Current trends in three-dimensional visualization and real-time navigation as well as robot-assisted technologies in hepatobiliary surgery

With the continuous development of digital medicine,minimally invasive precision and safety have become the primary development trends in hepatobiliary surgery.Due to the specificity and complexity of hepatobiliary surgery,traditional preoperative imaging techniques such as computed tomography and magnetic resonance imaging cannot meet the need for identification of fine anatomical regions.Imaging-based three-dimensional(3D)reconstruction,virtual simulation of surgery and 3D printing optimize the surgical plan through preoperative assessment,improving the controllability and safety of intraoperative operations,and in difficult-to-reach areas of the posterior and superior liver,assistive robots reproduce the surgeon’s natural movements with stable cameras,reducing natural vibrations.Electromagnetic navigation in abdominal surgery solves the problem of conventional surgery still relying on direct visual observation or preoperative image assessment.We summarize and compare these recent trends in digital medical solutions for the future development and refinement of digital medicine in hepatobiliary surgery.

Effect of navigation endoscopy combined with threedimensional printing technology in the treatment of orbital blowout fractures

●AIM:To explore the combined application of surgical navigation nasal endoscopy(NNE)and three-dimensional printing technology(3DPT)for the adjunctive treatment of orbital blowout fractures(OBF).●METHODS:Retrospective analysis was conducted on the data of patients with OBF who underwent surgical treatment at the Affiliated Eye Hospital of Nanchang University between July 2012 and November 2022.The control group consisted of patients who received traditional surgical treatment(n=43),while the new surgical group(n=52)consisted of patients who received NNE with 3DPT.The difference in therapeutic effects between the two groups was evaluated by comparing the duration of the operation,best corrected visual acuity(BCVA),enophthalmos difference,recovery rate of eye movement disorder,recovery rate of diplopia,and incidence of postoperative complications.●RESULTS:The study included 95 cases(95 eyes),with 63 men and 32 women.The patients’age ranged from 5 to 67y(35.21±15.75y).The new surgical group and the control group exhibited no statistically significant differences in the duration of the operation,BCVA and enophthalmos difference.The recovery rates of diplopia in the new surgical group were significantly higher than those in the control group at 1mo[OR=0.03,95%CI(0.01–0.15),P<0.0000]and 3mo[OR=0.11,95%CI(0.03–0.36),P<0.0000]postoperation.Additionally,the recovery rates of eye movement disorders at 1 and 3mo after surgery were OR=0.08,95%CI(0.03–0.24),P<0.0000;and OR=0.01,95%CI(0.00–0.18),P<0.0000.The incidence of postoperative complications was lower in the new surgical group compared to the control group[OR=4.86,95%CI(0.95–24.78),P<0.05].●CONCLUSION:The combination of NNE and 3DPT can shorten the recovery time of diplopia and eye movement disorder in patients with OBF.

New Method of Reconstruction from Nonparallel Stereo and Application to Surgical Navigator

A new method to reconstruct 3D scene points from nonparallel stereo is proposed. From a pair of conjugate images in an arbitrarily configured stereo system that has been calibrated, coordinates of 3D scene points can be computed directly using the method, bypassing the process of rectifying images or iterative solution involved in existing methods. Experiment results from both simulated data and real images validate the method. Practical application to surgical navigator shows that the method has advantages to improve efficiency and accuracy of 3D reconstruction from nonparallel stereo system in comparison with the conventional method that employs algorithm for standard parallel axes stereo geometry.

Real-time virtual sonography visualization and its clinical application in biliopancreatic disease

AIM:To evaluate the usefulness of real-time virtual sonography(RVS)in biliary and pancreatic diseases.METHODS:This study included 15 patients with biliary and pancreatic diseases.RVS can be used to observe an ultrasound image in real time by merging the ultrasound image with a multiplanar reconstruction computed tomography(CT)image,using pre-scanned CT volume data.The ultrasound used was EUB-8500with a convex probe EUP-C514.The RVS images were evaluated based on 3 levels,namely,excellent,good and poor,by the displacement in position.RESULTS:By combining the objectivity of CT with free scanning using RVS,it was possible to easily interpret the relationship between lesions and the surrounding organs as well as the position of vascular structures.The resulting evaluation levels of the RVS images were12 excellent(pancreatic cancer,bile duct cancer,cholecystolithiasis and cholangiocellular carcinoma)and 3 good(pancreatic cancer and gallbladder cancer).Compared with conventional B-mode ultrasonography and CT,RVS images achieved a rate of 80%superior visualization and 20%better visualization.CONCLUSION:RVS has potential usefulness in objective visualization and diagnosis in the field of biliary and pancreatic diseases.

