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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
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Stereotactic navigation using registration based on intra-abdominal landmarks in robotic-assisted lateral pelvic
K Ochiai1, E Kobayashi2, K Sasaki3
1Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. ochiaikun@gmail.com.
Techniques in Coloproctology
|June 8, 2022
Summary
Intra-abdominal landmarks improve the accuracy of robot-assisted lateral pelvic lymph node dissection (LPLND) for rectal cancer navigation. This method offers a more precise and feasible approach compared to external body surface landmarks.
Area of Science:
- Surgical Oncology
- Medical Robotics
- Medical Imaging
Background:
- Robot-assisted lateral pelvic lymph node dissection (LPLND) is utilized for rectal cancer treatment.
- Stereotactic navigation systems aim to enhance precision in minimally invasive procedures.
Purpose of the Study:
- To evaluate the accuracy and feasibility of a stereotactic navigation system for robot-assisted LPLND in rectal cancer.
- To compare the performance of intra-abdominal versus body surface landmarks for patient-to-image registration.
Main Methods:
- A navigation system was developed using optical tracking and open-source software.
- Landmark-based registration was performed using both body surface and intra-abdominal landmarks.
- Target Registration Error (TRE) and registration time were assessed for key anatomical points.
Main Results:
- Registration time was shorter with body surface landmarks (49 s) than intra-abdominal landmarks (88 s).
- Mean TRE significantly improved with intra-abdominal landmarks (10.0–12.6 mm) compared to body surface landmarks (53.4–55.8 mm).
- No adverse events were associated with the registration process.
Conclusions:
- Intra-abdominal landmarks provide a feasible and more accurate registration method for stereotactic navigation during LPLND.
- This approach enhances navigation simplicity and accuracy compared to using body surface landmarks.

