary and 3 for secondary orbito-zygomatic fractures, 15 for Le Fort fractures, 16 for orbital floor fractures, 10 for combined orbital floor and medial wall fractures, 7 for orbital medial wall fractures, 3 for NOE (naso-orbito-ethmoidal) fractures, 2 for isolated comminuted zygomatic arch fractures, 1 for enophthalmos, 3 for TMJ ankylosis and 2 for fibrous dysplasia bone recontouring), 8 patients had CAD/CAM PEEK-PSI for correction of residual orbital bone contour following craniomaxillofacial trauma, and 1 patient had CAD/CAM surgical splints and cutting guides for correction of orbital hypertelorism. Two patient (1.9%) required revision surgery for readjustment of an orbital mesh. The 1-year follow-up examination showed stable cosmetic and dimensional results in all patients. This study demonstrated that the application of 3D orbital CAS with regards to intra-operative navigation and CAD/CAM techniques allowed for a successful outcome in the patients presented in this series. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

[The 'Surgical Deck': a new generation of integrated operational rooms for ENT].

PubMed

Strauss, G; Gollnick, I; Neumuth, T; Meixensberger, J; Lueth, T C

2013-02-01

Existing operating room concepts do not meet modern technological opportunities anymore. The "Surgical Deck" is supposed to represent a prototype for a new operating room generation. The objective of the project is to achieve a better integration of functions and to develop an innovative concept for a highly developed surgical workstation. 3 working areas are defined: Surgical, Airway and Technical Cockpit. The evaluation was conducted on 284 surgeries carried out from 01.08. 2011 to 31.01. 2012. The evaluation team consisted of 6 surgeons, 3 surgery nurses, 3 anesthesiologists and 4 anesthesia nurses. Within a detailed analysis, the data of 50 FESS surgeries were compared to those of a control group. Within the FESS group, the average slot time was reduced by 13%. 88.2% of those questioned assessed ergonomics as being better than in the conventional OR. 71.5% stated that the Surgical Deck provided an added value with regard to the surgical procedure. 91.3% confirmed that the system control required additional training. 79.3% described the cost-benefit-ratio as appropriate. For 96% of the surgeries, respondents said that they were feeling adequately supported by the technology. The results show a clear advantage of the system architecture. The Surgical Deck may present a solid foundation with regard to the transfer of the system into the clinical practice. This is relevant for new assistance functions such as process control software or navigation-based collision warning systems. It is to be expected that the project will significantly contribute to further develop the future surgical workstation and its standardization. © Georg Thieme Verlag KG Stuttgart · New York.

A multiplanar complex resection of a low-grade chondrosarcoma of the distal femur guided by K-wires previously inserted under CT-guide: a case report.

PubMed

Zoccali, Carmine; Rossi, Barbara; Ferraresi, Virginia; Anelli, Vincenzo; Rita, Alessandro

2014-08-13

In muscular skeletal oncology aiming to achieve wide surgical margin is one of the main factors influencing patient prognosis. In cases where lesions are either meta or epiphyseal, surgery most often compromises joint integrity and stability because muscles, tendons and ligaments are involved in wide resection. When lesions are well circumscribed they can be completely resected by performing multi-planar osteotomies guided by computer-assisted navigation. We describe a case of low-grade chondrosarcoma of the distal femur where a simple but effective technique was useful to perform complex multiplanar osteotomies. No similar techniques are reported in the literature. A 57 year-old Caucasian female was referred to our department for the presence of a distal femur chondrosarcoma. A resection with the presenting technique was scheduled. The first step consists of inserting several K-wires under CT-scan control to delimitate the tumor; the second step consists of tumor removal: in operative theatre, following surgical access, k-wires are used as guide positioning; scalpels are externally placed to k-wires to perform a safe osteotomy. Computed assisted resections can be considered the most advantageous method to reach the best surgical outcome; unfortunately navigation systems are only available in specialized centres. The present technique allows for a multiplanar complex resection when navigation systems are not available. This technique can be applied in low-grade tumours where a minimal wide margin can be considered sufficient.

A navigation system for the visually impaired using colored navigation lines and RFID tags.

PubMed

Seto, First Tatsuya

2009-01-01

In this paper, we describe about a developed navigation system that supports the independent walking of the visually impaired in the indoor space. Our developed instrument consists of a navigation system and a map information system. These systems are installed on a white cane. Our navigation system can follow a colored navigation line that is set on the floor. In this system, a color sensor installed on the tip of a white cane senses the colored navigation line, and the system informs the visually impaired that he/she is walking along the navigation line by vibration. The color recognition system is controlled by a one-chip microprocessor and this system can discriminate 6 colored navigation lines. RFID tags and a receiver for these tags are used in the map information system. The RFID tags and the RFID tag receiver are also installed on a white cane. The receiver receives tag information and notifies map information to the user by mp3 formatted pre-recorded voice. Three normal subjects who were blindfolded with an eye mask were tested with this system. All of them were able to walk along the navigation line. The performance of the map information system was good. Therefore, our system will be extremely valuable in supporting the activities of the visually impaired.

Intra-operative ultrasound-based augmented reality guidance for laparoscopic surgery.

PubMed

Singla, Rohit; Edgcumbe, Philip; Pratt, Philip; Nguan, Christopher; Rohling, Robert

2017-10-01

In laparoscopic surgery, the surgeon must operate with a limited field of view and reduced depth perception. This makes spatial understanding of critical structures difficult, such as an endophytic tumour in a partial nephrectomy. Such tumours yield a high complication rate of 47%, and excising them increases the risk of cutting into the kidney's collecting system. To overcome these challenges, an augmented reality guidance system is proposed. Using intra-operative ultrasound, a single navigation aid, and surgical instrument tracking, four augmentations of guidance information are provided during tumour excision. Qualitative and quantitative system benefits are measured in simulated robot-assisted partial nephrectomies. Robot-to-camera calibration achieved a total registration error of 1.0 ± 0.4 mm while the total system error is 2.5 ± 0.5 mm. The system significantly reduced healthy tissue excised from an average (±standard deviation) of 30.6 ± 5.5 to 17.5 ± 2.4 cm 3 ( p < 0.05) and reduced the depth from the tumor underside to cut from an average (±standard deviation) of 10.2 ± 4.1 to 3.3 ± 2.3 mm ( p < 0.05). Further evaluation is required in vivo, but the system has promising potential to reduce the amount of healthy parenchymal tissue excised.

Development and evaluation of an instrumented linkage system for total knee surgery.

PubMed

Walker, Peter S; Wei, Chih-Shing; Forman, Rachel E; Balicki, M A

2007-10-01

The principles and application of total knee surgery using optical tracking have been well demonstrated, but electromagnetic tracking may offer further advantages. We asked whether an instrumented linkage that attaches directly to the bone can maintain the accuracy of the optical and electromagnetic systems but be quicker, more convenient, and less expensive to use. Initial testing using a table-mounted digitizer to navigate a drill guide for placing pins to mount a cutting guide demonstrated the feasibility in terms of access and availability. A first version (called the Mark 1) instrumented linkage designed to fix directly to the bone was constructed and software was written to carry out a complete total knee replacement procedure. The results showed the system largely fulfilled these goals, but some surgeons found that using a visual display for pin placement was difficult and time consuming. As a result, a second version of a linkage system (called the K-Link) was designed to further develop the concept. User-friendly flexible software was developed for facilitating each step quickly and accurately while the placement of cutting guides was facilitated. We concluded that an instrumented linkage system could be a useful and potentially lower-cost option to the current systems for total knee replacement and could possibly have application to other surgical procedures.

33 CFR 62.63 - Recommendations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Recommendations. 62.63 Section 62.63 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM Public Participation in the Aids to Navigation System § 62.63...

Terrain matching image pre-process and its format transform in autonomous underwater navigation

NASA Astrophysics Data System (ADS)

Cao, Xuejun; Zhang, Feizhou; Yang, Dongkai; Yang, Bogang

2007-06-01

Underwater passive navigation technology is one of the important development orientations in the field of modern navigation. With the advantage of high self-determination, stealth at sea, anti-jamming and high precision, passive navigation is completely meet with actual navigation requirements. Therefore passive navigation has become a specific navigating method for underwater vehicles. The scientists and researchers in the navigating field paid more attention to it. The underwater passive navigation can provide accurate navigation information with main Inertial Navigation System (INS) for a long period, such as location and speed. Along with the development of micro-electronics technology, the navigation of AUV is given priority to INS assisted with other navigation methods, such as terrain matching navigation. It can provide navigation ability for a long period, correct the errors of INS and make AUV not emerge from the seabed termly. With terrain matching navigation technique, in the assistance of digital charts and ocean geographical characteristics sensors, we carry through underwater image matching assistant navigation to obtain the higher location precision, therefore it is content with the requirement of underwater, long-term, high precision and all-weather of the navigation system for Autonomous Underwater Vehicles. Tertian-assistant navigation (TAN) is directly dependent on the image information (map information) in the navigating field to assist the primary navigation system according to the path appointed in advance. In TAN, a factor coordinative important with the system operation is precision and practicability of the storable images and the database which produce the image data. If the data used for characteristics are not suitable, the system navigation precision will be low. Comparing with terrain matching assistant navigation system, image matching navigation system is a kind of high precision and low cost assistant navigation system, and its matching precision directly influences the final precision of integrated navigation system. Image matching assistant navigation is spatially matching and aiming at two underwater scenery images coming from two different sensors matriculating of the same scenery in order to confirm the relative displacement of the two images. In this way, we can obtain the vehicle's location in fiducial image known geographical relation, and the precise location information given from image matching location is transmitted to INS to eliminate its location error and greatly enhance the navigation precision of vehicle. Digital image data analysis and processing of image matching in underwater passive navigation is important. In regard to underwater geographic data analysis, we focus on the acquirement, disposal, analysis, expression and measurement of database information. These analysis items structure one of the important contents of underwater terrain matching and are propitious to know the seabed terrain configuration of navigation areas so that the best advantageous seabed terrain district and dependable navigation algorithm can be selected. In this way, we can improve the precision and reliability of terrain assistant navigation system. The pre-process and format transformation of digital image during underwater image matching are expatiated in this paper. The information of the terrain status in navigation areas need further study to provide the reliable data terrain characteristic and underwater overcast for navigation. Through realizing the choice of sea route, danger district prediction and navigating algorithm analysis, TAN can obtain more high location precision and probability, hence provide technological support for image matching of underwater passive navigation.

Application of aircraft navigation sensors to enhanced vision systems

NASA Technical Reports Server (NTRS)

Sweet, Barbara T.

1993-01-01

In this presentation, the applicability of various aircraft navigation sensors to enhanced vision system design is discussed. First, the accuracy requirements of the FAA for precision landing systems are presented, followed by the current navigation systems and their characteristics. These systems include Instrument Landing System (ILS), Microwave Landing System (MLS), Inertial Navigation, Altimetry, and Global Positioning System (GPS). Finally, the use of navigation system data to improve enhanced vision systems is discussed. These applications include radar image rectification, motion compensation, and image registration.

A novel cost-effective computer-assisted imaging technology for accurate placement of thoracic pedicle screws.

PubMed

Abe, Yuichiro; Ito, Manabu; Abumi, Kuniyoshi; Kotani, Yoshihisa; Sudo, Hideki; Minami, Akio

2011-11-01

Use of computer-assisted spine surgery (CASS) technologies, such as navigation systems, to improve the accuracy of pedicle screw (PS) placement is increasingly popular. Despite of their benefits, previous CASS systems are too expensive to be ubiquitously employed, and more affordable and portable systems are desirable. The aim of this study was to introduce a novel and affordable computer-assisted technique that 3-dimensionally visualizes anatomical features of the pedicles and assists in PS insertion. The authors have termed this the 3D-visual guidance technique for inserting pedicle screws (3D-VG TIPS). The 3D-VG technique for placing PSs requires only a consumer-class computer with an inexpensive 3D DICOM viewer; other special equipment is unnecessary. Preoperative CT data of the spine were collected for each patient using the 3D-VG TIPS. In this technique, the anatomical axis of each pedicle can be analyzed by volume-rendered 3D models, as with existing navigation systems, and both the ideal entry point and the trajectory of each PS can be visualized on the surface of 3D-rendered images. Intraoperative guidance slides are made from these images and displayed on a TV monitor in the operating room. The surgeon can insert PSs according to these guidance slides. The authors enrolled 30 patients with adolescent idiopathic scoliosis (AIS) who underwent posterior fusion with segmental screw fixation for validation of this technique. The novel technique allowed surgeons, from office or home, to evaluate the precise anatomy of each pedicle and the risks of screw misplacement, and to perform 3D preoperative planning for screw placement on their own computer. Looking at both 3D guidance images on a TV monitor and the bony structures of the posterior elements in each patient in the operating theater, surgeons were able to determine the best entry point for each PS with ease and confidence. Using the current technique, the screw malposition rate was 4.5% in the thoracic region in corrective surgery for AIS. The authors found that 3D-VG TIPS worked on a consumer-class computer and easily visualized the ideal entry point and trajectory of PSs in any operating theater without costly special equipment. This new technique is suitable for preoperative planning and intraoperative guidance when performing reconstructive surgery with PSs.

An Effective Terrain Aided Navigation for Low-Cost Autonomous Underwater Vehicles.

PubMed

Zhou, Ling; Cheng, Xianghong; Zhu, Yixian; Dai, Chenxi; Fu, Jinbo

2017-03-25

Terrain-aided navigation is a potentially powerful solution for obtaining submerged position fixes for autonomous underwater vehicles. The application of terrain-aided navigation with high-accuracy inertial navigation systems has demonstrated meter-level navigation accuracy in sea trials. However, available sensors may be limited depending on the type of the mission. Such limitations, especially for low-grade navigation sensors, not only degrade the accuracy of traditional navigation systems, but further impact the ability to successfully employ terrain-aided navigation. To address this problem, a tightly-coupled navigation is presented to successfully estimate the critical sensor errors by incorporating raw sensor data directly into an augmented navigation system. Furthermore, three-dimensional distance errors are calculated, providing measurement updates through the particle filter for absolute and bounded position error. The development of the terrain aided navigation system is elaborated for a vehicle equipped with a non-inertial-grade strapdown inertial navigation system, a 4-beam Doppler Velocity Log range sensor and a sonar altimeter. Using experimental data for navigation performance evaluation in areas with different terrain characteristics, the experiment results further show that the proposed method can be successfully applied to the low-cost AUVs and significantly improves navigation performance.