Analysis and Design of Surgical Instrument Localization Algorithm

With the help of surgical navigation system,doctors can operate on patients more intuitively and accurately.The positioning accuracy and real-time performance of surgical instruments are very important to the whole system.In this paper,we analyze and design the detection algorithm of surgical instrument location mark,and estimate the posture of surgical instrument.In addition,we optimized the pose by remapping.Finally,the algorithm of location mark detection proposed in this paper and the posture analysis data of surgical instruments are verified and analyzed through experiments.The final result shows a high accuracy.

Precise Point Positioning Technique with IGS Real-Time Service (RTS) for Maritime Applications

The maritime navigation accuracy requirements for radionavigation systems such as GPS are specified by the International Maritime Organization (IMO). Maritime navigation usually consists of three major phases identified as Ocean/Coastal/Port approach/Inland waterway, in port navigation and automatic docking with an accuracy requirement that ranges from 10 m to 0.1 m. With the advancement in autonomous GPS positioning techniques such as Precise Point Positioning (PPP) and with the advent of the new IGS-Real-Time-Service (RTS), it is necessary to assess the possibility of a wider role of the PPP-based positioning technique in maritime applications. This paper investigates the performance of an autonomous real-time PPP-positioning solution by using the IGS- RTS service for maritime applications that require an accurate positioning system. To examine the performance of the real-time IGS-RTS PPP-based technique for maritime applications, kinematic data from a dual frequency GPS receiver is investigated. It is shown that the real-time IGS-RTS PPP-based GPS positioning technique fulfills IMO requirements for maritime applications with an accuracy requirement ranges from 10 m for Ocean/Coastal/Port approach/Inland waterways navigation to 1.0 m for in port navigation but cannot fulfill the automatic docking application with an accuracy requirement of 0.10 m. To further investigate the real-time PPP-based GPS positioning technique, a comparison is made between the real-time IGS-RTS PPP-based positioning technique and the real-time PPP-based positioning by using the predicted part of the IGS Ultra-Rapid products and the real-time GPS positioning technique with the Wide Area Differential GPS service (WADGPS). It is shown that the IGS-RTS PPP-based positioning technique is superior to the IGS-Ultra-Rapid PPP-based and WADGPS-based positioning techniques.

脊柱手术机器人治疗脊柱疾病的研究发展趋势及热点剖析

背景:近年来在脊柱外科领域,手术机器人的应用已成为研究热点,但目前中国尚缺乏脊柱手术机器人的的文献可视化分析相关研究。目的:对脊柱手术机器人治疗脊柱疾病的研究热点进行文献可视化分析,以期为中国脊柱手术机器人的研究和发展提供有益的参考。方法:在Web of Science核心集数据库中检索脊柱手术机器人治疗脊柱疾病的相关文献,最终纳入900篇文献。采用VOSviewer 1.6.19软件对纳入文献的发文量、期刊、机构、国家、关键词、共被引文献和高被引文献进行可视化分析。结果与结论:(1)脊柱手术机器人治疗脊柱疾病研究领域的文献呈逐年上升趋势,尤其在2023年达到了发文量的高峰。美国、中国和德国是该领域的研究热点国家。中国国家自然科学基金是该领域的主要资助基金。(2)中国北京积水潭医院和美国特殊外科医院在该领域的研究具有较高的发文量。(3)《World Neurosurgery》《Spine》和《Operative Neurosurgery》是该领域的主要发文期刊。(4)关键词分析显示,研究主要集中在机器人辅助脊柱手术的准确性、微创手术、机器人脊柱手术和导航技术等方面。(5)文献共被引分析结果显示了机器人辅助技术在脊柱手术中具有显著优势,与传统手术相比,脊柱手术机器人如ROSA?Spine,ExcelsiusGPS,Mazor X及TiRobot等,具有高精度导航、精确椎弓根螺钉置入及实时反馈等优点,它们通过减少手术中X射线辐射暴露,降低患者并发症风险,提高手术成功率,显示出其在脊柱外科领域的应用前景。(6)尽管如此,相关技术的应用和精确度仍需不断积累经验以提高;机器人手术技术在降低手术辐射暴露和提高手术精度方面显示出成本效益,但还需深入探讨其在椎弓根螺钉置入过程中的精确度、手术时间影响及经济效益。(7)2021-2024年的高被引文献分析结果进一步显示,目前该领域最新研究热点主要集中在虚拟现实和增强现实技术的应用、机器人辅助椎弓根螺钉置入的准确性提升以及导航机器人脊柱手术平台的应用等。例如,通过创新技术如有机电化学神经元为脑机接口、假肢和智能软机器人技术提供了新的集成方案。同时,虚拟现实和增强现实技术在脊柱畸形矫正等领域展示了广泛应用前景。

