Systems for tracking minimally invasive surgical instruments

Minimally invasive surgery (e.g. laparoscopy) requires special surgical skills, which should be objectively assessed. Several studies have shown that motion analysis is a valuable assessment tool of basic surgical skills in laparoscopy. However, to use motion analysis as the assessment tool, it is necessary to track and record the motions of laparoscopic instruments. This article describes the state of the art in research on tracking systems for laparoscopy. It gives an overview on existing systems, on how these systems work, their advantages, and their shortcomings. Although various approaches have been used, none of the tracking systems to date comes out as clearly superior. A great number of systems can be used in training environment only, most systems do not allow the use of real laparoscopic instruments, and only a small number of systems provide force feedback.     

侵入性心脏电生理检查在心律失常诊断中的应用现状

侵入性心脏电生理检查（electrophysiology，EPS）是以整体心脏或其一部分作为研究对象，通过心电标测系统记录心腔内电图或心电解剖图，并应用电刺激诱发心律失常以揭示心律失常机制、诊断和研究心律失常的技术方法。EPS对评价窦房结及房室结功能、定位预激综合征旁路：     

Systems for tracking minimally invasive surgical instruments.

Minimally invasive surgery (e.g. laparoscopy) requires special surgical skills, which should be objectively assessed. Several studies have shown that motion analysis is a valuable assessment tool of basic surgical skills in laparoscopy. However, to use motion analysis as the assessment tool, it is necessary to track and record the motions of laparoscopic instruments. This article describes the state of the art in research on tracking systems for laparoscopy. It gives an overview on existing systems, on how these systems work, their advantages, and their shortcomings. Although various approaches have been used, none of the tracking systems to date comes out as clearly superior. A great number of systems can be used in training environment only, most systems do not allow the use of real laparoscopic instruments, and only a small number of systems provide force feedback.     

Enhanced visualisation for minimally invasive surgery

Purpose  

Endoscopes used in minimally invasive surgery provide a limited field of view, thus requiring a high degree of spatial awareness and orientation. Attempts at expanding this small, restricted view with previously observed imagery have been made by researchers and is generally known as image mosaicing or dynamic view expansion. For minimally invasive endoscopy, SLAM-based methods have been shown to have potential values but have yet to address effective visualisation techniques.     

Anastomotic devices for minimally invasive surgery

Minimally invasive surgery (MIS) has had a tremendous impact on surgical practice in the last decades. For gastrointestinal surgery, construction of an anastomosis is often a critical part of the operation. Several technologies are used to perform an anastomosis in MIS. From smaller modifications of standard suturing techniques to the use of complex robotic surgery, suturing is still an essential part of MIS in this context. Stapling techniques have been adopted and modified from conventional open surgery. In the future, even more MIS procedures will be performed, especially if cancer surgery becomes more widely accepted. Further developments in MIS anastomotic techniques can be anticipated.     

Innovative handles for use in minimally invasive surgery

Summary

Most of the handles available for laparoscopic surgery are not ergonomically designed. Based on anatomic, physiologic and ergonomic principles, new criteria for handles for laparoscopic surgery have been developed. In minimally invasive surgery, handles have to be adjustable for various hand sizes. The functional elements need to be operated by the sensitive parts of the fingers, without causing pressure areas. Rotation movements have to be transmitted directly to the effector; the instrumen?s shaft represents an immediate extension of the lower arm rotation axis. Taking these factors into account, new concepts for handles were developed. The multi-functional handle ‘MFEHG Schafreuter’ is shaped to fit either the right or left hand. Manipulation of the various functional elements is carried out using the first three fingers, while the handle rests in the half-closed hand. The vario-handle ‘VG Hirschberg’ is shaped to fit either hand and can be held in various grip positions for precise dissection, or for strenuous work. Both handles fulfil ergonomic criteria and support a bimanual and more ergonomical laparoscopic surgery.     

Operating room design for minimally invasive surgery

Adapting the modern operating room (OR) for minimally invasive surgery (MIS) is a challenge that begins with the more general problem of designing the OR. Apart from the scarcity of practical publications and details in this area, the highly technical nature of many of the issues, and the difficulty of communicating them, often result in mistakes being made in planning at a very simple level. Three specific ways of improving communication in planning are: using a checklist, sharing a planning handbook among the intended users, and modifying architects' drawings to 1:10 scale floor plans with movable cut-outs to represent equipment and staff.     

