An Uncertainty-aware Workflow for Keyhole Surgery Planning using Hierarchical Image Semantics

Keyhole surgeries become mcreasingly important in clinical daily routine as they help minimizing the damage of a patient's healthy tissue.The planning of keyhole surgeries is based on medical imaging and an important factor that influences the surgeries*success.Due to the image reconstruction process,medical image data contains uncertainty that exacerbates the planning of a keyhole surgery.In this paper we present a visual workflow that helps clinicians to examine and compare different surgery paths as well as visualizing the patientsJ affected tissue.The analysis is based on the concept of hierarchical image semantics,that segment the underlying image data with respect to the input images'uncertainty and the users understanding of tissue composition.Users can define arbitrary surgery paths that they need to investigate further.The defined paths can be queried by a rating function to identify paths that fulfill user-defined properties.The workflow allows a visual inspection of the affected tissues and its substructures.Therefore,the workflow includes a linked view system indicating the three-dimensional location of selected surgery paths as well as how these paths affect the patients tissue.To show the effectiveness of the presented approach,we applied it to the planning of a keyhole surgery of a brain tumor removal and a kneecap surgery.

Minimally Invasive Neuronavigator-guided Microsurgery and Photodynamic Therapy for Gliomas

In order to evaluate the effectiveness ofneuronavigator-guided microsurgery and keyhole technique for the resection of gliomas, a total of 60 patients with gliomas were exactly located by using neuronavigator during microsurgery. Forty deep-seated gliomas were resected through a keyhole operative approach. Thirty out of the 60 cases were subjected to photodynamic therapy （PDT） after tumor resection. The therapeutic effectiveness of all the cases was recorded and analyzed. The resuits showed that glioma was totally resected in 52 cases （86.7%）, subtotally in 5 （8.3%）, and most partially in 3 （5%）. Neurological deficits occurred postoperatively in 4 cases. One patient died of multiple system organ failure 4 days after operation. It was concluded that the application of minimally invasive technique could dramatically decrease surgical complications following resection of glioma, and its combination with PDT could obviously improve the quality of life of patients and prolong the survival time.

Keyhole approach surgery for petroclival meningioma

Background In China, the feasibility of keyhole approach in surgical treatment of petroclival meningioma has not been well evaluated. This report summarized our experience in 25 patients with petroclival meningioma who had been treated with keyhole approach surgery. Methods From July 2000 to July 2005, 25 patients with petroclival meningioma were subjected to resection via subtemporal, retrosigmoid or combined keyhole approaches. The extent of tumor resection was evaluated by MRI 3 months after surgery, and postoperative complications were investigated. Results The maximum diameter of tumors ranged from 2 to 7 cm （mean, 4.5 cm）. Gross total resection （GTR） was achieved in 14 patients, giving a GTR rate of 56%. Subtotal resection （STR） was carried out in 8 patients and partial resection in 3. Thirteen patients kept normal neurological status, whereas others suffered from cranial nerve deficits （Ⅶ, Ⅶ, Ⅲ and lower CN）. One patient died in the postoperative period. Conclusions Keyhole approach surgery, especially the combined keyhole approach is suitable for the treatment of petroclival meningioma. It provides easy and quick access to the supra- and infratentorial juxta-clival region without drilling of the petrous bone. Complications related to the approach can be minimized.

Application of Keyhole Microneurosurgery in China

INTRODUCTIONMicroneurosurgery made its debut in the early 1960s. It became popular in the medical field and became a primary operation method in neurosurgery since it improved the efficacy of neurosurgery with a less surgery-related injury. Over the past five decades, the accumulation of experience of microsurgery, improvement of microsurgery techniques, refined micro-instruments, and advanced preoperative diagnostic imaging allowed the evolution of microneurosurgery techniques and further reduced surgery-related trauma.

Review of surgical robotic systems for keyhole and endoscopic procedures:state of the art and perspectives

Minimally invasive surgery,including laparoscopic and thoracoscopic procedures,benefits patients in terms of improved postoperative outcomes and short recovery time.The challenges in hand–eye coordination and manipulation dexterity during the aforementioned procedures have inspired an enormous wave of developments on surgical robotic systems to assist keyhole and endoscopic procedures in the past decades.This paper presents a systematic review of the state-of-the-art systems,picturing a detailed landscape of the system configurations,actuation schemes,and control approaches of the existing surgical robotic systems for keyhole and endoscopic procedures.The development challenges and future perspectives are discussed in depth to point out the need for new enabling technologies and inspire future researches.