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Surgical navigation system for laparoscopic lateral pelvic lymph node dissection in rectal cancer surgery using laparoscopic-vision-tracked ultrasonic imaging

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Abstract

Background

Laparoscopic lateral pelvic lymph node dissection (LPLND) in rectal cancer surgery requires considerable skill because the pelvic arteries, which need to be located to guide the dissection, are covered by other tissues and cannot be observed on laparoscopic views. Therefore, surgeons need to localize the pelvic arteries accurately before dissection, to prevent injury to these arteries.

Methods

This report proposes a surgical navigation system to facilitate artery localization in laparoscopic LPLND by combining ultrasonic imaging and laparoscopy. Specifically, free-hand laparoscopic ultrasound (LUS) is employed to capture the arteries intraoperatively in this approach, and a laparoscopic vision-based tracking system is utilized to track the LUS probe. To extract the artery contours from the two-dimensional ultrasound image sequences efficiently, an artery extraction framework based on local phase-based snakes was developed. After reconstructing the three-dimensional intraoperative artery model from ultrasound images, a high-resolution artery model segmented from preoperative computed tomography (CT) images was rigidly registered to the intraoperative artery model and overlaid onto the laparoscopic view to guide laparoscopic LPLND.

Results

Experiments were conducted to evaluate the performance of the vision-based tracking system, and the average reconstruction error of the proposed tracking system was found to be 2.4 mm. Then, the proposed navigation system was quantitatively evaluated on an artery phantom. The reconstruction time and average navigation error were 8 min and 2.3 mm, respectively. A navigation system was also successfully constructed to localize the pelvic arteries in laparoscopic and open surgeries of a swine. This demonstrated the feasibility of the proposed system in vivo. The construction times in the laparoscopic and open surgeries were 14 and 12 min, respectively.

Conclusions

The experimental results showed that the proposed navigation system can guide laparoscopic LPLND and requires a significantly shorter setting time than the state-of-the-art navigation systems do.

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Acknowledgements

This work was supported by JSPS KAKENHI Grant Number 26108008 and a Joint Research Project. This work was also partly supported by the JST COI Grant Number JPMJCEJPMJCE1304.

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Authors and Affiliations

  1. Graduate School of Engineering, The University of Tokyo, Tokyo, Japan

    Lei Ma, Hidemichi Kiyomatsu, Hiroyuki Tsukihara, Ichiro Sakuma & Etsuko Kobayashi

  2. School of Mechanical Engineering, Beihang University, Beijing, China

    Junchen Wang

Authors
  1. Lei Ma
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  2. Junchen Wang
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  3. Hidemichi Kiyomatsu
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  4. Hiroyuki Tsukihara
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  5. Ichiro Sakuma
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Corresponding author

Correspondence to Etsuko Kobayashi.

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Disclosures

Dr. Etsuko Kobayashi and Dr. Ichiro Sakuma received grants from the Japan Society for the Promotion of Science. Dr. Lei Ma, Dr. Junchen Wang, Mr. Hidemichi Kiyomatsu, and Dr. Hiroshi Tsukihara have no conflicts of interest or financial ties to disclose.

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Ma, L., Wang, J., Kiyomatsu, H. et al. Surgical navigation system for laparoscopic lateral pelvic lymph node dissection in rectal cancer surgery using laparoscopic-vision-tracked ultrasonic imaging. Surg Endosc 35, 6556–6567 (2021). https://doi.org/10.1007/s00464-020-08153-8

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  • DOI: https://doi.org/10.1007/s00464-020-08153-8

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