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Real-time computed tomography-based augmented reality for natural orifice transluminal endoscopic surgery navigation.
D E Azagury1, M Ryou, S N Shaikh
1Minimally Invasive and Bariatric Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
An image registration system for natural orifice transluminal endoscopic surgery (NOTES) significantly improved navigation efficacy and ease of access to intra-abdominal organs for endoscopists of all skill levels. This system made previously inaccessible organs reachable, reducing a key barrier to NOTES procedures.
Area of Science:
- Minimally Invasive Surgery
- Surgical Navigation Technologies
- Medical Imaging and Augmented Reality
Background:
- Natural orifice transluminal endoscopic surgery (NOTES) presents significant technical challenges including limited visualization and instrumentation.
- Augmented reality (AR) systems offer potential solutions to overcome these inherent difficulties in NOTES procedures.
Purpose of the Study:
- To evaluate the effectiveness of an image registration system for NOTES procedures (IR-NOTES) in facilitating endoscopic navigation.
- To assess the impact of IR-NOTES on navigation efficacy and ease of access to intra-abdominal organs.
Main Methods:
- The IR-NOTES system was tested in three human cadavers, targeting 15 intra-abdominal organs via transgastric and transcolonic routes.
- Navigation was performed by three endoscopists with varying expertise, with objective evaluation using kinematic analysis and an organ access complexity score.
Main Results:
- The IR-NOTES system significantly reduced unreached targets from 11.7% to 1% (P = 0.002).
- Endoscope movements were less complex in 8 of 15 organs with IR-NOTES, particularly for the spleen and rectum.
- Access time to the rectum via transgastric approach was reduced from 206.3s to 54.9s (P = 0.027).
Conclusions:
- The IR-NOTES system demonstrably enhances navigation efficacy and ease for intra-abdominal NOTES exploration across all operator skill levels.
- This technology makes certain organs accessible to less experienced operators, mitigating a major impediment to wider NOTES adoption.