Future trends in minimally invasive surgery

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HEALTH CARE COSTS in the United States are climbing annually at a staggering rate. Technology often is blamed for rising health care costs; however, some medical advances, such as minimally invasive surgery (MIS), are critical to improving health care efficiency, enhancing the quality of care provided, and decreasing overall expenses.

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SAVINGS OR PROFITS relating to technology may be difficult to measure quantitatively, but when surgeons and perioperative personnel have reached the peak of the learning curve for performing MIS procedures, complication rates drop significantly.

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PATIENTS ARE EXPERIENCING the benefits of MIS (eg, decreased postoperative pain, shorter hospital stays and often no need for an overnight stay, ability to return to work sooner), all of which encourage technologically savvy consumers to seek MIS options. AORN J 82 (December 2005) 1006-1018.

     

Video-based assistance system for training in minimally invasive surgery

Abstract

In this paper, the development of an assisting system for laparoscopic surgical training is presented. With this system, we expect to facilitate the training process at the first stages of training in laparoscopic surgery and to contribute to an objective evaluation of surgical skills. To achieve this, we propose the insertion of multimedia contents and outlines of work adapted to the level of experience of trainees and the detection of the movements of the laparoscopic instrument into the monitored image. A module to track the instrument is implemented focusing on the tip of the laparoscopic tool. This tracking method does not need the presence of artificial marks or special colours to distinguish the instruments. Similarly, the system has another method based on visual tracking to localize support multimedia content in a stable position of the field of vision. Therefore, this position of the support content is adapted to the movements of the camera or the working area. Experimental results are presented to show the feasibility of the proposed system for assisting in laparoscopic surgical training.     

High-throughput multi-resolution foveated laparoscope for minimally invasive surgery

Feasibility and clinical utility of a multi-resolution foveated laparoscope (MRFL) was previously tested in a porcine surgical study. The study revealed several clinical limitations of the system including moisture proofing, working distance, image quality, low light performance, color accuracy, size, and weight. In this paper, we discuss the root causes of these limitations and strategies to correct them, present the design and prototyping of a new high throughput multi resolution foveated laparoscope (HT-MRFL), and demonstrate the HT-MRFL prototype performance in comparison to the MRFL and simulated performance metrics.     

Transanal minimally invasive surgery for total mesorectal excision

Abstract

Transanal TME is a new and important application for TAMIS. It allows for resection and mobilization of the rectum while preserving the quality of the mesorectal envelop. This new approach has gained considerable interest not only because of its minimally invasive nature, but because TAMIS-TME offers a solution to one of the most difficult problems in rectal cancer surgery: Specifically, access to the distal rectum in obese male patients with a narrow pelvis. Recently, transanal TME has become one of the most rapidly expanding areas in rectal cancer surgery. Interestingly, the origin and inception of this approach began decades ago. The evolution of transanal TME with a historical perspective is described.     

机器人在微创外科手术中的应用

背景：微创外科手术机器人具有稳定性好、操作灵活、运动精准、手眼协调等特点,是微创手术未来发展的方向。目的：分析微创外科手术机器人的现状,探讨微创外科手术机器人的关键技术。方法：分别从体外手术机器人与体内手术机器人等方面,详细分析和介绍了国内外近年来的主要研究成果,并对微创外科手术机器人的力反馈、主从控制策略等关键技术进行了探讨。结果与结论：综合国内外微创外科机器人的研究情况来看,微型体内手术机器人是手术机器人领域的研究热点,特别是微型机器人的灵巧性设计、手术机器人的定位、运动规划与控制、操作力的实时测量与力反馈等关键技术。主从操控技术是手术机器人进行遥操作和微操作的关键环节。     

机器人在微创外科手术中的应用

背景:微创外科手术机器人具有稳定性好、操作灵活、运动精准、手眼协调等特点,是微创手术未来发展的方向.目的:分析微创外科手术机器人的现状,探讨微创外科手术机器人的关键技术.方法:分别从体外手术机器人与体内手术机器人等方面,详细分析和介绍了国内外近年来的主要研究成果,并对微创外科手术机器人的力反馈、主从控制策略等关键技术进行了探讨.结果与结论:综合国内外微创外科机器人的研究情况来看,微型体内手术机器人是手术机器人领域的研究热点,特别是微型机器人的灵巧性设计、手术机器人的定位、运动规划与控制、操作力的实时测量与力反馈等关键技术.主从操控技术是手术机器人进行遥操作和微操作的关键环节.     