An Effective Terrain Aided Navigation for Low-Cost Autonomous Underwater Vehicles

PubMed Central

Zhou, Ling; Cheng, Xianghong; Zhu, Yixian; Dai, Chenxi; Fu, Jinbo

2017-01-01

Terrain-aided navigation is a potentially powerful solution for obtaining submerged position fixes for autonomous underwater vehicles. The application of terrain-aided navigation with high-accuracy inertial navigation systems has demonstrated meter-level navigation accuracy in sea trials. However, available sensors may be limited depending on the type of the mission. Such limitations, especially for low-grade navigation sensors, not only degrade the accuracy of traditional navigation systems, but further impact the ability to successfully employ terrain-aided navigation. To address this problem, a tightly-coupled navigation is presented to successfully estimate the critical sensor errors by incorporating raw sensor data directly into an augmented navigation system. Furthermore, three-dimensional distance errors are calculated, providing measurement updates through the particle filter for absolute and bounded position error. The development of the terrain aided navigation system is elaborated for a vehicle equipped with a non-inertial-grade strapdown inertial navigation system, a 4-beam Doppler Velocity Log range sensor and a sonar altimeter. Using experimental data for navigation performance evaluation in areas with different terrain characteristics, the experiment results further show that the proposed method can be successfully applied to the low-cost AUVs and significantly improves navigation performance. PMID:28346346

New Directions in 3D Medical Modeling: 3D-Printing Anatomy and Functions in Neurosurgical Planning

PubMed Central

Árnadóttir, Íris; Gíslason, Magnús; Ólafsson, Ingvar

2017-01-01

This paper illustrates the feasibility and utility of combining cranial anatomy and brain function on the same 3D-printed model, as evidenced by a neurosurgical planning case study of a 29-year-old female patient with a low-grade frontal-lobe glioma. We herein report the rapid prototyping methodology utilized in conjunction with surgical navigation to prepare and plan a complex neurosurgery. The method introduced here combines CT and MRI images with DTI tractography, while using various image segmentation protocols to 3D model the skull base, tumor, and five eloquent fiber tracts. This 3D model is rapid-prototyped and coregistered with patient images and a reported surgical navigation system, establishing a clear link between the printed model and surgical navigation. This methodology highlights the potential for advanced neurosurgical preparation, which can begin before the patient enters the operation theatre. Moreover, the work presented here demonstrates the workflow developed at the National University Hospital of Iceland, Landspitali, focusing on the processes of anatomy segmentation, fiber tract extrapolation, MRI/CT registration, and 3D printing. Furthermore, we present a qualitative and quantitative assessment for fiber tract generation in a case study where these processes are applied in the preparation of brain tumor resection surgery. PMID:29065569

33 CFR 62.31 - Special marks.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Special marks. 62.31 Section 62.31 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.31 Special marks. Special...

33 CFR 62.25 - Lateral marks.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Lateral marks. 62.25 Section 62.25 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.25 Lateral marks. (a...

33 CFR 62.32 - Inland waters obstruction mark.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Inland waters obstruction mark. 62.32 Section 62.32 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.32...

33 CFR 62.33 - Information and regulatory marks.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Information and regulatory marks. 62.33 Section 62.33 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.33...

33 CFR 62.41 - Ranges.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Ranges. 62.41 Section 62.41 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.41 Ranges. Ranges are aids to...

33 CFR 62.29 - Isolated danger marks.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Isolated danger marks. 62.29 Section 62.29 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.29 Isolated danger...

33 CFR 62.32 - Inland waters obstruction mark.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Inland waters obstruction mark. 62.32 Section 62.32 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.32...

33 CFR 62.31 - Special marks.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Special marks. 62.31 Section 62.31 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.31 Special marks. Special...

33 CFR 62.29 - Isolated danger marks.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Isolated danger marks. 62.29 Section 62.29 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.29 Isolated danger...

33 CFR 62.33 - Information and regulatory marks.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Information and regulatory marks. 62.33 Section 62.33 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.33...

33 CFR 62.31 - Special marks.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Special marks. 62.31 Section 62.31 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.31 Special marks. Special...

33 CFR 62.41 - Ranges.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Ranges. 62.41 Section 62.41 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.41 Ranges. Ranges are aids to...

33 CFR 62.25 - Lateral marks.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Lateral marks. 62.25 Section 62.25 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.25 Lateral marks. (a...

33 CFR 62.33 - Information and regulatory marks.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Information and regulatory marks. 62.33 Section 62.33 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.33...

33 CFR 62.25 - Lateral marks.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Lateral marks. 62.25 Section 62.25 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.25 Lateral marks. (a...

33 CFR 62.29 - Isolated danger marks.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Isolated danger marks. 62.29 Section 62.29 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.29 Isolated danger...

33 CFR 62.31 - Special marks.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Special marks. 62.31 Section 62.31 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.31 Special marks. Special...

33 CFR 62.32 - Inland waters obstruction mark.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Inland waters obstruction mark. 62.32 Section 62.32 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.32...

33 CFR 62.37 - Lighthouses.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Lighthouses. 62.37 Section 62.37 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.37 Lighthouses. Lighthouses are...

33 CFR 62.37 - Lighthouses.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Lighthouses. 62.37 Section 62.37 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.37 Lighthouses. Lighthouses are...

33 CFR 62.37 - Lighthouses.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Lighthouses. 62.37 Section 62.37 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.37 Lighthouses. Lighthouses are...

33 CFR 62.33 - Information and regulatory marks.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Information and regulatory marks. 62.33 Section 62.33 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.33...

33 CFR 62.32 - Inland waters obstruction mark.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Inland waters obstruction mark. 62.32 Section 62.32 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.32...

33 CFR 62.29 - Isolated danger marks.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Isolated danger marks. 62.29 Section 62.29 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.29 Isolated danger...

33 CFR 62.41 - Ranges.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Ranges. 62.41 Section 62.41 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.41 Ranges. Ranges are aids to...

33 CFR 62.25 - Lateral marks.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Lateral marks. 62.25 Section 62.25 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.25 Lateral marks. (a...

33 CFR 62.37 - Lighthouses.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Lighthouses. 62.37 Section 62.37 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.37 Lighthouses. Lighthouses are...

33 CFR 62.41 - Ranges.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Ranges. 62.41 Section 62.41 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.41 Ranges. Ranges are aids to...

33 CFR 62.37 - Lighthouses.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Lighthouses. 62.37 Section 62.37 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.37 Lighthouses. Lighthouses are...

33 CFR 62.31 - Special marks.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Special marks. 62.31 Section 62.31 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.31 Special marks. Special...

33 CFR 62.41 - Ranges.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Ranges. 62.41 Section 62.41 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.41 Ranges. Ranges are aids to...

33 CFR 62.29 - Isolated danger marks.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Isolated danger marks. 62.29 Section 62.29 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.29 Isolated danger...

33 CFR 62.33 - Information and regulatory marks.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Information and regulatory marks. 62.33 Section 62.33 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.33...

33 CFR 62.32 - Inland waters obstruction mark.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Inland waters obstruction mark. 62.32 Section 62.32 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.32...

33 CFR 62.25 - Lateral marks.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Lateral marks. 62.25 Section 62.25 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.25 Lateral marks. (a...

Patient Registration Using Photogrammetric Surface Reconstruction from Smartphone Imagery

NASA Astrophysics Data System (ADS)

Hellwich, O.; Rose, A.; Bien, T.; Malolepszy, C.; Mucha, D.; Krüger, T.

2016-06-01

In navigated surgery the patient's body has to be co-registered with presurgically acquired 3D data in order to enable navigation of the surgical instrument. For this purpose the body surface of the patient can be acquired by means of photogrammetry and co-registered to corresponding surfaces in the presurgical data. In this paper this task is exemplarily solved for 3D data of human heads using the face surface to establish correspondence. We focus on investigation of achieved geometric accuracies reporting positioning errors in the range of 1 mm.

Research on the error model of airborne celestial/inertial integrated navigation system

NASA Astrophysics Data System (ADS)

Zheng, Xiaoqiang; Deng, Xiaoguo; Yang, Xiaoxu; Dong, Qiang

2015-02-01

Celestial navigation subsystem of airborne celestial/inertial integrated navigation system periodically correct the positioning error and heading drift of the inertial navigation system, by which the inertial navigation system can greatly improve the accuracy of long-endurance navigation. Thus the navigation accuracy of airborne celestial navigation subsystem directly decides the accuracy of the integrated navigation system if it works for long time. By building the mathematical model of the airborne celestial navigation system based on the inertial navigation system, using the method of linear coordinate transformation, we establish the error transfer equation for the positioning algorithm of airborne celestial system. Based on these we built the positioning error model of the celestial navigation. And then, based on the positioning error model we analyze and simulate the positioning error which are caused by the error of the star tracking platform with the MATLAB software. Finally, the positioning error model is verified by the information of the star obtained from the optical measurement device in range and the device whose location are known. The analysis and simulation results show that the level accuracy and north accuracy of tracking platform are important factors that limit airborne celestial navigation systems to improve the positioning accuracy, and the positioning error have an approximate linear relationship with the level error and north error of tracking platform. The error of the verification results are in 1000m, which shows that the model is correct.

Current status of sentinel lymph node navigation surgery in breast and gastrointestinal tract.

PubMed

Tangoku, Akira; Seike, Junichi; Nakano, Kiichiro; Nagao, Taeko; Honda, Junko; Yoshida, Takahiro; Yamai, Hiromichi; Matsuoka, Hisashi; Uyama, Kou; Goto, Masakazu; Miyoshi, Takanori; Morimoto, Tadaoki

2007-02-01

Sentinel lymph node biopsy (SLNB) has been developed as a new diagnostic and therapeutic modality in melanoma and breast cancer surgery. The purpose of the SLNB include preventing the operative morbidity and improving the pathologic stage by focusing on fewer lymph nodes using immunocytochemic and molecular technology has almost achieved in breast cancer surgery. The prognostic meaning of immunocytochemically detected micrometastases is also evaluating in the SLN and bone marrow aspirates of women with early-stage breast cancer. SLNB using available techniques have suggested that the lymphatic drainage of the gastrointestinal tract is much more complicated than other sites, skip metastasis being rather frequent because of an aberrant lymphatic drainage outside of the basin exist. At the moment, the available data does not justify reduced extent of lymphadenectomy, but provides strong evidence for an improvement in tumor staging on the basis of SLNB. Two large scale prospective multi-center trials concerning feasibility of gamma-probe and dye detection for gastric cancer are ongoing in Japan. Recent studies have shown favorable results for identification of SLN in esophageal cancer. CT lymphography with endoscopic mucosal injection of iopamidol was applicable for SLN navigation of superficial esophageal cancer. The aim of surgical treatment is complete resection of the tumor-infiltrated organ including the regional lymph nodes. Accurate detection of SLN can achieve a selection of a more sophisticated tailor made approach. The patient can make a individualized choice from a broader spectrum of therapeutic options including endoscopic, laparoscopic or laparoscopy-assisted surgery, modified radical surgery, and typical radical surgery with lymph node dissection. Ultrastaging by detecting micrometastasis at the molecular level and the choice of an adequate treatment improve the postoperative quality of life and survival. However these issues require further investigation.

Setup presentation and clinical outcome analysis of treating highly language-eloquent gliomas via preoperative navigated transcranial magnetic stimulation and tractography.

PubMed

Sollmann, Nico; Kelm, Anna; Ille, Sebastian; Schröder, Axel; Zimmer, Claus; Ringel, Florian; Meyer, Bernhard; Krieg, Sandro M

2018-06-01

OBJECTIVE Awake surgery combined with intraoperative direct electrical stimulation (DES) and intraoperative neuromonitoring (IONM) is considered the gold standard for the resection of highly language-eloquent brain tumors. Different modalities, such as functional magnetic resonance imaging (fMRI) or magnetoencephalography (MEG), are commonly added as adjuncts for preoperative language mapping but have been shown to have relevant limitations. Thus, this study presents a novel multimodal setup consisting of preoperative navigated transcranial magnetic stimulation (nTMS) and nTMS-based diffusion tensor imaging fiber tracking (DTI FT) as an adjunct to awake surgery. METHODS Sixty consecutive patients (63.3% men, mean age 47.6 ± 13.3 years) suffering from highly language-eloquent left-hemispheric low- or high-grade glioma underwent preoperative nTMS language mapping and nTMS-based DTI FT, followed by awake surgery for tumor resection. Both nTMS language mapping and DTI FT data were available for resection planning and intraoperative guidance. Clinical outcome parameters, including craniotomy size, extent of resection (EOR), language deficits at different time points, Karnofsky Performance Scale (KPS) score, duration of surgery, and inpatient stay, were assessed. RESULTS According to postoperative evaluation, 28.3% of patients showed tumor residuals, whereas new surgery-related permanent language deficits occurred in 8.3% of patients. KPS scores remained unchanged (median preoperative score 90, median follow-up score 90). CONCLUSIONS This is the first study to present a clinical outcome analysis of this very modern approach, which is increasingly applied in neurooncological centers worldwide. Although human language function is a highly complex and dynamic cortico-subcortical network, the presented approach offers excellent functional and oncological outcomes in patients undergoing surgery of lesions affecting this network.

33 CFR 62.35 - Mooring buoys.

Code of Federal Regulations, 2013 CFR

2013-07-01

....35 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.35 Mooring buoys. Mooring... identification and to avoid confusion with aids to navigation. ...

