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Checcucci E, Piana A, Volpi G, Quarà A, De Cillis S, Piramide F, Burgio M, Meziere J, Cisero E, Colombo M, Bignante G, Sica M, Granato S, Verri P, Gatti C, Alessio P, Di Dio M, Alba S, Fiori C, Amparore D, Porpiglia F. Visual extended reality tools in image-guided surgery in urology: a systematic review. Eur J Nucl Med Mol Imaging 2024; 51:3109-3134. [PMID: 38589511 DOI: 10.1007/s00259-024-06699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE The aim of this systematic review is to assess the clinical implications of employing various Extended Reality (XR) tools for image guidance in urological surgery. METHODS In June 2023, a systematic electronic literature search was conducted using the Medline database (via PubMed), Embase (via Ovid), Scopus, and Web of Science. The search strategy was designed based on the PICO (Patients, Intervention, Comparison, Outcome) criteria. Study protocol was registered on PROSPERO (registry number CRD42023449025). We incorporated retrospective and prospective comparative studies, along with single-arm studies, which provided information on the use of XR, Mixed Reality (MR), Augmented Reality (AR), and Virtual Reality (VR) in urological surgical procedures. Studies that were not written in English, non-original investigations, and those involving experimental research on animals or cadavers were excluded from our analysis. The quality assessment of comparative and cohort studies was conducted utilizing the Newcastle-Ottawa scale, whilst for randomized controlled trials (RCTs), the Jadad scale was adopted. The level of evidence for each study was determined based on the guidelines provided by the Oxford Centre for Evidence-Based Medicine. RESULTS The initial electronic search yielded 1,803 papers after removing duplicates. Among these, 58 publications underwent a comprehensive review, leading to the inclusion of 40 studies that met the specified criteria for analysis. 11, 20 and 9 studies tested XR on prostate cancer, kidney cancer and miscellaneous, including bladder cancer and lithiasis surgeries, respectively. Focusing on the different technologies 20, 15 and 5 explored the potential of VR, AR and MR. The majority of the included studies (i.e., 22) were prospective non-randomized, whilst 7 and 11 were RCT and retrospective studies respectively. The included studies that revealed how these new tools can be useful both in preoperative and intraoperative setting for a tailored surgical approach. CONCLUSIONS AR, VR and MR techniques have emerged as highly effective new tools for image-guided surgery, especially for urologic oncology. Nevertheless, the complete clinical advantages of these innovations are still in the process of evaluation.
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Affiliation(s)
- Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3,95, Candiolo, Turin, 10060, Italy.
| | - Alberto Piana
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | - Gabriele Volpi
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3,95, Candiolo, Turin, 10060, Italy
| | - Alberto Quarà
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Federico Piramide
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Mariano Burgio
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Juliette Meziere
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Edoardo Cisero
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Marco Colombo
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Gabriele Bignante
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Michele Sica
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Stefano Granato
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Paolo Verri
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Cecilia Gatti
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3,95, Candiolo, Turin, 10060, Italy
| | - Paolo Alessio
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3,95, Candiolo, Turin, 10060, Italy
| | - Michele Di Dio
- Dept. of Surgery, Division of Urology, SS Annunziata Hospital, Cosenza, Italy
| | - Stefano Alba
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | - Cristian Fiori
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Daniele Amparore
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
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Single Evaluation of Use of a Mixed Reality Headset for Intra-Procedural Image-Guidance during a Mock Laparoscopic Myomectomy on an Ex-Vivo Fibroid Model. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Uterine fibroids represent the highest prevalence of benign tumors in women, with reports ranging from 4.5% to 68.6%, with a significant bias towards African American women. For uterine fibroids, a significant decision is determining whether fibroids can be successfully removed using minimally invasive (MI) techniques or their removal requires open surgery. Currently, the standard-of-care for intra-procedural visualization for myomectomies is ultrasound, which has low image quality and requires a specially trained assistant. Currently, the state-of-the-art is to obtain a pre-procedural MRI scan of the patient, which can be used for diagnosis and pre-procedural planning. Although proven incredibly useful pre-procedurally, MRI scans are not often used intra-procedurally due to the inconvenient visualization as 2D slices, which are seen on 2D monitors that do not intuitively convey the depth or orientation of the fibroids, as needed to effectively perform myomectomies. To address this limitation, herein, we present the use of a mixed reality headset (i.e., Microsoft HoloLens 2), as a tool for intra-procedural image-guidance during a mock myomectomy of an ex vivo animal uterus. In this work, we created a patient-specific holographic rendering by performing image segmentation of an MRI scan of a custom-made uterine fibroid animal model. A physician qualitatively assessed the usefulness of the renderings for fibroid localization, as compared to the same visualization on a 2D monitor. In conclusion, the use of mixed reality as an intra-procedural image guidance tool for myomectomies was perceived as a better visualization technique that could lead to improvements in MI approaches and make them accessible to patients from lower socioeconomic populations.