Navigated liver surgery:State of the art and future perspectives

Background:In recent years,the development of digital imaging technology has had a significant influence in liver surgery.The ability to obtain a 3-dimensional(3D)visualization of the liver anatomy has provided surgery with virtual reality of simulation 3D computer models,3D printing models and more recently holograms and augmented reality(when virtual reality knowledge is superimposed onto reality).In addition,the utilization of real-time fluorescent imaging techniques based on indocyanine green(ICG)uptake allows clinicians to precisely delineate the liver anatomy and/or tumors within the parenchyma,applying the knowledge obtained preoperatively through digital imaging.The combination of both has transformed the abstract thinking until now based on 2D imaging into a 3D preoperative conception(virtual reality),enhanced with real-time visualization of the fluorescent liver structures,effectively facilitating intraoperative navigated liver surgery(augmented reality).Data sources:A literature search was performed from inception until January 2021 in MEDLINE(Pub Med),Embase,Cochrane library and database for systematic reviews(CDSR),Google Scholar,and National Institute for Health and Clinical Excellence(NICE)databases.Results:Fifty-one pertinent articles were retrieved and included.The different types of digital imaging technologies and the real-time navigated liver surgery were estimated and compared.Conclusions:ICG fluorescent imaging techniques can contribute essentially to the real-time definition of liver segments;as a result,precise hepatic resection can be guided by the presence of fluorescence.Furthermore,3D models can help essentially to further advancing of precision in hepatic surgery by permitting estimation of liver volume and functional liver remnant,delineation of resection lines along the liver segments and evaluation of tumor margins.In liver transplantation and especially in living donor liver transplantation(LDLT),3D printed models of the donor’s liver and models of the recipient’s hilar anatomy can contribute further to improving the results.In particular,pediatric LDLT abdominal cavity models can help to manage the largest challenge of this procedure,namely large-for-size syndrome.

A retrospective study to compare the treatment outcomes with and without surgical navigation for fracture of the orbital wall

Purpose To evaluate the outcomes with and without aid of a computer-assisted surgical navigation system(CASNS)for treatment of unilateral orbital wall fracture(OWF).Methods Patients who came to our hospital for repairing unilateral traumatic OWF from 2014 to 2017 were included in this study.The patients were divided into the navigation group who accepted orbital wall reconstruction aided by CASNS and the conventional group.We evaluated the surgical precision in the navigation group by analyzing the difference between actual postoperative computed tomography data and preoperative virtual surgical plan through color order ratios.We also compared the duration of surgery,enophthalmos correction,restoration of orbital volumes,and improvement of clinical symptoms in both groups systemically.Quantitative data were presented as mean±SD.Significance was determined by the two-sample t-test using SPSS Version 19.0 A p<0.05 was considered statistically significant.Results Seventy patients with unilateral OWF were included in the study cohort.The mean difference between preoperative virtual planning and actual reconstruction outcome was(0.869±0.472)mm,which means the reconstruction result could match the navigation planning accurately.The mean duration of surgery in the navigation group was shorter than it is in the control group,but not significantly.Discrepancies between the reconstructed and unaffected orbital-cavity volume and eyeball projection in the navigation group were significantly less than that in the conventional group.One patient had remnant diplopia and two patients had enophthalmos after surgery in the navigation group;two patients had postoperative diplopia and four patients had postoperative enophthalmos in the conventional group.Conclusion Compare with the conventional treatment for OWF,the use of CASNS can provide a significantly better surgical precision,greater improvements in orbital-cavity volume and eyeball projection,and better clinical results,without increasing the duration of surgery.