33 CFR 62.35 - Mooring buoys.

Code of Federal Regulations, 2014 CFR

2014-07-01

....35 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.35 Mooring buoys. Mooring... identification and to avoid confusion with aids to navigation. ...

33 CFR 62.35 - Mooring buoys.

Code of Federal Regulations, 2011 CFR

2011-07-01

....35 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.35 Mooring buoys. Mooring... identification and to avoid confusion with aids to navigation. ...

33 CFR 62.35 - Mooring buoys.

Code of Federal Regulations, 2012 CFR

2012-07-01

....35 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.35 Mooring buoys. Mooring... identification and to avoid confusion with aids to navigation. ...

33 CFR 62.35 - Mooring buoys.

Code of Federal Regulations, 2010 CFR

2010-07-01

....35 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.35 Mooring buoys. Mooring... identification and to avoid confusion with aids to navigation. ...

Training femoral neck screw insertion skills to surgical trainees: computer-assisted surgery versus conventional fluoroscopic technique.

PubMed

Nousiainen, Markku T; Omoto, Daniel M; Zingg, Patrick O; Weil, Yoram A; Mardam-Bey, Sami W; Eward, William C

2013-02-01

: Femoral neck fractures are among the most common orthopaedic injuries impacting the health care system. Surgical management of such fractures with cannulated screws is a commonly performed procedure. The acquisition of surgical skills necessary to perform this procedure typically involves learning on real patients with fluoroscopic guidance. This study attempts to determine if a novel computer-navigated training model improves the learning of this basic surgical skill. A multicenter, prospective, randomized, and controlled study was conducted using surgical trainees with no prior experience in surgically managing femoral neck fractures. After a training session, participants underwent a pretest by performing the surgical task (screw placement) on a simulated hip fracture using fluoroscopic guidance. Immediately after, participants were randomized into either undergoing a training session using conventional fluoroscopy or computer-based navigation. Immediate posttest, retention (4 weeks later), and transfer tests were performed. Performance during the tests was determined by radiographic analysis of hardware placement. Screw placement by trainees was ultimately equal to the level of an expert surgeon with either training technique. Participants who trained with computer navigation took fewer attempts to position hardware and used less fluoroscopy time than those trained with fluoroscopy. When those trained with fluoroscopy used computer navigation at the transfer test, less fluoroscopy time and dosage was used. The concurrent augmented feedback provided by computer navigation did not affect the learning of this basic surgical skill in surgical novices. No compromise in learning occurred if the surgical novice trained with one type of technology and transferred to using the other. The findings of this study suggest that computer navigation may be safely used to train surgical novices in a basic procedure. This model avoids using both live patients and harmful radiation without a compromise in the acquisition of a 3-dimensional technical skill.

Space shuttle navigation analysis. Volume 2: Baseline system navigation

NASA Technical Reports Server (NTRS)

Jones, H. L.; Luders, G.; Matchett, G. A.; Rains, R. G.

1980-01-01

Studies related to the baseline navigation system for the orbiter are presented. The baseline navigation system studies include a covariance analysis of the Inertial Measurement Unit calibration and alignment procedures, postflight IMU error recovery for the approach and landing phases, on-orbit calibration of IMU instrument biases, and a covariance analysis of entry and prelaunch navigation system performance.

Maximum Correntropy Unscented Kalman Filter for Ballistic Missile Navigation System based on SINS/CNS Deeply Integrated Mode.

PubMed

Hou, Bowen; He, Zhangming; Li, Dong; Zhou, Haiyin; Wang, Jiongqi

2018-05-27

Strap-down inertial navigation system/celestial navigation system ( SINS/CNS) integrated navigation is a high precision navigation technique for ballistic missiles. The traditional navigation method has a divergence in the position error. A deeply integrated mode for SINS/CNS navigation system is proposed to improve the navigation accuracy of ballistic missile. The deeply integrated navigation principle is described and the observability of the navigation system is analyzed. The nonlinearity, as well as the large outliers and the Gaussian mixture noises, often exists during the actual navigation process, leading to the divergence phenomenon of the navigation filter. The new nonlinear Kalman filter on the basis of the maximum correntropy theory and unscented transformation, named the maximum correntropy unscented Kalman filter, is deduced, and the computational complexity is analyzed. The unscented transformation is used for restricting the nonlinearity of the system equation, and the maximum correntropy theory is used to deal with the non-Gaussian noises. Finally, numerical simulation illustrates the superiority of the proposed filter compared with the traditional unscented Kalman filter. The comparison results show that the large outliers and the influence of non-Gaussian noises for SINS/CNS deeply integrated navigation is significantly reduced through the proposed filter.

33 CFR 62.27 - Safe water marks.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Safe water marks. 62.27 Section 62.27 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.27 Safe water marks. Safe...

Comparison of Intraoperative Portable CT Scanners in Skull Base and Endoscopic Sinus Surgery: Single Center Case Series

PubMed Central

Conley, David B.; Tan, Bruce; Bendok, Bernard R.; Batjer, H. Hunt; Chandra, Rakesh; Sidle, Douglas; Rahme, Rudy J.; Adel, Joseph G.; Fishman, Andrew J.

2011-01-01

Precise and safe management of complex skull base lesions can be enhanced by intraoperative computed tomography (CT) scanning. Surgery in these areas requires real-time feedback of anatomic landmarks. Several portable CT scanners are currently available. We present a comparison of our clinical experience with three portable scanners in skull base and craniofacial surgery. We present clinical case series and the participants were from the Northwestern Memorial Hospital. Three scanners are studied: one conventional multidetector CT (MDCT), two digital flat panel cone-beam CT (CBCT) devices. Technical considerations, ease of use, image characteristics, and integration with image guidance are presented for each device. All three scanners provide good quality images. Intraoperative scanning can be used to update the image guidance system in real time. The conventional MDCT is unique in its ability to resolve soft tissue. The flat panel CBCT scanners generally emit lower levels of radiation and have less metal artifact effect. In this series, intraoperative CT scanning was technically feasible and deemed useful in surgical decision-making in 75% of patients. Intraoperative portable CT scanning has significant utility in complex skull base surgery. This technology informs the surgeon of the precise extent of dissection and updates intraoperative stereotactic navigation. PMID:22470270

Design and implementation of a PC-based image-guided surgical system.

PubMed

Stefansic, James D; Bass, W Andrew; Hartmann, Steven L; Beasley, Ryan A; Sinha, Tuhin K; Cash, David M; Herline, Alan J; Galloway, Robert L

2002-11-01

In interactive, image-guided surgery, current physical space position in the operating room is displayed on various sets of medical images used for surgical navigation. We have developed a PC-based surgical guidance system (ORION) which synchronously displays surgical position on up to four image sets and updates them in real time. There are three essential components which must be developed for this system: (1) accurately tracked instruments; (2) accurate registration techniques to map physical space to image space; and (3) methods to display and update the image sets on a computer monitor. For each of these components, we have developed a set of dynamic link libraries in MS Visual C++ 6.0 supporting various hardware tools and software techniques. Surgical instruments are tracked in physical space using an active optical tracking system. Several of the different registration algorithms were developed with a library of robust math kernel functions, and the accuracy of all registration techniques was thoroughly investigated. Our display was developed using the Win32 API for windows management and tomographic visualization, a frame grabber for live video capture, and OpenGL for visualization of surface renderings. We have begun to use this current implementation of our system for several surgical procedures, including open and minimally invasive liver surgery.

33 CFR 62.63 - Recommendations.

Code of Federal Regulations, 2013 CFR

2013-07-01

....63 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM Public Participation in the Aids to Navigation System § 62.63 Recommendations. (a) The public may recommend changes to existing aids to navigation, request new aids or the...

33 CFR 62.63 - Recommendations.

Code of Federal Regulations, 2014 CFR

2014-07-01

....63 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM Public Participation in the Aids to Navigation System § 62.63 Recommendations. (a) The public may recommend changes to existing aids to navigation, request new aids or the...

Restoration of the ascending reticular activating system compressed by hematoma in a stroke patient

PubMed Central

Jang, Sung Ho; Seo, Jeong Pyo

2017-01-01

Abstract Rationale: We report on restoration of the ascending reticular activating system (ARAS), compressed by an intracerebral hematoma and perihematomal edema following a stroke. The restoration of the ARAS was demonstrated by diffusion tensor tractography (DTT). Patient concerns: In a 60-year-old male, a brain MRI taken at 2 weeks after the surgery showed a hematoma and perihematomal edema in the left posterolateral pons and cerebellum, which were markedly resolved on a brain MRI after 5 weeks. Diagnoses: Intraventricular hemorrhage. Interventions: Navigation-guided stereotactic drainage of a hematoma in the left cerebellum, comprehensive rehabilitative therapy, including hypersomnia medication (modafinil), physical therapy, and occupational therapy. Outcomes: His hypersomnia improved significantly with rehabilitation, with no daytime hypersomnia beginning 3 weeks after the surgery. On 2-week DTT, neither the neural tract of the left lower dorsal or ventral ARAS were reconstructed, but these neural tracts were wellreconstructed on 5-week DTT. Lessons: In conclusion, restoration of nonreconstructed neural tracts of the lower ARAS with the resolution of the hematoma and perihematomal edema was demonstrated in a stroke patient, using DTT. PMID:28207526

Optical surgical navigation system causes pulse oximeter malfunction.

PubMed

Satoh, Masaaki; Hara, Tetsuhito; Tamai, Kenji; Shiba, Juntaro; Hotta, Kunihisa; Takeuchi, Mamoru; Watanabe, Eiju

2015-01-01

An optical surgical navigation system is used as a navigator to facilitate surgical approaches, and pulse oximeters provide valuable information for anesthetic management. However, saw-tooth waves on the monitor of a pulse oximeter and the inability of the pulse oximeter to accurately record the saturation of a percutaneous artery were observed when a surgeon started an optical navigation system. The current case is thought to be the first report of this navigation system interfering with pulse oximetry. The causes of pulse jamming and how to manage an optical navigation system are discussed.

Gravity Gradiometry and Map Matching: An Aid to Aircraft Inertial Navigation Systems

DTIC Science & Technology

2010-03-01

improve its performance. In all of these cases, because information from two or more different navigation systems feeds into a navigation solution...GRAVITY GRADIOMETRY AND MAP MATCHING: AN AID TO AIRCRAFT INERTIAL NAVIGATION SYSTEMS THESIS...M06 GRAVITY GRADIOMETRY AND MAP MATCHING: AN AID TO AIRCRAFT INERTIAL NAVIGATION SYSTEMS THESIS Presented to the Faculty Department of

Overcoming extreme obesity with robotic surgery.

PubMed

Stone, Pamela; Burnett, Alexander; Burton, Brian; Roman, Juan

2010-12-01

Obesity is often associated with endometrial cancer and has posed a challenge in surgical management. Complications such as wound breakdown, respiratory challenges, cardiac complications and difficult intubations are associated with obesity. For the patient with uterine cancer, surgery is necessary for staging, control of symptoms and cure. With the advent of the da Vinci(™) intuitive robot, alternative surgical options can now be offered to these patients. While surgery is the principal modality for the treatment and management of uterine cancer, the morbidly obese patient faces increased complications and longer postoperative recovery. As studied in the LAP2, comparable outcomes have been noted in laparotomy vs laparoscopic surgery. Recently, minimally invasive surgery has been refined with the advent of the da Vinci robotic system. Applying a minimally invasive technique further enhanced with the da Vinci robotic system, a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed on a patient with a BMI of 98. A 35 year-old G0 woman with a BMI of 98 presented with heavy vaginal bleeding and anaemia. She was diagnosed with endometrioid adenocarcinoma of the uterus, FIGO grade 1. She was treated with a robotically assisted total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Her postoperative course was uncomplicated and she was discharged home on post-operative day 1. Since obesity is a significant risk factor for endometrial cancer and the prevalence of obesity is increasing, developing surgical techniques to appropriately manage these patients is important. Minimally invasive surgery, specifically with robotic assistance, has increased the possibilities of performing minimally invasive surgery in morbidly obese women. It allows navigation around anatomical barriers and decreases the fatigue experienced by the surgeons. With the increasing obesity of our population and the high prevalence of uterine cancer, further advancement of equipment, anaesthesia and surgical techniques to accommodate the larger patient while decreasing complications have yet to be standardized. Copyright © 2010 John Wiley & Sons, Ltd.

33 CFR 62.27 - Safe water marks.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Safe water marks. 62.27 Section 62.27 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.27 Safe water marks. Safe water marks indicate that there is...

33 CFR 62.53 - Racons.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.53 Racons. (a) Aids to navigation may... non-laterally significant aids alike, the racon signal itself is for identification purposes only, and...

33 CFR 62.53 - Racons.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.53 Racons. (a) Aids to navigation may... non-laterally significant aids alike, the racon signal itself is for identification purposes only, and...

33 CFR 62.53 - Racons.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.53 Racons. (a) Aids to navigation may... non-laterally significant aids alike, the racon signal itself is for identification purposes only, and...

Virtual Reality and Augmented Reality in Plastic Surgery: A Review.

PubMed

Kim, Youngjun; Kim, Hannah; Kim, Yong Oock

2017-05-01

Recently, virtual reality (VR) and augmented reality (AR) have received increasing attention, with the development of VR/AR devices such as head-mounted displays, haptic devices, and AR glasses. Medicine is considered to be one of the most effective applications of VR/AR. In this article, we describe a systematic literature review conducted to investigate the state-of-the-art VR/AR technology relevant to plastic surgery. The 35 studies that were ultimately selected were categorized into 3 representative topics: VR/AR-based preoperative planning, navigation, and training. In addition, future trends of VR/AR technology associated with plastic surgery and related fields are discussed.

