Validating and helping surgical laparoscopies using radiological images and 3D segmentations. Applications to gastroplasties and cholecystectomies
Angel Osorio, Jean-Marie Biset, Roland Boustani, patricia Donars, Julien Nauroy, Emmanuelle Frenoux.
In this paper, we present a new computerized system to make 3D segmentations and instant volume measurements of organs and lesions from DICOM standard images (CT, MR) using standard protocols and a simple PC. Specific functions allow the operator to only reconstruct the clinically interesting organs and lesions. This system is used to plan laparoscopic interventions, such as gastroplasty and cholecystectomy. Using an operating room model and a video projection technique, the 3D images are displayed on the patient’s body, helping the surgeon in real time to make laparoscopic surgical acts more accurate and faster.
Nowadays surgical acts are directed towards the use of laparoscopy, which leads to less morbidity and complications and induces shorter hospitalization times. Unfortunately, laparoscopic trocars are implicated in reports of death and life-threatening injury which appear most frequently during initial insertion . The major problem is the precise localization of organs and lesions in order to identify the best trocars trajectory. Making the decision of using laparoscopy and planning it require an exhaustive knowledge concerning organs’ and lesions’ volumes. Furthermore their precise location is necessary for the trocars’ placement. The system we present here is able to make 3D segmentation to compute geometry, volume and precise position of the liver, gallbladder, stomach and anatomic landmarks. It also has a 3D fusion module which allows 3D registration of parts issued from various phases (arterial, delayed …) if necessary. After validating the use of laparoscopy, a geometrical model of the operating room allows scaling the 3D images according to the patient position, skin shape and deformations. The projection in real time of these images before and after inflating the abdomen (classical laparoscopic technique) shows the surgeon the precise position of critical organs and helps for accurate trocars insertion.
The system we present is operational on any standard PC, and can be freely downloaded and tested at http://perso.limsi.fr/osorio/PTM3D/. The 3D segmentation software is operational on all examinations written in DICOM format (CT, MRI, TEP …). The segmentation and volume measurement steps are operator-independent and easy to use: an operator can learn the main system functionalities in less than one hour. The 3D segmentations are carried out in a total time of about 10 minutes. It helps during the surgery simulation (pre-operative simulation of the laparoscopy). The Augmented Reality setup is adaptable to any operating room, and only requires the use of a PC and a video projector, and ensures a visual monitoring in real time during the intervention, and does not need surgery protocol modification. It is an asset for the location and representation of the liver, the stomach, the gallbladder and the anatomical landmarks, using only images displayed on the body. Using our system makes it possible to avoid part of the irradiation during the intervention (less need of x-rays if fluoroscopy is used in the operating room). It can also be a perfect tool for teaching residents in the operating theater.