Augmented Reality Imaging for Robot-Assisted Partial Nephrectomy Surgery

摘要

Laparoscopic partial nephrectomy (LPN) is a standard of care for small kidney cancer tumours. A successful LPN is the complete excision of the kidney tumour while preserving as much of the non-cancerous kidney as possible. This is a challenging procedure because the surgeon has a limited field of view and reduced or no haptic feedback while performing delicate excisions as fast as possible. This work introduces and evaluates a novel surgical navigation marker called the Dynamic Augmented Reality Tracker (DART). The DART is used in a novel intra-operative augmented reality ultrasound navigation system (ARUNS) for robot-assisted minimally invasive surgery to overcome some of these challenges. The DART is inserted into a kidney and the DART and pick-up laparoscopic ultrasound transducer are tracked during an intra-operative freehand ultrasound scan of the tumour. After ultrasound, the system continues to track the DART and display the segmented 3D tumour and location of surgical instruments relative to the tumour throughout the surgery. The ultrasound point reconstruction root mean squared error (RMSE) was 0.9 mm, the RMSE of tracking the da Vinci surgical instruments was 1.5 mm and the total system RMSE, which includes ultrasound imaging and da Vinci kinematic instrument tracking, was 5.1 mm. The system was evaluated by an expert surgeon who used the DART and ARUNS to excise a tumour from a kidney phantom. This work serves as a preliminary evaluation in anticipation of further refinement and validation in vivo.