Virtual Reality and Augmented Reality in Plastic Surgery: A Review

PubMed Central

Kim, Youngjun; Kim, Hannah

2017-01-01

Recently, virtual reality (VR) and augmented reality (AR) have received increasing attention, with the development of VR/AR devices such as head-mounted displays, haptic devices, and AR glasses. Medicine is considered to be one of the most effective applications of VR/AR. In this article, we describe a systematic literature review conducted to investigate the state-of-the-art VR/AR technology relevant to plastic surgery. The 35 studies that were ultimately selected were categorized into 3 representative topics: VR/AR-based preoperative planning, navigation, and training. In addition, future trends of VR/AR technology associated with plastic surgery and related fields are discussed. PMID:28573091

Clinical indications for high-field 1.5 T intraoperative magnetic resonance imaging and neuro-navigation for neurosurgical procedures. Review of initial 100 cases.

PubMed

Maesawa, Satoshi; Fujii, Masazumi; Nakahara, Norimoto; Watanabe, Tadashi; Saito, Kiyoshi; Kajita, Yasukazu; Nagatani, Tetsuya; Wakabayashi, Toshihiko; Yoshida, Jun

2009-08-01

Initial experiences are reviewed in an integrated operation theater equipped with an intraoperative high-field (1.5 T) magnetic resonance (MR) imager and neuro-navigation (BrainSUITE), to evaluate the indications and limitations. One hundred consecutive cases were treated, consisting of 38 gliomas, 49 other tumors, 11 cerebrovascular diseases, and 2 functional diseases. The feasibility and usefulness of the integrated theater were evaluated for individual diseases, focusing on whether intraoperative images (including diffusion tensor imaging) affected the surgical strategy. The extent of resection and outcomes in each histological category of brain tumors were examined. Intraoperative high-field MR imaging frequently affected or modified the surgical strategy in the glioma group (27/38 cases, 71.1%), but less in the other tumor group (13/49 cases, 26.5%). The surgical strategy was not modified in cerebrovascular or functional diseases, but the success of procedures and the absence of complications could be confirmed. In glioma surgery, subtotal or greater resection was achieved in 22 of the 31 patients (71%) excluding biopsies, and intraoperative images revealed tumor remnants resulting in the extension of resection in 21 of the 22 patients (95.4%), the highest rate of extension among all types of pathologies. The integrated neuro-navigation improved workflow. The best indication for intraoperative high-field MR imaging and integrated neuro-navigation is brain tumors, especially gliomas, and is supplementary in assuring quality in surgery for cerebrovascular or functional diseases. Immediate quality assurance is provided in several types of neurosurgical procedures.

A Randomized controlled trial to evaluate the impact of a Nurse Navigator Programme on outcomes of people with breast cancer: study protocol.

PubMed

Chillakunnel Hussain Rawther, Shejila; Pai, Mamatha Shivananda; Fernandes, Donald J; Mathew, Stanley; Binu, V S; Chakrabarty, Jyothi; Devi, Elsa Sanatombi; George, Anice; Nayak, Baby S

2017-04-01

To evaluate the effectiveness of a Nurse Navigator Programme on anxiety, psychological distress and quality of life in people with breast cancer. Breast cancer is the most frequently detected malignancy and a major cause of cancer death among women around the world. The lengthy course of illness from initial diagnosis to treatment and subsequent follow-up causes deterioration in physical, psychological and social status among patients. Nurses have a major role in cancer care. As women with breast cancer have to undergo various treatment modalities, continued care by a pivot nurse is thought to enhance treatment adherence. Limited studies have been reported from developing countries on Nurse Navigation Programmes. A Stratified Randomized controlled trial with repeated measures. One hundred and twenty newly diagnosed women with breast cancer admitted to surgery wards of a tertiary care hospital in South India will be recruited. (Project funded in Octo"ber 2014). Women are randomly allocated to a control and intervention group. The outcome variables are anxiety, psychological distress and quality of life. Data on outcome measures will be collected at five different time points: before surgery, at discharge, beginning of adjuvant therapy, middle of adjuvant therapy and at the end of adjuvant therapy. This study may give evidence on the effectiveness of a Nurse Navigator Programme for women with breast cancer. If significant effects were detected, the programme could be integrated into hospital services to improve the patient care. © 2016 John Wiley & Sons Ltd.

33 CFR 62.23 - Beacons and buoys.

Code of Federal Regulations, 2010 CFR

2010-07-01

... navigation. The primary components of the U.S. Aids to Navigation System are beacons and buoys. (b) Beacons are aids to navigation structures which are permanently fixed to the earth's surface. They range from... UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.23 Beacons and buoys. (a...

33 CFR 62.23 - Beacons and buoys.

Code of Federal Regulations, 2011 CFR

2011-07-01

... navigation. The primary components of the U.S. Aids to Navigation System are beacons and buoys. (b) Beacons are aids to navigation structures which are permanently fixed to the earth's surface. They range from... UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.23 Beacons and buoys. (a...

33 CFR 62.23 - Beacons and buoys.

Code of Federal Regulations, 2013 CFR

2013-07-01

... navigation. The primary components of the U.S. Aids to Navigation System are beacons and buoys. (b) Beacons are aids to navigation structures which are permanently fixed to the earth's surface. They range from... UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.23 Beacons and buoys. (a...

33 CFR 62.23 - Beacons and buoys.

Code of Federal Regulations, 2014 CFR

2014-07-01

... navigation. The primary components of the U.S. Aids to Navigation System are beacons and buoys. (b) Beacons are aids to navigation structures which are permanently fixed to the earth's surface. They range from... UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.23 Beacons and buoys. (a...

33 CFR 62.23 - Beacons and buoys.

Code of Federal Regulations, 2012 CFR

2012-07-01

... navigation. The primary components of the U.S. Aids to Navigation System are beacons and buoys. (b) Beacons are aids to navigation structures which are permanently fixed to the earth's surface. They range from... UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.23 Beacons and buoys. (a...

33 CFR 62.54 - Ownership identification.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Section 62.54 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.54 Ownership identification. Ownership identification on private or state aids to navigation is permitted so long as it does...

33 CFR 62.54 - Ownership identification.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Section 62.54 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.54 Ownership identification. Ownership identification on private or state aids to navigation is permitted so long as it does...

33 CFR 62.54 - Ownership identification.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Section 62.54 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.54 Ownership identification. Ownership identification on private or state aids to navigation is permitted so long as it does...

33 CFR 62.54 - Ownership identification.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Section 62.54 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.54 Ownership identification. Ownership identification on private or state aids to navigation is permitted so long as it does...

33 CFR 62.54 - Ownership identification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 62.54 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.54 Ownership identification. Ownership identification on private or state aids to navigation is permitted so long as it does...

33 CFR 62.45 - Light characteristics.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Light characteristics. 62.45... NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.45 Light characteristics. (a) Lights on aids to navigation are differentiated by color and rhythm. Lighthouses and range...

33 CFR 62.45 - Light characteristics.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Light characteristics. 62.45... NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.45 Light characteristics. (a) Lights on aids to navigation are differentiated by color and rhythm. Lighthouses and range...

33 CFR 62.45 - Light characteristics.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Light characteristics. 62.45... NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.45 Light characteristics. (a) Lights on aids to navigation are differentiated by color and rhythm. Lighthouses and range...

33 CFR 62.45 - Light characteristics.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Light characteristics. 62.45... NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.45 Light characteristics. (a) Lights on aids to navigation are differentiated by color and rhythm. Lighthouses and range...

33 CFR 62.45 - Light characteristics.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Light characteristics. 62.45... NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.45 Light characteristics. (a) Lights on aids to navigation are differentiated by color and rhythm. Lighthouses and range...

Cadaveric feasibility study of da Vinci Si-assisted cochlear implant with augmented visual navigation for otologic surgery.

PubMed

Liu, Wen P; Azizian, Mahdi; Sorger, Jonathan; Taylor, Russell H; Reilly, Brian K; Cleary, Kevin; Preciado, Diego

2014-03-01

To our knowledge, this is the first reported cadaveric feasibility study of a master-slave-assisted cochlear implant procedure in the otolaryngology-head and neck surgery field using the da Vinci Si system (da Vinci Surgical System; Intuitive Surgical, Inc). We describe the surgical workflow adaptations using a minimally invasive system and image guidance integrating intraoperative cone beam computed tomography through augmented reality. To test the feasibility of da Vinci Si-assisted cochlear implant surgery with augmented reality, with visualization of critical structures and facilitation with precise cochleostomy for electrode insertion. Cadaveric case study of bilateral cochlear implant approaches conducted at Intuitive Surgical Inc, Sunnyvale, California. Bilateral cadaveric mastoidectomies, posterior tympanostomies, and cochleostomies were performed using the da Vinci Si system on a single adult human donor cadaveric specimen. Radiographic confirmation of successful cochleostomies, placement of a phantom cochlear implant wire, and visual confirmation of critical anatomic structures (facial nerve, cochlea, and round window) in augmented stereoendoscopy. With a surgical mean time of 160 minutes per side, complete bilateral cochlear implant procedures were successfully performed with no violation of critical structures, notably the facial nerve, chorda tympani, sigmoid sinus, dura, or ossicles. Augmented reality image overlay of the facial nerve, round window position, and basal turn of the cochlea was precise. Postoperative cone beam computed tomography scans confirmed successful placement of the phantom implant electrode array into the basal turn of the cochlea. To our knowledge, this is the first study in the otolaryngology-head and neck surgery literature examining the use of master-slave-assisted cochleostomy with augmented reality for cochlear implants using the da Vinci Si system. The described system for cochleostomy has the potential to improve the surgeon's confidence, as well as surgical safety, efficiency, and precision by filtering tremor. The integration of augmented reality may be valuable for surgeons dealing with complex cases of congenital anatomic abnormality, for revision cochlear implant with distorted anatomy and poorly pneumatized mastoids, and as a method of interactive teaching. Further research into the cost-benefit ratio of da Vinci Si-assisted otologic surgery, as well as refinements of the proposed workflow, are required before considering clinical studies.

Area navigation and required navigation performance procedures and depictions

DOT National Transportation Integrated Search

2012-09-30

Area navigation (RNAV) and required navigation performance (RNP) procedures are fundamental to the implementation of a performance based navigation (PBN) system, which is a key enabling technology for the Next Generation Air Transportation System (Ne...

An on-line monitoring system for navigation equipment

NASA Astrophysics Data System (ADS)

Wang, Bo; Yang, Ping; Liu, Jing; Yang, Zhengbo; Liang, Fei

2017-10-01

Civil air navigation equipment is the most important infrastructure of Civil Aviation, which is closely related to flight safety. In addition to regular flight inspection, navigation equipment's patrol measuring, maintenance measuring, running measuring under special weather conditions are the important means of ensuring aviation flight safety. According to the safety maintenance requirements of Civil Aviation Air Traffic Control navigation equipment, this paper developed one on-line monitoring system with independent intellectual property rights for navigation equipment, the system breakthroughs the key technologies of measuring navigation equipment on-line including Instrument Landing System (ILS) and VHF Omni-directional Range (VOR), which also meets the requirements of navigation equipment ground measurement set by the ICAO DOC 8071, it provides technical means of the ground on-line measurement for navigation equipment, improves the safety of navigation equipment operation, and reduces the impact of measuring navigation equipment on airport operation.

Precision insertion of percutaneous sacroiliac screws using a novel augmented reality-based navigation system: a pilot study.

PubMed

Wang, Huixiang; Wang, Fang; Leong, Anthony Peng Yew; Xu, Lu; Chen, Xiaojun; Wang, Qiugen

2016-09-01

Augmented reality (AR) enables superimposition of virtual images onto the real world. The aim of this study is to present a novel AR-based navigation system for sacroiliac screw insertion and to evaluate its feasibility and accuracy in cadaveric experiments. Six cadavers with intact pelvises were employed in our study. They were CT scanned and the pelvis and vessels were segmented into 3D models. The ideal trajectory of the sacroiliac screw was planned and represented visually as a cylinder. For the intervention, the head mounted display created a real-time AR environment by superimposing the virtual 3D models onto the surgeon's field of view. The screws were drilled into the pelvis as guided by the trajectory represented by the cylinder. Following the intervention, a repeat CT scan was performed to evaluate the accuracy of the system, by assessing the screw positions and the deviations between the planned trajectories and inserted screws. Post-operative CT images showed that all 12 screws were correctly placed with no perforation. The mean deviation between the planned trajectories and the inserted screws was 2.7 ± 1.2 mm at the bony entry point, 3.7 ± 1.1 mm at the screw tip, and the mean angular deviation between the two trajectories was 2.9° ± 1.1°. The mean deviation at the nerve root tunnels region on the sagittal plane was 3.6 ± 1.0 mm. This study suggests an intuitive approach for guiding screw placement by way of AR-based navigation. This approach was feasible and accurate. It may serve as a valuable tool for assisting percutaneous sacroiliac screw insertion in live surgery.

Design of all-weather celestial navigation system

NASA Astrophysics Data System (ADS)

Sun, Hongchi; Mu, Rongjun; Du, Huajun; Wu, Peng

2018-03-01

In order to realize autonomous navigation in the atmosphere, an all-weather celestial navigation system is designed. The research of celestial navigation system include discrimination method of comentropy and the adaptive navigation algorithm based on the P value. The discrimination method of comentropy is studied to realize the independent switching of two celestial navigation modes, starlight and radio. Finally, an adaptive filtering algorithm based on P value is proposed, which can greatly improve the disturbance rejection capability of the system. The experimental results show that the accuracy of the three axis attitude is better than 10″, and it can work all weather. In perturbation environment, the position accuracy of the integrated navigation system can be increased 20% comparing with the traditional method. It basically meets the requirements of the all-weather celestial navigation system, and it has the ability of stability, reliability, high accuracy and strong anti-interference.

Preoperative planning of thoracic surgery with use of three-dimensional reconstruction, rapid prototyping, simulation and virtual navigation

PubMed Central

Heuts, Samuel; Maessen, Jos G.