RRVPE:A Robust and Real-Time Visual-Inertial-GNSS Pose Estimator for Aerial Robot Navigation

Self-localization and orientation estimation are the essential capabilities for mobile robot navigation.In this article,a robust and real-time visual-inertial-GNSS(Global Navigation Satellite System)tightly coupled pose estimation(RRVPE)method for aerial robot navigation is presented.The aerial robot carries a front-facing stereo camera for self-localization and an RGB-D camera to generate 3D voxel map.Ulteriorly,a GNSS receiver is used to continuously provide pseudorange,Doppler frequency shift and universal time coordinated(UTC)pulse signals to the pose estimator.The proposed system leverages the Kanade Lucas algorithm to track Shi-Tomasi features in each video frame,and the local factor graph solution process is bounded in a circumscribed container,which can immensely abandon the computational complexity in nonlinear optimization procedure.The proposed robot pose estimator can achieve camera-rate(30 Hz)performance on the aerial robot companion computer.We thoroughly experimented the RRVPE system in both simulated and practical circumstances,and the results demonstrate dramatic advantages over the state-of-the-art robot pose estimators.

Nanomaterials for visualized tumor surgical navigation and postoperative recurrence inhibition

Preoperative localization of the tumor sites and intraoperative real-time monitoring are essential for precise surgery but are meanwhile challenging due to the lack of high-resolution,easy-to-operate,and fast visualization techniques.On the other hand,tumor recurrence and metastasis after surgery greatly reduce the survival rate of patients.Intervening tumor recurrence during surgery is a future direction of tumor treatment.Nanomaterials with external condition responsiveness(light,ultrasound,and magnetic field)can accurately assist intraoperative detection and surgical resection due to their functions such as tumor cell targeting,fluorescence imaging,and real time monitoring,providing a more accurate,shorter duration,and visualization method of surgical resection.Moreover,nanomaterials are versatile and can easily be tailored for application in different tumors.Locally filled or systemically circulating nanomaterials with slow drug release and residual tumor cell-targeting ability have promising applications in inhibiting tumor recurrence.Here,we review surgical navigation and postoperative recurrence interventional nanomaterials and their landscape in guiding tumor treatment.We summarize the classification and characteristics of these nanomaterials and discuss their application in the surgical navigation and recurrence inhibition of different tumors.We also provide an outlook on the challenges and future development of nanomaterials for visualized tumor surgical navigation and postoperative recurrence inhibition.

混合现实技术在口腔颌面部肿瘤诊疗中的应用

口腔颌面部肿瘤是口腔颌面外科的常见疾病,以虚拟手术设计、手术导航为代表的数字化外科技术目前已成为口腔颌面部肿瘤外科诊治的主要辅助手段。然而,现有的数字化技术在三维可视化成像、术中手眼配合等方面仍存在提升空间。目前,以混合现实技术为代表的三维可视化技术已经在医学领域迅速发展和应用,通过将三维虚拟图像叠加到真实的手术环境中,可辅助实现医学影像实时立体呈现,已逐步应用于口腔颌面部肿瘤的诊治中。术前可基于影像数据构建肿瘤及其周边重要结构三维模型,在混合现实环境中,进行个性化术前评估和手术方案设计;术中将混合现实技术与手术导航技术相结合,可以在术区真实环境中实时显示三维虚拟模型,克服单纯使用导航技术的手眼协调问题,进一步提高口腔颌面部肿瘤手术的精确性和安全性。混合现实技术与远程互联网医疗技术相结合,还可以提供高质量的教学平台,推动地区口腔颌面外科诊疗水平的发展。混合现实技术的局限性主要在于术区影像遮挡、单纯使用时精度不足、配准时间长等。笔者结合国内外文献报道以及本课题组的临床实践,对混合现实技术在口腔颌面部肿瘤诊疗中的应用进行归纳与总结。

屈光性白内障手术质效优化技术现状与进展

当前白内障手术已经进入屈光性白内障手术时代,精准控制目标屈光度,快速有效提高患者的视觉质量成为白内障医生的共同追求。而飞秒激光辅助的白内障手术、手术导航技术、主动控制液流超声乳化技术、专用的高质量眼内灌注液、无滴眼液手术模式、眼表修复与干眼管理、功能型人工晶状体的应用、术后视功能训练等手术质效优化方面,可以进一步提升患者诊疗体验、加速患者康复、提升术后视觉质量、提升患者满意度等,促进屈光白内障手术发展。

