Progressive internal landmark registration for surgical navigation in laparoscopic gastrectomy for gastric cancer

  • Yuichiro HayashiEmail author
  • Kazunari Misawa
  • David J. Hawkes
  • Kensaku Mori
Original Article



A surgical navigation system supports the comprehension of anatomical information during surgery. Patient-to-image registration is the alignment process between CT volume and patient coordinate systems. Achieving accurate registration in the surgical navigation of laparoscopic surgery is very challenging due to soft tissue deformation. This paper presents a new patient-to-image registration method based on internal anatomical landmarks for improving registration accuracy in the surgical navigation of laparoscopic gastrectomy for gastric cancer.


Our proposed registration method progressively utilizes internal anatomical landmarks. In laparoscopic gastrectomy for gastric cancer, the surgeon cuts the blood vessels around the stomach. The positions of the cut vessels are sequentially used as fiducials for registration during surgery. The proposed method uses a weighted point-based registration method for computing the transformation matrix using the fiducials both on the body surface and on the blood vessels. When a blood vessel is cut during surgery, the proposed progressive registration method measures the cut vessel’s position and computes a transformation matrix by adding the cut vessel as a fiducial.


We applied our proposed progressive registration method using the positional information of the blood vessels acquired during laparoscopic gastrectomy in 20 cases. We evaluated it using target registration error in four blood vessels. The average target registration error in the four blood vessels was 12.6 mm and ranged from 2.1 to 32.9 mm.


Since the proposed progressive registration can reduce registration error, our proposed method is very useful for the surgical navigation of laparoscopic gastrectomy. Our proposed progressive registration method might increase the accuracy of surgical navigation in laparoscopic gastrectomy.


Surgical navigation Registration Laparoscopic surgery Laparoscopic gastrectomy Gastric cancer 



The authors thank our colleagues for suggestions and advice. This work was supported in part by a Health and Labour Sciences Research Grant from the Ministry of Health Labour and Welfare, by the Practical Research for Innovative Cancer Control from Japan Agency for Medical Research and Development, AMED, and by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology and the Japan Society for the Promotion of Science (26108006, 25242047, 26560255).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The study was approved by the institutional review board of the Aichi Cancer Center.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© CARS 2016

Authors and Affiliations

  • Yuichiro Hayashi
    • 1
    Email author
  • Kazunari Misawa
    • 2
  • David J. Hawkes
    • 3
    • 4
  • Kensaku Mori
    • 1
  1. 1.Information & CommunicationsNagoya UniversityNagoyaJapan
  2. 2.Department of Gastroenterological SurgeryAichi Cancer Center HospitalNagoyaJapan
  3. 3.Information Technology CenterNagoya UniversityNagoyaJapan
  4. 4.Centre for Medical Image ComputingUniversity College LondonLondonUK

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