Augmented reality haptic (ARH): an approach of electromagnetic tracking in minimally invasive surgery

Purpose  

Minimally Invasive Surgery (MIS) is a widely used surgical technique that requires a long training process due to its difficulty and complexity. We developed an Augmented Reality Haptic (ARH) System based on electromagnetic tracking devices for use in creation training models (computer-enhanced trainers), in computer-assisted surgery or telemanipulation applications.     

显微镜下微创斜视矫正术与传统斜视矫正术治疗斜视的对比研究

目的 探讨显微镜下微创斜视矫正术与传统斜视矫正术治疗斜视的临床疗效及安全性。方法 回顾接受眼科手术的斜视患者68例（108眼）,其中传统组33例（53眼）接受肉眼下传统斜视矫正术,微创组35例（55眼）接受显微镜下微创斜视矫正术,术后随访6个月。以眼位矫正效果、术后疼痛情况、眼表状态变化、手术时间、术中出血量及并发症为观察指标。结果 微创组眼位矫正治愈率（94.2%）较传统组（75.8%）高（P < 0.05）,微创组疼痛视觉模拟评分在术后2 h、1 d、7 d均低于传统组（P均< 0.05）。微创组首次泪膜破裂时间在术后1 d、7 d较传统组缩短的少,泪河高度在术后1 d、7 d较传统组升高幅度小,眼红评分在术后1 d、7 d、30 d均低于传统组（P均< 0.05）。2组平均手术时间差异无统计学意义（P > 0.05）,微创组术中出血较传统组减少（P < 0.05）。微创组随访未见并发症,传统组有3例术后出现结膜肉芽肿,2例手术切口明显瘢痕,2组比较差异均无统计学意义（P均> 0.05）。结论 显微镜下微创斜视矫正术较传统斜视矫正术有明显的优越性,不仅创伤更小,疗效更好,而且对眼表的影响更小,疼痛更轻,外观更好,手术并发症更少。     

Unsupervised feature disentanglement for video retrieval in minimally invasive surgery

In this paper, we propose a novel method of Unsupervised Disentanglement of Scene and Motion (UDSM) representations for minimally invasive surgery video retrieval within large databases, which has the potential to advance intelligent and efficient surgical teaching systems. To extract more discriminative video representations, two designed encoders with a triplet ranking loss and an adversarial learning mechanism are established to respectively capture the spatial and temporal information for achieving disentangled features from each frame with promising interpretability. In addition, the long-range temporal dependencies are improved in an integrated video level using a temporal aggregation module and then a set of compact binary codes that carries representative features is yielded to realize fast retrieval. The entire framework is trained in an unsupervised scheme, i.e., purely learning from raw surgical videos without using any annotation. We construct two large-scale minimally invasive surgery video datasets based on the public dataset Cholec80 and our in-house dataset of laparoscopic hysterectomy, to establish the learning process and validate the effectiveness of our proposed method qualitatively and quantitatively on the surgical video retrieval task. Extensive experiments show that our approach significantly outperforms the state-of-the-art video retrieval methods on both datasets, revealing a promising future for injecting intelligence in the next generation of surgical teaching systems.     

Design of multifunctional compliant mechanisms for minimally invasive surgery

Summary

Compliant mechanisms that can perform multiple unique functions have great potential for use in minimally invasive therapy. A fully compliant mechanism may be thought of as a monolithic mechanism without hinge joints which uses elastic deformation to achieve force and motion transmission. Incorporating multifunctional compliant mechanisms into minimally invasive surgical tools has many possible advantages, including reduced instrument exchanges and additional dexterity at the surgical site. Compliant mechanisms also offer the advantage of single-piece construction and ease of manufacture over their rigid-link counterparts, eliminating the need for complex millimeter-scale assembly and cleaning in hinge areas. A multicriteria topology optimization procedure for the design of multifunctional compliant mechanisms is illustrated through the design of a combination tool that will perform forceps and scissor function. A working solid model of the combination forceps/scissors has been generated based on the optimal topology. Results of detailed finite element modeling are discussed along with implications for practical manufacture and implementation.