2016-01-01

For the past decades, surgeries have become more complex, due to the increasing age of the patient population referred for thoracic surgery, more complex pathology and the emergence of minimally invasive thoracic surgery. Together with the early detection of thoracic disease as a result of innovations in diagnostic possibilities and the paradigm shift to personalized medicine, preoperative planning is becoming an indispensable and crucial aspect of surgery. Several new techniques facilitating this paradigm shift have emerged. Pre-operative marking and staining of lesions are already a widely accepted method of preoperative planning in thoracic surgery. However, three-dimensional (3D) image reconstructions, virtual simulation and rapid prototyping (RP) are still in development phase. These new techniques are expected to become an important part of the standard work-up of patients undergoing thoracic surgery in the future. This review aims at graphically presenting and summarizing these new diagnostic and therapeutic tools PMID:29078505

Three-Dimensional Liver Surgery Simulation: Computer-Assisted Surgical Planning with Three-Dimensional Simulation Software and Three-Dimensional Printing^.

PubMed

Oshiro, Yukio; Ohkohchi, Nobuhiro

2017-06-01

To perform accurate hepatectomy without injury, it is necessary to understand the anatomical relationship among the branches of Glisson's sheath, hepatic veins, and tumor. In Japan, three-dimensional (3D) preoperative simulation for liver surgery is becoming increasingly common, and liver 3D modeling and 3D hepatectomy simulation by 3D analysis software for liver surgery have been covered by universal healthcare insurance since 2012. Herein, we review the history of virtual hepatectomy using computer-assisted surgery (CAS) and our research to date, and we discuss the future prospects of CAS. We have used the SYNAPSE VINCENT medical imaging system (Fujifilm Medical, Tokyo, Japan) for 3D visualization and virtual resection of the liver since 2010. We developed a novel fusion imaging technique combining 3D computed tomography (CT) with magnetic resonance imaging (MRI). The fusion image enables us to easily visualize anatomic relationships among the hepatic arteries, portal veins, bile duct, and tumor in the hepatic hilum. In 2013, we developed an original software, called Liversim, which enables real-time deformation of the liver using physical simulation, and a randomized control trial has recently been conducted to evaluate the use of Liversim and SYNAPSE VINCENT for preoperative simulation and planning. Furthermore, we developed a novel hollow 3D-printed liver model whose surface is covered with frames. This model is useful for safe liver resection, has better visibility, and the production cost is reduced to one-third of a previous model. Preoperative simulation and navigation with CAS in liver resection are expected to help planning and conducting a surgery and surgical education. Thus, a novel CAS system will contribute to not only the performance of reliable hepatectomy but also to surgical education.

a New Survey on Self-Tuning Integrated Low-Cost Gps/ins Vehicle Navigation System in Harsh Environment

NASA Astrophysics Data System (ADS)

Navidi, N.; Landry, R., Jr.

2015-08-01

Nowadays, Global Positioning System (GPS) receivers are aided by some complementary radio navigation systems and Inertial Navigation Systems (INS) to obtain more accuracy and robustness in land vehicular navigation. Extended Kalman Filter (EKF) is an acceptable conventional method to estimate the position, the velocity, and the attitude of the navigation system when INS measurements are fused with GPS data. However, the usage of the low-cost Inertial Measurement Units (IMUs) based on the Micro-Electro-Mechanical Systems (MEMS), for the land navigation systems, reduces the precision and stability of the navigation system due to their inherent errors. The main goal of this paper is to provide a new model for fusing low-cost IMU and GPS measurements. The proposed model is based on EKF aided by Fuzzy Inference Systems (FIS) as a promising method to solve the mentioned problems. This model considers the parameters of the measurement noise to adjust the measurement and noise process covariance. The simulation results show the efficiency of the proposed method to reduce the navigation system errors compared with EKF.

Method, accuracy and limitation of computer interaction in the operating room by a navigated surgical instrument.

PubMed

Hurka, Florian; Wenger, Thomas; Heininger, Sebastian; Lueth, Tim C

2011-01-01

This article describes a new interaction device for surgical navigation systems--the so-called navigation mouse system. The idea is to use a tracked instrument of a surgical navigation system like a pointer to control the software. The new interaction system extends existing navigation systems with a microcontroller-unit. The microcontroller-unit uses the existing communication line to extract the needed 3D-information of an instrument to calculate positions analogous to the PC mouse cursor and click events. These positions and events are used to manipulate the navigation system. In an experimental setup the reachable accuracy with the new mouse system is shown.

Spinal intra-operative three-dimensional navigation with infra-red tool tracking: correlation between clinical and absolute engineering accuracy

NASA Astrophysics Data System (ADS)

Guha, Daipayan; Jakubovic, Raphael; Gupta, Shaurya; Yang, Victor X. D.

2017-02-01

Computer-assisted navigation (CAN) may guide spinal surgeries, reliably reducing screw breach rates. Definitions of screw breach, if reported, vary widely across studies. Absolute quantitative error is theoretically a more precise and generalizable metric of navigation accuracy, but has been computed variably and reported in fewer than 25% of clinical studies of CAN-guided pedicle screw accuracy. We reviewed a prospectively-collected series of 209 pedicle screws placed with CAN guidance to characterize the correlation between clinical pedicle screw accuracy, based on postoperative imaging, and absolute quantitative navigation accuracy. We found that acceptable screw accuracy was achieved for significantly fewer screws based on 2mm grade vs. Heary grade, particularly in the lumbar spine. Inter-rater agreement was good for the Heary classification and moderate for the 2mm grade, significantly greater among radiologists than surgeon raters. Mean absolute translational/angular accuracies were 1.75mm/3.13° and 1.20mm/3.64° in the axial and sagittal planes, respectively. There was no correlation between clinical and absolute navigation accuracy, in part because surgeons appear to compensate for perceived translational navigation error by adjusting screw medialization angle. Future studies of navigation accuracy should therefore report absolute translational and angular errors. Clinical screw grades based on post-operative imaging, if reported, may be more reliable if performed in multiple by radiologist raters.

Implementation of a vector-based tracking loop receiver in a pseudolite navigation system.

PubMed

So, Hyoungmin; Lee, Taikjin; Jeon, Sanghoon; Kim, Chongwon; Kee, Changdon; Kim, Taehee; Lee, Sanguk

2010-01-01

We propose a vector tracking loop (VTL) algorithm for an asynchronous pseudolite navigation system. It was implemented in a software receiver and experiments in an indoor navigation system were conducted. Test results show that the VTL successfully tracks signals against the near-far problem, one of the major limitations in pseudolite navigation systems, and could improve positioning availability by extending pseudolite navigation coverage.

Institute of Navigation, Annual Meeting, 47th, Williamsburg, VA, June 10-12, 1991, Proceedings

NASA Astrophysics Data System (ADS)

1991-11-01

The present volume of navigation and exploration discusses space exploration, mapping and geodesy, aircraft navigation, undersea navigation, land and vehicular location, international and legal aspects of navigation, the history of navigation technology and applications, Loran development and implementation, GPS and GLONASS developments, and search and rescue. Topics addressed include stabilization of low orbiting spacecraft using GPS, the employment of laser navigation for automatic rendezvous and docking systems, enhanced pseudostatic processing, and the expanding role of sensor fusion. Attention is given to a gravity-aided inertial navigation system, recent developments in aviation products liability and navigation, the ICAO future air navigation system, and Loran's implementation in NAS. Also discussed are Inmarsat integrated navigation/communication activities, the GPS program status, the evolution of military GPS technology into the Navcore V receiver engine, and Sarsat location algorithms.

Stereo Navi 2.0: software for stereotaxic surgery of the common marmoset (Callithrix jacchus).

PubMed

Tokuno, Hironobu; Tanaka, Ikuko; Umitsu, Yoshitomo; Nakamura, Yasuhisa

2009-11-01

Recently, we reported our web-accessible digital brain atlas of the common marmoset (Callithrix jacchus) at http://marmoset-brain.org:2008. Using digital images obtained during construction of this website, we developed stand-alone software for navigation of electrodes or injection needles for stereotaxic electrophysiological or anatomical experiments in vivo. This software enables us to draw lines on exchangeable section images, measure the length and angle of lines, superimpose a stereotaxic reference grid on the image, and send the image to the system clipboard. The software, Stereo Navi 2.0, is freely available at our brain atlas website.

33 CFR 146.105 - General alarm system.

Code of Federal Regulations, 2010 CFR

2010-07-01

... manned facility must have a general alarm system. When operated, this system shall be audible in all... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false General alarm system. 146.105 Section 146.105 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED...

Interference and deception detection technology of satellite navigation based on deep learning

NASA Astrophysics Data System (ADS)

Chen, Weiyi; Deng, Pingke; Qu, Yi; Zhang, Xiaoguang; Li, Yaping

2017-10-01

Satellite navigation system plays an important role in people's daily life and war. The strategic position of satellite navigation system is prominent, so it is very important to ensure that the satellite navigation system is not disturbed or destroyed. It is a critical means to detect the jamming signal to avoid the accident in a navigation system. At present, the detection technology of jamming signal in satellite navigation system is not intelligent , mainly relying on artificial decision and experience. For this issue, the paper proposes a method based on deep learning to monitor the interference source in a satellite navigation. By training the interference signal data, and extracting the features of the interference signal, the detection sys tem model is constructed. The simulation results show that, the detection accuracy of our detection system can reach nearly 70%. The method in our paper provides a new idea for the research on intelligent detection of interference and deception signal in a satellite navigation system.

Three-dimensional navigation is more accurate than two-dimensional navigation or conventional fluoroscopy for percutaneous sacroiliac screw fixation in the dysmorphic sacrum: a randomized multicenter study.

PubMed

Matityahu, Amir; Kahler, David; Krettek, Christian; Stöckle, Ulrich; Grutzner, Paul Alfred; Messmer, Peter; Ljungqvist, Jan; Gebhard, Florian

2014-12-01

To evaluate the accuracy of computer-assisted sacral screw fixation compared with conventional techniques in the dysmorphic versus normal sacrum. Review of a previous study database. Database of a multinational study with 9 participating trauma centers. The reviewed group included 130 patients, 72 from the navigated group and 58 from the conventional group. Of these, 109 were in the nondysmorphic group and 21 in the dysmorphic group. Placement of sacroiliac (SI) screws was performed using standard fluoroscopy for the conventional group and BrainLAB navigation software with either 2-dimensional or 3-dimensional (3D) navigation for the navigated group. Accuracy of SI screw placement by 2-dimensional and 3D navigation versus conventional fluoroscopy in dysmorphic and nondysmorphic patients, as evaluated by 6 observers using postoperative computerized tomography imaging at least 1 year after initial surgery. Intraobserver agreement was also evaluated. There were 11.9% (13/109) of patients with misplaced screws in the nondysmorphic group and 28.6% (6/21) of patients with misplaced screws in the dysmorphic group, none of which were in the 3D navigation group. Raw agreement between the 6 observers regarding misplaced screws was 32%. However, the percent overall agreement was 69.0% (kappa = 0.38, P < 0.05). The use of 3D navigation to improve intraoperative imaging for accurate insertion of SI screws is magnified in the dysmorphic proximal sacral segment. We recommend the use of 3D navigation, where available, for insertion of SI screws in patients with normal and dysmorphic proximal sacral segments. Therapeutic level I.

Modified Navigation Instructions for Spatial Navigation Assistance Systems Lead to Incidental Spatial Learning

PubMed Central

Gramann, Klaus; Hoepner, Paul; Karrer-Gauss, Katja

2017-01-01

Spatial cognitive skills deteriorate with the increasing use of automated GPS navigation and a general decrease in the ability to orient in space might have further impact on independence, autonomy, and quality of life. In the present study we investigate whether modified navigation instructions support incidental spatial knowledge acquisition. A virtual driving environment was used to examine the impact of modified navigation instructions on spatial learning while using a GPS navigation assistance system. Participants navigated through a simulated urban and suburban environment, using navigation support to reach their destination. Driving performance as well as spatial learning was thereby assessed. Three navigation instruction conditions were tested: (i) a control group that was provided with classical navigation instructions at decision points, and two other groups that received navigation instructions at decision points including either (ii) additional irrelevant information about landmarks or (iii) additional personally relevant information (i.e., individual preferences regarding food, hobbies, etc.), associated with landmarks. Driving performance revealed no differences between navigation instructions. Significant improvements were observed in both modified navigation instruction conditions on three different measures of spatial learning and memory: subsequent navigation of the initial route without navigation assistance, landmark recognition, and sketch map drawing. Future navigation assistance systems could incorporate modified instructions to promote incidental spatial learning and to foster more general spatial cognitive abilities. Such systems might extend mobility across the lifespan. PMID:28243219

Mission Operations and Navigation Toolkit Environment

NASA Technical Reports Server (NTRS)

Sunseri, Richard F.; Wu, Hsi-Cheng; Hanna, Robert A.; Mossey, Michael P.; Duncan, Courtney B.; Evans, Scott E.; Evans, James R.; Drain, Theodore R.; Guevara, Michelle M.; Martin Mur, Tomas J.;

Web-Based, Pictograph-Formatted Discharge Instructions for Low-Literacy Older Adults After Hip Replacement Surgery: Findings of End-User Evaluation of the Website.

PubMed

Choi, Jeungok; Jacelon, Cynthia S; Kalmakis, Karen A

The purpose of this study was to develop web-based, pictograph-formatted discharge instructions and evaluate the website with intended users to maximize the relevance and clarity of the website. A descriptive study. Low-literacy text and 45 sets of pictographs were implemented in web-based instructions. The content, design, function, and navigation of the website were reviewed by 15 low-literate older adults following hip replacement surgery. Participants observed that the simple line drawings with clear background were well suited to web pages and helped to convey the points made. They also suggested changes such as adding an additional alphabetical index menu to enhance easy navigation and removing hypertext links to avoid distraction. Web-based, pictograph-formatted discharge instructions were well received by low-literate older adults, who perceived the website easy to use and understand. A pictograph-formatted approach may provide effective strategies to promote understanding of lengthy, complex action-based discharge instructions in rehabilitation facilities.

