Surgical Endoscopy

, Volume 30, Issue 9, pp 4136–4149

Self-contained image mapping of placental vasculature in 3D ultrasound-guided fetoscopy

  • Liangjing Yang
  • Junchen Wang
  • Takehiro Ando
  • Akihiro Kubota
  • Hiromasa Yamashita
  • Ichiro Sakuma
  • Toshio Chiba
  • Etsuko Kobayashi
Dynamic Manuscript

DOI: 10.1007/s00464-015-4690-z

Cite this article as:
Yang, L., Wang, J., Ando, T. et al. Surg Endosc (2016) 30: 4136. doi:10.1007/s00464-015-4690-z



Surgical navigation technology directed at fetoscopic procedures is relatively underdeveloped compared with other forms of endoscopy. The narrow fetoscopic field of views and the vast vascular network on the placenta make examination and photocoagulation treatment of twin-to-twin transfusion syndrome challenging. Though ultrasonography is used for intraoperative guidance, its navigational ability is not fully exploited. This work aims to integrate 3D ultrasound imaging and endoscopic vision seamlessly for placental vasculature mapping through a self-contained framework without external navigational devices.


This is achieved through development, integration, and experimentation of novel navigational modules. Firstly, a framework design that addresses the current limitations based on identified gaps is conceptualized. Secondly, integration of navigational modules including (1) ultrasound-based localization, (2) image alignment, and (3) vision-based tracking to update the scene texture map is implemented. This updated texture map is projected to an ultrasound-constructed 3D model for photorealistic texturing of the 3D scene creating a panoramic view of the moving fetoscope. In addition, a collaborative scheme for the integration of the modular workflow system is proposed to schedule updates in a systematic fashion. Finally, experiments are carried out to evaluate each modular variation and an integrated collaborative scheme of the framework.


The modules and the collaborative scheme are evaluated through a series of phantom experiments with controlled trajectories for repeatability. The collaborative framework demonstrated the best accuracy (5.2 % RMS error) compared with all the three single-module variations during the experiment. Validation on an ex vivo monkey placenta shows visual continuity of the freehand fetoscopic panorama.


The proposed developed collaborative framework and the evaluation study of the framework variations provide analytical insights for effective integration of ultrasonography and endoscopy. This contributes to the development of navigation techniques in fetoscopic procedures and can potentially be extended to other applications in intraoperative imaging.


Surgical navigation Intraoperative registration Vasculature mapping Minimally invasive fetal surgery 

Supplementary material

Video 1: 3D Placental Vasculature Image Mapping

Video 2: Ultrasound-Based Image Mapping

Video 3: Vision-Based Image Mapping

Video 4: 3D Placental Vasculature Image Mapping on Monkey Placenta

Funding information

Funder NameGrant NumberFunding Note
Japan Society for the Promotion of Science
  • 26108008
  • 20345268
Translational Systems Biology and Medicine Initiative

    Copyright information

    © Springer Science+Business Media New York 2015

    Authors and Affiliations

    1. 1.Graduate School of EngineeringThe University of TokyoTokyoJapan
    2. 2.Clinical Research CenterNational Center for Child Health and DevelopmentTokyoJapan

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