计算机辅助口腔种植手术的临床应用进展

为了提高种植体的植入精度,减轻手术创伤,提高种植治疗的成功率和美学效果,计算机辅助技术被应用于种植手术。计算机辅助的种植手术主要分为两类:静态计算机辅助种植手术与动态计算机辅助种植手术。其中,静态计算机辅助种植手术通过术前设计制作的手术导板引导术者植入种植体;而动态计算机辅助种植手术通过实时定位与追踪技术引导术者,其操作高效、快捷,具有广阔的应用前景。近年来,得益于数字化技术的快速发展,计算机辅助口腔种植手术在临床实践中得到了越来越广泛的应用。本文对计算机辅助口腔种植手术的分类和临床流程、种植体植入精度和影响植入精度的因素、临床效果和患者报告指标进行详细论述。

面向手术导航3D/2D配准的无监督跨域迁移网络

3D/2D配准是手术导航的关键技术,现有基于深度学习的配准方法通过网络提取图像特征,继而回归出相应的姿态变换参数。此类方法依赖于真实的样本以及对应的3D标签用于训练,然而这部分专家标注的医疗数据十分稀缺。替代的方案用数字重建放射影像(DRR)图像训练网络,由于图像特征跨域的差异,在X射线图像上难以保持原有的配准精度。针对上述问题,设计基于自注意力的无监督跨域迁移网络(UCDTN),无须依赖X射线图像与其对应的3D空间标签作为训练样本,将源域所捕获的图像特征与空间变换间的对应关系迁移到目标域,借助公共特征减小域间特征的差距、降低跨域所带来的负面影响。实验结果表明,UCDTN预测结果的平均配准误差(mTRE)为2.66 mm;与未经跨域迁移训练的模型相比,mTRE指标降低了70.61%,验证了UCDTN在跨域配准任务上的有效性。

3D打印技术在肝脏手术中的应用进展

3D打印作为一种新兴的技术,可以辅助提高肝脏手术的手术效率。3D打印的器官模型能够帮助术者制订手术计划、模拟手术过程以及通过手术导航对手术进行指导。3D打印利用特定个体的组织或细胞产生肝脏手术中的移植物,解决移植物短缺等问题,推动个性化医疗的发展。

入路姿态光纤导航的经鼻柔性手术机器人

针对深腔狭小空间下传统经鼻手术操作灵巧性不足、术中入路导航信息匮乏等问题,提出了入路姿态光纤导航的经鼻柔性手术机器人。采用柔性球铰串联和销钉-滑槽配置,设计出兼具灵巧和抗扭扰动的柔性机械臂构型,结合几何分析和D-H参数法建立了手术机器人正、逆运动学模型;通过在各柔性机械臂内间隔90°嵌入两路分布式光纤导航传感器,联合双目视觉和极限学习机提出的数据驱动的入路姿态光纤原位标定法,避免了传统离线标定导致的测量误差及基于微分几何理论获取其姿态方法中误差累积的问题,实现了手术机器人术中形位高精度自感知。实验结果表明:柔性机械臂的极限弯曲角度可达105°,弯曲角80°范围内容许负载为0.9 N;通过光纤导航,在自由和障碍物环境中,柔性机械臂末端最大位置预测误差分别为0.920 mm,1.635 mm,验证了本文提出的入路姿态光纤导航的经鼻柔性手术机器人有效性和可行性。

寰枢椎脱位手术中置钉技术应用进展

近年来,伴随着科学技术的进步,在寰枢椎脱位的手术中置钉的技术也在不断发展。本文整理了寰枢椎脱位近十年常用的重要置钉技术,分为徒手置钉技术和新型机器人置钉技术,并介绍了徒手置钉技术及机器人置钉技术的置钉原理及常用设备,分别阐述其优缺点,最后进行整理比较和总结归纳,并提出目前临床及研究领域置钉技术所面临的局限,以促进置钉技术的未来发展。

数字智能化诊疗技术在复杂性肝癌研究现状

复杂性肝癌位置特殊,临近重要脉管结构,且肝脏解剖结构复杂,行肝切除术难度大,手术的精准性和安全性难以保证。近年来,随着医学影像技术的不断发展,以三维可视化、虚拟仿真手术、增强现实导航为代表的数字智能化诊疗技术已广泛应用于复杂性肝癌肝切除术,有效减少了术中出血、术后并发症的发生,改善了短期预后,指导手术更精准、安全地实施。数字智能化诊疗技术对肝脏外科的发展产生了巨大的推动作用,肝脏外科自此进入"智能化"时代。笔者结合团队开展数字智能化诊疗技术应用于复杂性肝癌肝切除术的经验及相关文献,详细阐述数字智能化技术在复杂性肝癌应用现状。

可见-近红外二区双通道荧光成像系统

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