A navigation system for the visually impaired an intelligent white cane.

PubMed

Fukasawa, A Jin; Magatani, Kazusihge

2012-01-01

In this paper, we describe about a developed navigation system that supports the independent walking of the visually impaired in the indoor space. Our developed instrument consists of a navigation system and a map information system. These systems are installed on a white cane. Our navigation system can follow a colored navigation line that is set on the floor. In this system, a color sensor installed on the tip of a white cane, this sensor senses a color of navigation line and the system informs the visually impaired that he/she is walking along the navigation line by vibration. This color recognition system is controlled by a one-chip microprocessor. RFID tags and a receiver for these tags are used in the map information system. RFID tags are set on the colored navigation line. An antenna for RFID tags and a tag receiver are also installed on a white cane. The receiver receives the area information as a tag-number and notifies map information to the user by mp3 formatted pre-recorded voice. And now, we developed the direction identification technique. Using this technique, we can detect a user's walking direction. A triaxiality acceleration sensor is used in this system. Three normal subjects who were blindfolded with an eye mask were tested with our developed navigation system. All of them were able to walk along the navigation line perfectly. We think that the performance of the system is good. Therefore, our system will be extremely valuable in supporting the activities of the visually impaired.

A novel platform for electromagnetic navigated ultrasound bronchoscopy (EBUS).

PubMed

Sorger, Hanne; Hofstad, Erlend Fagertun; Amundsen, Tore; Langø, Thomas; Leira, Håkon Olav

2016-08-01

Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) of mediastinal lymph nodes is essential for lung cancer staging and distinction between curative and palliative treatment. Precise sampling is crucial. Navigation and multimodal imaging may improve the efficiency of EBUS-TBNA. We demonstrate a novel EBUS-TBNA navigation system in a dedicated airway phantom. Using a convex probe EBUS bronchoscope (CP-EBUS) with an integrated sensor for electromagnetic (EM) position tracking, we performed navigated CP-EBUS in a phantom. Preoperative computed tomography (CT) and real-time ultrasound (US) images were integrated into a navigation platform for EM navigated bronchoscopy. The coordinates of targets in CT and US volumes were registered in the navigation system, and the position deviation was calculated. The system visualized all tumor models and displayed their fused CT and US images in correct positions in the navigation system. Navigating the EBUS bronchoscope was fast and easy. Mean error observed between US and CT positions for 11 target lesions (37 measurements) was [Formula: see text] mm, maximum error was 5.9 mm. The feasibility of our novel navigated CP-EBUS system was successfully demonstrated. An EBUS navigation system is needed to meet future requirements of precise mediastinal lymph node mapping, and provides new opportunities for procedure documentation in EBUS-TBNA.

Regionalized Lunar South Pole Surface Navigation System Analysis

NASA Technical Reports Server (NTRS)

Welch, Bryan W.

2008-01-01

Apollo missions utilized Earth-based assets for navigation because the landings took place at lunar locations in constant view from the Earth. The new exploration campaign to the lunar south pole region will have limited Earth visibility, but the extent to which a navigation system comprised solely of Earth-based tracking stations will provide adequate navigation solutions in this region is unknown. This report presents a dilution-of-precision (DoP)-based, stationary surface navigation analysis of the performance of multiple lunar satellite constellations, Earth-based deep space network assets, and combinations thereof. Results show that kinematic and integrated solutions cannot be provided by the Earth-based deep space network stations. Also, the stationary surface navigation system needs to be operated either as a two-way navigation system or as a one-way navigation system with local terrain information, while the position solution is integrated over a short duration of time with navigation signals being provided by a lunar satellite constellation.

A paradigm shift in orthognathic surgery? A comparison of navigation, computer-aided designed/computer-aided manufactured splints, and "classic" intermaxillary splints to surgical transfer of virtual orthognathic planning.

PubMed

Zinser, Max J; Sailer, Hermann F; Ritter, Lutz; Braumann, Bert; Maegele, Marc; Zöller, Joachim E

2013-12-01

Advances in computers and imaging have permitted the adoption of 3-dimensional (3D) virtual planning protocols in orthognathic surgery, which may allow a paradigm shift when the virtual planning can be transferred properly. The purpose of this investigation was to compare the versatility and precision of innovative computer-aided designed and computer-aided manufactured (CAD/CAM) surgical splints, intraoperative navigation, and "classic" intermaxillary occlusal splints for surgical transfer of virtual orthognathic planning. The protocols consisted of maxillofacial imaging, diagnosis, virtual orthognathic planning, and surgical planning transfer using newly designed CAD/CAM splints (approach A), navigation (approach B), and intermaxillary occlusal splints (approach C). In this prospective observational study, all patients underwent bimaxillary osteotomy. Eight patients were treated using approach A, 10 using approach B, and 12 using approach C. These techniques were evaluated by applying 13 hard and 7 soft tissue parameters to compare the virtual orthognathic planning (T0) with the postoperative result (T1) using 3D cephalometry and image fusion (ΔT1 vs T0). The highest precision (ΔT1 vs T0) for the maxillary planning transfer was observed with CAD/CAM splints (<0.23 mm; P > .05) followed by surgical "waferless" navigation (<0.61 mm, P < .05) and classic intermaxillary occlusal splints (<1.1 mm; P < .05). Only the innovative CAD/CAM splints kept the condyles in their central position in the temporomandibular joint. However, no technique enables a precise prediction of the mandible and soft tissue. CAD/CAM splints and surgical navigation provide a reliable, innovative, and precise approach for the transfer of virtual orthognathic planning. These computer-assisted techniques may offer an alternate approach to the use of classic intermaxillary occlusal splints. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Measurement of lower limb alignment: there are within-person differences between weight-bearing and non-weight-bearing measurement modalities.

PubMed

Schoenmakers, Daphne A L; Feczko, Peter Z; Boonen, Bert; Schotanus, Martijn G M; Kort, Nanne P; Emans, Pieter J

2017-11-01

Previous studies have compared weight-bearing mechanical leg axis (MLA) measurements to non-weight-bearing measurement modalities. Most of these studies compared mean or median values and did not analyse within-person differences between measurements. This study evaluates the within-person agreement of MLA measurements between weight-bearing full-length radiographs (FLR) and non-weight-bearing measurement modalities (computer-assisted surgery (CAS) navigation or MRI). Two independent observers measured the MLA on pre- and postoperative weight-bearing FLR in 168 patients. These measurements were compared to non-weight-bearing measurements obtained by CAS navigation or MRI. Absolute differences in individual subjects were calculated to determine the agreement between measurement modalities. Linear regression was used to evaluate the possibility that other independent variables impact the differences in measurements. A difference was found in preoperative measurements between FLR and CAS navigation (mean of 2.5° with limit of agreement (1.96 SD) of 6.4°), as well as between FLR and MRI measurements (mean of 2.4° with limit of agreement (1.96 SD) of 6.9°). Postoperatively, the mean difference between MLA measured on FLR compared to CAS navigation was 1.5° (limit of agreement (1.96 SD) of 4.6°). Linear regression analysis showed that weight-bearing MLA measurements vary significantly from non-weight-bearing MLA measurements. Differences were more severe in patients with mediolateral instability (p = 0.010), age (p = 0.049) and ≥3° varus or valgus alignment (p = 0.008). The clinical importance of this study lies in the finding that there are within-person differences between weight-bearing and non-weight-bearing measurement modalities. This has implications for preoperative planning, performing total knee arthroplasty (TKA), and clinical follow-up after TKA surgery using CAS navigation or patient-specific instrumentation. III.

RT-06GAMMA KNIFE SURGERY AFTER NAVIGATION-GUIDED ASPIRATION FOR CYSTIC METASTATIC BRAIN TUMORS

PubMed Central

Chiba, Yasuyoshi; Mori, Kanji; Toyota, Shingo; Kumagai, Tetsuya; Yamamoto, Shota; Sugano, Hirofumi; Taki, Takuyu

2014-01-01

Metastatic brain tumors over 3 cm in diameter (volume of 14.1ml) are generally considered poor candidates for Gamma Knife surgery (GKS). We retrospectively assessed the method and efficacy of GKS for large cystic metastatic brain tumors after navigation-guided aspiration under local anesthesia. From September 2007 to April 2014, 38 cystic metastatic brain tumors in 32 patients (12 males, 20 females; mean age, 63.2 years) were treated at Kansai Rosai Hospital. The patients were performed navigation-guided cyst aspiration under local anesthesia, then at the day or the next day, were performed GKS and usually discharged on the day. The methods for preventing of leptomeningeal dissemination are following: 1) puncture from the place whose cerebral thickness is 1 cm or more; 2) avoidance of Ommaya reservoir implantation; and 3) placement of absorbable gelatin sponge to the tap tract. Tumor volume, including the cystic component, decreased from 25.4 ml (range 8.7-84.7 ml) to 11.4 ml (range 2.9-36.7 ml) following aspiration; the volume reduction was approximately 51.6%. Follow-up periods in the study population ranged from 0 to 24 months (median 3.5 months). The overall median survival was 6.7 months. There was no leptomeningeal dissemination related to the aspiration. One patient experienced radiation necrosis after GKS, one patient experienced re-aspiration by failure of aspiration, and two patients experienced surgical resections and one patient experienced re-aspiration by cyst regrowth after GKS. Long-term hospitalization is not desirable for the patients with brain metastases. In japan, Long-term hospitalization is required for surgical resection or whole brain radiation therapy, but only two days hospitalization is required for GKS after navigation-guided aspiration at our hospital. This GKS after navigation-guided aspiration is more effective and less invasive than surgical resection or whole brain radiation therapy.

Sensitivity analysis of helicopter IMC decelerating steep approach and landing performance to navigation system parameters

NASA Technical Reports Server (NTRS)

Karmali, M. S.; Phatak, A. V.

1982-01-01

Results of a study to investigate, by means of a computer simulation, the performance sensitivity of helicopter IMC DSAL operations as a function of navigation system parameters are presented. A mathematical model representing generically a navigation system is formulated. The scenario simulated consists of a straight in helicopter approach to landing along a 6 deg glideslope. The deceleration magnitude chosen is 03g. The navigation model parameters are varied and the statistics of the total system errors (TSE) computed. These statistics are used to determine the critical navigation system parameters that affect the performance of the closed-loop navigation, guidance and control system of a UH-1H helicopter.

33 CFR 127.1109 - Lighting systems.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Lighting systems. 127.1109 Section 127.1109 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... Waterfront Facilities Handling Liquefied Hazardous Gas Design and Construction § 127.1109 Lighting systems...

33 CFR 127.1109 - Lighting systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Lighting systems. 127.1109 Section 127.1109 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... Waterfront Facilities Handling Liquefied Hazardous Gas Design and Construction § 127.1109 Lighting systems...

33 CFR 127.1109 - Lighting systems.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Lighting systems. 127.1109 Section 127.1109 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... Waterfront Facilities Handling Liquefied Hazardous Gas Design and Construction § 127.1109 Lighting systems...

33 CFR 127.1109 - Lighting systems.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Lighting systems. 127.1109 Section 127.1109 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... Waterfront Facilities Handling Liquefied Hazardous Gas Design and Construction § 127.1109 Lighting systems...

33 CFR 127.1109 - Lighting systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Lighting systems. 127.1109 Section 127.1109 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... Waterfront Facilities Handling Liquefied Hazardous Gas Design and Construction § 127.1109 Lighting systems...

A multiplanar complex resection of a low-grade chondrosarcoma of the distal femur guided by K-wires previously inserted under CT-guide: a case report

PubMed Central

2014-01-01

Background In muscular skeletal oncology aiming to achieve wide surgical margin is one of the main factors influencing patient prognosis. In cases where lesions are either meta or epiphyseal, surgery most often compromises joint integrity and stability because muscles, tendons and ligaments are involved in wide resection. When lesions are well circumscribed they can be completely resected by performing multi-planar osteotomies guided by computer-assisted navigation. We describe a case of low-grade chondrosarcoma of the distal femur where a simple but effective technique was useful to perform complex multiplanar osteotomies. No similar techniques are reported in the literature. Case presentation A 57 year-old Caucasian female was referred to our department for the presence of a distal femur chondrosarcoma. A resection with the presenting technique was scheduled. The first step consists of inserting several K-wires under CT-scan control to delimitate the tumor; the second step consists of tumor removal: in operative theatre, following surgical access, k-wires are used as guide positioning; scalpels are externally placed to k-wires to perform a safe osteotomy. Conclusions Computed assisted resections can be considered the most advantageous method to reach the best surgical outcome; unfortunately navigation systems are only available in specialized centres. The present technique allows for a multiplanar complex resection when navigation systems are not available. This technique can be applied in low-grade tumours where a minimal wide margin can be considered sufficient. PMID:25123066

Needle and catheter navigation using electromagnetic tracking for computer-assisted C-arm CT interventions

NASA Astrophysics Data System (ADS)

Nagel, Markus; Hoheisel, Martin; Petzold, Ralf; Kalender, Willi A.; Krause, Ulrich H. W.

2007-03-01

Integrated solutions for navigation systems with CT, MR or US systems become more and more popular for medical products. Such solutions improve the medical workflow, reduce hardware, space and costs requirements. The purpose of our project was to develop a new electromagnetic navigation system for interventional radiology which is integrated into C-arm CT systems. The application is focused on minimally invasive percutaneous interventions performed under local anaesthesia. Together with a vacuum-based patient immobilization device and newly developed navigation tools (needles, panels) we developed a safe and fully automatic navigation system. The radiologist can directly start with navigated interventions after loading images without any prior user interaction. The complete system is adapted to the requirements of the radiologist and to the clinical workflow. For evaluation of the navigation system we performed different phantom studies and achieved an average accuracy of better than 2.0 mm.

