利用仿真手术模型探索腹腔镜胃癌手术动态导航的初步经验

Exploring surgical navigation in laparoscopic gastrectomy by using simulation model

腹腔镜技术目前在胃肠外科应用广泛，但其管状视野的局限性为手术造成了不便。计算机辅助技术通过动态导航，实现手术场景和术前重建的三维模型在术中的实时匹配，从而达到实时跟踪的效果，有望弥补腹腔镜技术视野上的局限性。本研究以腹腔镜胃癌手术中最关键的解剖器官——胰腺作为实验对象，介绍笔者团队利用仿真手术模型探索腹腔镜胃癌手术动态导航的初步经验，以供同道们参考借鉴。方法如下：（1）将胃癌患者腹部CT数据导入Mimics17.0软件进行胰腺及其周围血管的三维模型重建，用跟踪程序获得虚拟模型标记点在虚拟场景的坐标。（2）把重建后的三维图像的STL文件导入快速成型软件ZEdit^TM3.21，采用Spectrum Z^TM510打印机进行3D打印，将打印出来的模型固定在腹腔镜训练盒，建立仿真手术场景，用跟踪软件分别标定3D模型、训练器镜头、和腔镜器械，并获得手术场景中标记点的坐标。（3）完成虚拟手术场景和仿真手术场景的跟踪匹配。研究中我们发现，将腹腔镜胃癌手术＂分解动作＂有助于导航的匹配。

Laparoscopic technique is now widely used in gastrointestinal surgery, but the limitation of its ＂tubular vision＂ pose disadvantages. Benefits from the realization of dynamic navigation which can match the preoperative dimensional reconstruction model and the surgical scene in real time, the computer-aided surgery （CAS） can supplement the insufficiency of laparoscopic view. Focusing on pancreas, the key organ in the laparoscopic gastrectomy for cancer cancer,the initial experience of dynamic navigation in such surgery using a virtual surgical model is shared. The method is as follows： First, the virtual model of pancreas and peripheral blood vessels was reconstructed with the Mimicsl7.0 based on the abdominal computed tomography data of the patients with gastric cancer; and the location information of the virtual marker was captured with the tracking software. Second, the three dimensional （3D） construction image displayed in SLT file, was read in ZEdit^TM3.21 and was printed by Spectrum Z^TM510 printer. Then, the 3D model was fixed in a laparoscopic simulation training device to achieve the simulation operation. The location information of the laparoscopic training device, lens and laparoscopic instrument was recorded with tracking software. Besides, the coordinate information of simulation operation was also achieved. Third, we conducted a match between the virtual and simulation operation. Our study show that scenes splitting is conducive to the tracking and matching of the surgical navigation in laparoscopic surgery for gastric cancer.