Geo-navigation system for rotary percussion drilling in rocks of high and low electrical conductivity

NASA Astrophysics Data System (ADS)

Konurin, AI; Khmelinin, AP; Denisova, EV

2018-03-01

The currently available drill navigation systems, with their benefits and shortcomings are reviewed. A mathematical model is built to describe the inertial navigation system movement in horizontal and inclined drilling. A prototype model of the inertial navigation system for rotary percussion drills has been designed.

Preliminary navigation accuracy analysis for the TDRSS Onboard Navigation System (TONS) experiment on EP/EUVE

NASA Technical Reports Server (NTRS)

Gramling, C. J.; Long, A. C.; Lee, T.; Ottenstein, N. A.; Samii, M. V.

1991-01-01

A Tracking and Data Relay Satellite System (TDRSS) Onboard Navigation System (TONS) is currently being developed by NASA to provide a high accuracy autonomous navigation capability for users of TDRSS and its successor, the Advanced TDRSS (ATDRSS). The fully autonomous user onboard navigation system will support orbit determination, time determination, and frequency determination, based on observation of a continuously available, unscheduled navigation beacon signal. A TONS experiment will be performed in conjunction with the Explorer Platform (EP) Extreme Ultraviolet Explorer (EUVE) mission to flight quality TONS Block 1. An overview is presented of TONS and a preliminary analysis of the navigation accuracy anticipated for the TONS experiment. Descriptions of the TONS experiment and the associated navigation objectives, as well as a description of the onboard navigation algorithms, are provided. The accuracy of the selected algorithms is evaluated based on the processing of realistic simulated TDRSS one way forward link Doppler measurements. The analysis process is discussed and the associated navigation accuracy results are presented.

Comparison of Precision between Optical and Electromagnetic Navigation Systems in Total Knee Arthroplasty

PubMed Central

Rhee, Seung Joon; Park, Shi Hwan; Cho, He Myung

2014-01-01

Purpose The purpose of this study is to compare and analyze the precision of optical and electromagnetic navigation systems in total knee arthroplasty (TKA). Materials and Methods We retrospectively reviewed 60 patients who underwent TKA using an optical navigation system and 60 patients who underwent TKA using an electromagnetic navigation system from June 2010 to March 2012. The mechanical axis that was measured on preoperative radiographs and by the intraoperative navigation systems were compared between the groups. The postoperative positions of the femoral and tibial components in the sagittal and coronal plane were assessed. Results The difference of the mechanical axis measured on the preoperative radiograph and by the intraoperative navigation systems was 0.6 degrees more varus in the electromagnetic navigation system group than in the optical navigation system group, but showed no statistically significant difference between the two groups (p>0.05). The positions of the femoral and tibial components in the sagittal and coronal planes on the postoperative radiographs also showed no statistically significant difference between the two groups (p>0.05). Conclusions In TKA, both optical and electromagnetic navigation systems showed high accuracy and reproducibility, and the measurements from the postoperative radiographs showed no significant difference between the two groups. PMID:25505703

A Self-Tuning Kalman Filter for Autonomous Navigation Using the Global Positioning System (GPS)

NASA Technical Reports Server (NTRS)

Truong, Son H.

1999-01-01

Most navigation systems currently operated by NASA are ground-based, and require extensive support to produce accurate results. Recently developed systems that use Kalman filter and GPS (Global Positioning Systems) data for orbit determination greatly reduce dependency on ground support, and have potential to provide significant economies for NASA spacecraft navigation. These systems, however, still rely on manual tuning from analysts. A sophisticated neuro-fuzzy component fully integrated with the flight navigation system can perform the self-tuning capability for the Kalman filter and help the navigation system recover from estimation errors in real time.

A novel passive/active hybrid robot for orthopaedic trauma surgery.

PubMed

Kuang, Shaolong; Leung, Kwok-sui; Wang, Tianmiao; Hu, Lei; Chui, Elvis; Liu, Wenyong; Wang, Yu

2012-12-01

Image guided navigation systems (IGNS) have been implemented successfully in orthopaedic trauma surgery procedures because of their ability to help surgeons position and orient hand-held drills at optimal entry points. However, current IGNS cannot prevent drilling tools or instruments from slipping or deviating from the planned trajectory during the drilling process. A method is therefore needed to overcome such problems. A novel passive/active hybrid robot (the HybriDot) for positioning and supporting surgical tools and instruments while drilling and/or cutting in orthopaedic trauma surgery is presented in this paper. This new robot, consisting of a circular prismatic joint and five passive/active back-drivable joints, is designed to fulfill clinical needs. In this paper, a system configuration and three operational modes are introduced and analyzed. Workspace and layout in the operating theatre (OT) are also analyzed in order to validate the structure design. Finally, experiments to evaluate the feasibility of the robot system are described. Analysis, simulation, and experimental results show that the novel structure of the robot can provide an appropriate workspace without risk of collision within OT environments during operation. The back-drivable joint mechanism can provide surgeons with more safety and flexibility in operational modes. The mean square value of the positional accuracy of this robot is 0.811 mm, with a standard deviation (SD) of 0.361 mm; the orientation is accurate to within 2.186º, with a SD of 0.932º. Trials on actual patients undergoing surgery for distal locking of intramedullary nails were successfully conducted in one pass using the robot. This robot has the advantages of having an appropriate workspace, being well designed for human-robot cooperation, and having high accuracy, sufficient rigidity, and easy deployability within the OT for use in common orthopaedic trauma surgery tasks such as screw fixation and drilling assistance. Copyright © 2012 John Wiley & Sons, Ltd.

Navigation Operations for the Magnetospheric Multiscale Mission

NASA Technical Reports Server (NTRS)

Long, Anne; Farahmand, Mitra; Carpenter, Russell

2015-01-01

The Magnetospheric Multiscale (MMS) mission employs four identical spinning spacecraft flying in highly elliptical Earth orbits. These spacecraft will fly in a series of tetrahedral formations with separations of less than 10 km. MMS navigation operations use onboard navigation to satisfy the mission definitive orbit and time determination requirements and in addition to minimize operations cost and complexity. The onboard navigation subsystem consists of the Navigator GPS receiver with Goddard Enhanced Onboard Navigation System (GEONS) software, and an Ultra-Stable Oscillator. The four MMS spacecraft are operated from a single Mission Operations Center, which includes a Flight Dynamics Operations Area (FDOA) that supports MMS navigation operations, as well as maneuver planning, conjunction assessment and attitude ground operations. The System Manager component of the FDOA automates routine operations processes. The GEONS Ground Support System component of the FDOA provides the tools needed to support MMS navigation operations. This paper provides an overview of the MMS mission and associated navigation requirements and constraints and discusses MMS navigation operations and the associated MMS ground system components built to support navigation-related operations.

33 CFR 127.705 - Security systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Security systems. 127.705 Section 127.705 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... Waterfront Facilities Handling Liquefied Natural Gas Security § 127.705 Security systems. The operator shall...

33 CFR 127.705 - Security systems.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Security systems. 127.705 Section 127.705 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... Waterfront Facilities Handling Liquefied Natural Gas Security § 127.705 Security systems. The operator shall...

33 CFR 127.705 - Security systems.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Security systems. 127.705 Section 127.705 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... Waterfront Facilities Handling Liquefied Natural Gas Security § 127.705 Security systems. The operator shall...

33 CFR 127.705 - Security systems.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Security systems. 127.705 Section 127.705 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... Waterfront Facilities Handling Liquefied Natural Gas Security § 127.705 Security systems. The operator shall...

33 CFR 127.705 - Security systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Security systems. 127.705 Section 127.705 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... Waterfront Facilities Handling Liquefied Natural Gas Security § 127.705 Security systems. The operator shall...

[Flexible endoscope in thoracic surgery: CITES or cVATS?].

PubMed

Assouad, J; Fénane, H; Masmoudi, H; Giol, M; Karsenti, A; Gounant, V; Grunenwald, D

2013-10-01

Early pain and persistent parietal disorders remains a major unresolved problem in thoracic surgery. Thoracotomy and the use of multiple ports in most Video Assisted Thoracic Surgery (VATS) procedures are the major cause of this persistent pain. For the last decade, a few publications describing the use of either single incision VATS and cervical thoracic approaches have been reported without significant results in comparison with current used techniques. Intercostals compression during surgery and early after by intercostals chest tube placement, are probably the major cause of postoperative pain. Flexible endoscope is currently used in several surgeries and will take more and more importance in our daily use in thoracic surgery. Instrument flexibility allows its use through minimally invasive approaches and offers a very interesting intra-thoracic navigation. We describe here the first use in France of a flexible endoscope in thoracic surgery through a single cervical incision to perform simultaneous exploration and biopsies of the mediastinum and right pleura using the original approach of Cervical Incision Thoracic Endoscopic Surgery (CITES). Copyright © 2013 Elsevier Masson SAS. All rights reserved.

A new minimally invasive heart surgery instrument for atrial fibrillation treatment: first in vitro and animal tests.

PubMed

Abadie, J; Faure, A; Chaillet, N; Rougeot, P; Beaufort, D; Goldstein, J P; Finlay, P A; Bogaerts, G

2006-06-01

The paper presents a new robotic system for beating heart surgery. The final goal of this project is to develop a tele-operated system for the thoracoscopic treatment of patients with atrial fibrillation. The system consists of a robot that moves an innovative end-effector used to perform lines as in the Cox-Maze technique. The device is an electrode mesh that is introduced in the thorax through a trocar and is deployed inside the left atrium, where it can create selective ablation lines at any atrial region, using radio frequency. The current version of the umbrella has 22 electrodes. Using visual feedback from an ultrasound based navigation system, the surgeon can choose which electrodes on the mesh to activate. Once the umbrella is in contact with the endocardium of the left atrium, at the expected position, the surgeon activates the chosen electrodes sequentially. The umbrella can then be moved to another position. In vitro and in vivo animal tests have been carried out in order to test and improve the instrument, the robotic system and the operative procedure. The performed trials proved the ability of the system to treat atrial fibrillation. More in vivo tests are currently being performed to make the robot and its device ready for clinical use. Copyright 2006 John Wiley & Sons, Ltd.

Multimedia human brain database system for surgical candidacy determination in temporal lobe epilepsy with content-based image retrieval

NASA Astrophysics Data System (ADS)

Siadat, Mohammad-Reza; Soltanian-Zadeh, Hamid; Fotouhi, Farshad A.; Elisevich, Kost

2003-01-01

This paper presents the development of a human brain multimedia database for surgical candidacy determination in temporal lobe epilepsy. The focus of the paper is on content-based image management, navigation and retrieval. Several medical image-processing methods including our newly developed segmentation method are utilized for information extraction/correlation and indexing. The input data includes T1-, T2-Weighted MRI and FLAIR MRI and ictal and interictal SPECT modalities with associated clinical data and EEG data analysis. The database can answer queries regarding issues such as the correlation between the attribute X of the entity Y and the outcome of a temporal lobe epilepsy surgery. The entity Y can be a brain anatomical structure such as the hippocampus. The attribute X can be either a functionality feature of the anatomical structure Y, calculated with SPECT modalities, such as signal average, or a volumetric/morphological feature of the entity Y such as volume or average curvature. The outcome of the surgery can be any surgery assessment such as memory quotient. A determination is made regarding surgical candidacy by analysis of both textual and image data. The current database system suggests a surgical determination for the cases with relatively small hippocampus and high signal intensity average on FLAIR images within the hippocampus. This indication pretty much fits with the surgeons" expectations/observations. Moreover, as the database gets more populated with patient profiles and individual surgical outcomes, using data mining methods one may discover partially invisible correlations between the contents of different modalities of data and the outcome of the surgery.

Augmented reality technology for preoperative planning and intraoperative navigation during hepatobiliary surgery: A review of current methods.

PubMed

Tang, Rui; Ma, Long-Fei; Rong, Zhi-Xia; Li, Mo-Dan; Zeng, Jian-Ping; Wang, Xue-Dong; Liao, Hong-En; Dong, Jia-Hong

2018-04-01

Augmented reality (AR) technology is used to reconstruct three-dimensional (3D) images of hepatic and biliary structures from computed tomography and magnetic resonance imaging data, and to superimpose the virtual images onto a view of the surgical field. In liver surgery, these superimposed virtual images help the surgeon to visualize intrahepatic structures and therefore, to operate precisely and to improve clinical outcomes. The keywords "augmented reality", "liver", "laparoscopic" and "hepatectomy" were used for searching publications in the PubMed database. The primary source of literatures was from peer-reviewed journals up to December 2016. Additional articles were identified by manual search of references found in the key articles. In general, AR technology mainly includes 3D reconstruction, display, registration as well as tracking techniques and has recently been adopted gradually for liver surgeries including laparoscopy and laparotomy with video-based AR assisted laparoscopic resection as the main technical application. By applying AR technology, blood vessels and tumor structures in the liver can be displayed during surgery, which permits precise navigation during complex surgical procedures. Liver transformation and registration errors during surgery were the main factors that limit the application of AR technology. With recent advances, AR technologies have the potential to improve hepatobiliary surgical procedures. However, additional clinical studies will be required to evaluate AR as a tool for reducing postoperative morbidity and mortality and for the improvement of long-term clinical outcomes. Future research is needed in the fusion of multiple imaging modalities, improving biomechanical liver modeling, and enhancing image data processing and tracking technologies to increase the accuracy of current AR methods. Copyright © 2018 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.

A Fast, Accurate and Easy to Implement Method for Pose Recognition of an Intramedullary Nail using a Tracked C-arm

NASA Astrophysics Data System (ADS)

Esfandiari, H.; Amiri, S.; Lichti, D. D.; Anglin, C.

2014-06-01

A C-arm is a mobile X-ray device that is frequently used during orthopaedic surgeries. It consists of a semi-circular, arc-shaped arm that holds an X-ray transmitter at one end and an X-ray detector at the other. Intramedullary nail (IM nail) fixation is a popular orthopaedic surgery in which a metallic rod is placed into the patient's fractured bone (femur or tibia) and fixed using metal screws. The main challenge of IM-nail fixation surgery is to achieve the X-ray shot in which the distal holes of the IM nail appear as circles (desired view) so that the surgeon can easily insert the screws. Although C-arm X-ray devices are routinely used in IM-nail fixation surgeries, the surgeons or radiation technologists (rad-techs) usually use it in a trial-and-error manner. This method raises both radiation exposure and surgery time. In this study, we have designed and developed an IM-nail distal locking navigation technique that leads to more accurate and faster screw placement with a lower radiation dose and a minimum number of added steps to the operation to make it more accepted within the orthopaedic community. The specific purpose of this study was to develop and validate an automated technique for identifying the current pose of the IM nail relative to the C-arm. An accuracy assessment was performed to test the reliability of the navigation results. Translational accuracy was demonstrated to be better than 1 mm, roll and pitch rotations better than 2° and yaw rotational accuracy better than 2-5° depending on the separate angle. Computation time was less than 3.5 seconds.

46 CFR 112.43-7 - Navigating bridge distribution panel.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Navigating bridge distribution panel. 112.43-7 Section... EMERGENCY LIGHTING AND POWER SYSTEMS Emergency Lighting Systems § 112.43-7 Navigating bridge distribution... supplied from a distribution panel on the navigating bridge: (1) Navigation lights not supplied by the...

33 CFR 62.63 - Recommendations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Recommendations. 62.63 Section 62... UNITED STATES AIDS TO NAVIGATION SYSTEM Public Participation in the Aids to Navigation System § 62.63 Recommendations. (a) The public may recommend changes to existing aids to navigation, request new aids or the...

46 CFR 112.43-7 - Navigating bridge distribution panel.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Navigating bridge distribution panel. 112.43-7 Section... EMERGENCY LIGHTING AND POWER SYSTEMS Emergency Lighting Systems § 112.43-7 Navigating bridge distribution... supplied from a distribution panel on the navigating bridge: (1) Navigation lights not supplied by the...

NFC Internal: An Indoor Navigation System

PubMed Central

Ozdenizci, Busra; Coskun, Vedat; Ok, Kerem

2015-01-01

Indoor navigation systems have recently become a popular research field due to the lack of GPS signals indoors. Several indoors navigation systems have already been proposed in order to eliminate deficiencies; however each of them has several technical and usability limitations. In this study, we propose NFC Internal, a Near Field Communication (NFC)-based indoor navigation system, which enables users to navigate through a building or a complex by enabling a simple location update, simply by touching NFC tags those are spread around and orient users to the destination. In this paper, we initially present the system requirements, give the design details and study the viability of NFC Internal with a prototype application and a case study. Moreover, we evaluate the performance of the system and compare it with existing indoor navigation systems. It is seen that NFC Internal has considerable advantages and significant contributions to existing indoor navigation systems in terms of security and privacy, cost, performance, robustness, complexity, user preference and commercial availability. PMID:25825976

A Self-Tuning Kalman Filter for Autonomous Navigation using the Global Positioning System (GPS)

NASA Technical Reports Server (NTRS)

Truong, S. H.

1999-01-01

Most navigation systems currently operated by NASA are ground-based, and require extensive support to produce accurate results. Recently developed systems that use Kalman filter and GPS data for orbit determination greatly reduce dependency on ground support, and have potential to provide significant economies for NASA spacecraft navigation. These systems, however, still rely on manual tuning from analysts. A sophisticated neuro-fuzzy component fully integrated with the flight navigation system can perform the self-tuning capability for the Kalman filter and help the navigation system recover from estimation errors in real time.

Relative Navigation of Formation Flying Satellites

NASA Technical Reports Server (NTRS)

Long, Anne; Kelbel, David; Lee, Taesul; Leung, Dominic; Carpenter, Russell; Gramling, Cheryl; Bauer, Frank (Technical Monitor)

2002-01-01

The Guidance, Navigation, and Control Center (GNCC) at Goddard Space Flight Center (GSFC) has successfully developed high-accuracy autonomous satellite navigation systems using the National Aeronautics and Space Administration's (NASA's) space and ground communications systems and the Global Positioning System (GPS). In addition, an autonomous navigation system that uses celestial object sensor measurements is currently under development and has been successfully tested using real Sun and Earth horizon measurements.The GNCC has developed advanced spacecraft systems that provide autonomous navigation and control of formation flyers in near-Earth, high-Earth, and libration point orbits. To support this effort, the GNCC is assessing the relative navigation accuracy achievable for proposed formations using GPS, intersatellite crosslink, ground-to-satellite Doppler, and celestial object sensor measurements. This paper evaluates the performance of these relative navigation approaches for three proposed missions with two or more vehicles maintaining relatively tight formations. High-fidelity simulations were performed to quantify the absolute and relative navigation accuracy as a function of navigation algorithm and measurement type. Realistically-simulated measurements were processed using the extended Kalman filter implemented in the GPS Enhanced Inboard Navigation System (GEONS) flight software developed by GSFC GNCC. Solutions obtained by simultaneously estimating all satellites in the formation were compared with the results obtained using a simpler approach based on differencing independently estimated state vectors.

33 CFR 164.43 - Automatic Identification System Shipborne Equipment-Prince William Sound.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Automatic Identification System Shipborne Equipment-Prince William Sound. 164.43 Section 164.43 Navigation and Navigable Waters COAST GUARD... Automatic Identification System Shipborne Equipment—Prince William Sound. (a) Until December 31, 2004, each...

33 CFR 164.43 - Automatic Identification System Shipborne Equipment-Prince William Sound.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Automatic Identification System Shipborne Equipment-Prince William Sound. 164.43 Section 164.43 Navigation and Navigable Waters COAST GUARD... Automatic Identification System Shipborne Equipment—Prince William Sound. (a) Until December 31, 2004, each...

33 CFR 164.43 - Automatic Identification System Shipborne Equipment-Prince William Sound.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Automatic Identification System Shipborne Equipment-Prince William Sound. 164.43 Section 164.43 Navigation and Navigable Waters COAST GUARD... Automatic Identification System Shipborne Equipment—Prince William Sound. (a) Until December 31, 2004, each...

Compensation of Horizontal Gravity Disturbances for High Precision Inertial Navigation

PubMed Central

Cao, Juliang; Wu, Meiping; Lian, Junxiang; Cai, Shaokun; Wang, Lin

2018-01-01

Horizontal gravity disturbances are an important factor that affects the accuracy of inertial navigation systems in long-duration ship navigation. In this paper, from the perspective of the coordinate system and vector calculation, the effects of horizontal gravity disturbance on the initial alignment and navigation calculation are simultaneously analyzed. Horizontal gravity disturbances cause the navigation coordinate frame built in initial alignment to not be consistent with the navigation coordinate frame in which the navigation calculation is implemented. The mismatching of coordinate frame violates the vector calculation law, which will have an adverse effect on the precision of the inertial navigation system. To address this issue, two compensation methods suitable for two different navigation coordinate frames are proposed, one of the methods implements the compensation in velocity calculation, and the other does the compensation in attitude calculation. Finally, simulations and ship navigation experiments confirm the effectiveness of the proposed methods. PMID:29562653

The value of intraoperative ultrasonography during the resection of relapsed irradiated malignant gliomas in the brain.

PubMed

Mursch, Kay; Scholz, Martin; Brück, Wolfgang; Behnke-Mursch, Julianne

2017-01-01

The aim of this study was to investigate whether intraoperative ultrasonography (IOUS) helped the surgeon navigate towards the tumor as seen in preoperative magnetic resonance imaging and whether IOUS was able to distinguish between tumor margins and the surrounding tissue. Twenty-five patients suffering from high-grade gliomas who were previously treated by surgery and radiotherapy were included. Intraoperatively, two histopathologic samples were obtained a sample of unequivocal tumor tissue (according to anatomical landmarks and the surgeon's visual and tactile impressions) and a small tissue sample obtained using a navigated needle when the surgeon decided to stop the resection. This specimen was considered to be a boundary specimen, where no tumor tissue was apparent. The decision to take the second sample was not influenced by IOUS. The effect of IOUS was analyzed semi-quantitatively. All 25 samples of unequivocal tumor tissue were histopathologically classified as tumor tissue and were hyperechoic on IOUS. Of the boundary specimens, eight were hypoechoic. Only one harbored tumor tissue (P=0.150). Seventeen boundaries were moderately hyperechoic, and these samples contained all possible histological results (i.e., tumor, infiltration, or no tumor). During surgery performed on relapsed, irradiated, high-grade gliomas, IOUS provided a reliable method of navigating towards the core of the tumor. At borders, it did not reliably distinguish between remnants or tumor-free tissue, but hypoechoic areas seldom contained tumor tissue.

Robot-assisted three-dimensional registration for cochlear implant surgery using a common-path swept-source optical coherence tomography probe

NASA Astrophysics Data System (ADS)

Gurbani, Saumya S.; Wilkening, Paul; Zhao, Mingtao; Gonenc, Berk; Cheon, Gyeong Woo; Iordachita, Iulian I.; Chien, Wade; Taylor, Russell H.; Niparko, John K.; Kang, Jin U.

2014-05-01

Cochlear implantation offers the potential to restore sensitive hearing in patients with severe to profound deafness. However, surgical placement of the electrode array within the cochlea can produce trauma to sensorineural components, particularly if the initial turn of the cochlea is not successfully navigated as the array is advanced. In this work, we present a robot-mounted common-path swept-source optical coherence tomography endoscopic platform for three-dimensional (3-D) optical coherence tomography (OCT) registration and preoperative surgical planning for cochlear implant surgery. The platform is composed of a common-path 600-μm diameter fiber optic rotary probe attached to a five degrees of freedom robot capable of 1 μm precision movement. The system is tested on a dry fixed ex vivo human temporal bone, and we demonstrate the feasibility of a 3-D OCT registration of the cochlea to accurately describe the spatial and angular profiles of the canal formed by the scala tympani into the first cochlear turn.

Prosthetically directed implant placement using computer software to ensure precise placement and predictable prosthetic outcomes. Part 2: rapid-prototype medical modeling and stereolithographic drilling guides requiring bone exposure.

PubMed

Rosenfeld, Alan L; Mandelaris, George A; Tardieu, Philippe B

2006-08-01

The purpose of this paper is to expand on part 1 of this series (published in the previous issue) regarding the emerging future of computer-guided implant dentistry. This article will introduce the concept of rapid-prototype medical modeling as well as describe the utilization and fabrication of computer-generated surgical drilling guides used during implant surgery. The placement of dental implants has traditionally been an intuitive process, whereby the surgeon relies on mental navigation to achieve optimal implant positioning. Through rapid-prototype medical modeling and the ste-reolithographic process, surgical drilling guides (eg, SurgiGuide) can be created. These guides are generated from a surgical implant plan created with a computer software system that incorporates all relevant prosthetic information from which the surgical plan is developed. The utilization of computer-generated planning and stereolithographically generated surgical drilling guides embraces the concept of collaborative accountability and supersedes traditional mental navigation on all levels of implant therapy.

Computer Assisted Surgery and Current Trends in Orthopaedics Research and Total Joint Replacements

NASA Astrophysics Data System (ADS)

Amirouche, Farid

2008-06-01

Musculoskeletal research has brought about revolutionary changes in our ability to perform high precision surgery in joint replacement procedures. Recent advances in computer assisted surgery as well better materials have lead to reduced wear and greatly enhanced the quality of life of patients. The new surgical techniques to reduce the size of the incision and damage to underlying structures have been the primary advance toward this goal. These new techniques are known as MIS or Minimally Invasive Surgery. Total hip and knee Arthoplasties are at all time high reaching 1.2 million surgeries per year in the USA. Primary joint failures are usually due to osteoarthristis, rheumatoid arthritis, osteocronis and other inflammatory arthritis conditions. The methods for THR and TKA are critical to initial stability and longevity of the prostheses. This research aims at understanding the fundamental mechanics of the joint Arthoplasty and providing an insight into current challenges in patient specific fitting, fixing, and stability. Both experimental and analytical work will be presented. We will examine Cementless total hip arthroplasty success in the last 10 years and how computer assisted navigation is playing in the follow up studies. Cementless total hip arthroplasty attains permanent fixation by the ingrowth of bone into a porous coated surface. Loosening of an ingrown total hip arthroplasty occurs as a result of osteolysis of the periprosthetic bone and degradation of the bone prosthetic interface. The osteolytic process occurs as a result of polyethylene wear particles produced by the metal polyethylene articulation of the prosthesis. The total hip arthroplasty is a congruent joint and the submicron wear particles produced are phagocytized by macrophages initiating an inflammatory cascade. This cascade produces cytokines ultimately implicated in osteolysis. Resulting bone loss both on the acetabular and femoral sides eventually leads to component instability. As patients are living longer and total hip arthroplasty is performed in younger patients the risks of osteolysis associated with cumulative wear is increased. Computer-assisted surgery is based on sensing feedback; vision and imaging that help surgeons align the patient's joints during total knee or hip replacement with a degree of accuracy not possible with the naked eye. For the first time, the computer feedback is essential for ligament balancing and longevity of the implants. The computers navigation systems also help surgeons to use smaller incisions instead of the traditional larger openings. Small-incision surgery offers the potential for faster recovery, less bleeding and less pain for patients. The development of SESCAN imaging technique to create a patient based model of a 3D joint will be presented to show the effective solution of complex geometry of joints.

33 CFR 62.51 - Western Rivers Marking System.

Code of Federal Regulations, 2010 CFR

2010-07-01

... NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.51 Western Rivers... toward the Gulf of Mexico. (b) The Western Rivers System varies from the standard U.S. system as follows...

33 CFR 62.51 - Western Rivers Marking System.

Code of Federal Regulations, 2011 CFR

2011-07-01

... NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM The U.S. Aids to Navigation System § 62.51 Western Rivers... toward the Gulf of Mexico. (b) The Western Rivers System varies from the standard U.S. system as follows...