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Qian L, Wu JY, DiMaio SP, Navab N, Kazanzides P. A Review of Augmented Reality in Robotic-Assisted Surgery. ACTA ACUST UNITED AC 2020. [DOI: 10.1109/tmrb.2019.2957061] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Coronary Heart Disease Preoperative Gesture Interactive Diagnostic System Based on Augmented Reality. J Med Syst 2017; 41:126. [PMID: 28718051 DOI: 10.1007/s10916-017-0768-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
Abstract
Coronary heart disease preoperative diagnosis plays an important role in the treatment of vascular interventional surgery. Actually, most doctors are used to diagnosing the position of the vascular stenosis and then empirically estimating vascular stenosis by selective coronary angiography images instead of using mouse, keyboard and computer during preoperative diagnosis. The invasive diagnostic modality is short of intuitive and natural interaction and the results are not accurate enough. Aiming at above problems, the coronary heart disease preoperative gesture interactive diagnostic system based on Augmented Reality is proposed. The system uses Leap Motion Controller to capture hand gesture video sequences and extract the features which that are the position and orientation vector of the gesture motion trajectory and the change of the hand shape. The training planet is determined by K-means algorithm and then the effect of gesture training is improved by multi-features and multi-observation sequences for gesture training. The reusability of gesture is improved by establishing the state transition model. The algorithm efficiency is improved by gesture prejudgment which is used by threshold discriminating before recognition. The integrity of the trajectory is preserved and the gesture motion space is extended by employing space rotation transformation of gesture manipulation plane. Ultimately, the gesture recognition based on SRT-HMM is realized. The diagnosis and measurement of the vascular stenosis are intuitively and naturally realized by operating and measuring the coronary artery model with augmented reality and gesture interaction techniques. All of the gesture recognition experiments show the distinguish ability and generalization ability of the algorithm and gesture interaction experiments prove the availability and reliability of the system.
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The status of augmented reality in laparoscopic surgery as of 2016. Med Image Anal 2017; 37:66-90. [DOI: 10.1016/j.media.2017.01.007] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 01/16/2017] [Accepted: 01/23/2017] [Indexed: 12/27/2022]
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Yamamoto M, Murakami Y, Iwatsuki K, Kurimoto S, Hirata H. Feasibility of four-dimensional preoperative simulation for elbow debridement arthroplasty. BMC Musculoskelet Disord 2016; 17:144. [PMID: 27039373 PMCID: PMC4818897 DOI: 10.1186/s12891-016-0996-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 03/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent advances in imaging modalities have enabled three-dimensional preoperative simulation. A four-dimensional preoperative simulation system would be useful for debridement arthroplasty of primary degenerative elbow osteoarthritis because it would be able to detect the impingement lesions. METHODS We developed a four-dimensional simulation system by adding the anatomical axis to the three-dimensional computed tomography scan data of the affected arm in one position. Eleven patients with primary degenerative elbow osteoarthritis were included. A "two rings" method was used to calculate the flexion-extension axis of the elbow by converting the surface of the trochlea and capitellum into two rings. A four-dimensional simulation movie was created and showed the optimal range of motion and the impingement area requiring excision. To evaluate the reliability of the flexion-extension axis, interobserver and intraobserver reliabilities regarding the assessment of bony overlap volumes were calculated twice for each patient by two authors. Patients were treated by open or arthroscopic debridement arthroplasties. Pre- and postoperative examinations included elbow range of motion measurement, and completion of the patient-rated questionnaire Hand20, Japanese Orthopaedic Association-Japan Elbow Society Elbow Function Score, and the Mayo Elbow Performance Score. RESULTS Measurement of the bony overlap volume showed an intraobserver intraclass correlation coefficient of 0.93 and 0.90, and an interobserver intraclass correlation coefficient of 0.94. The mean elbow flexion-extension arc significantly improved from 101° to 125°. The mean Hand20 score significantly improved from 52 to 22. The mean Japanese Orthopaedic Association-Japan Elbow Society Elbow Function Score significantly improved from 67 to 88. The mean Mayo Elbow Performance Score significantly improved from 71 to 91 at the final follow-up evaluation. CONCLUSION We showed that four-dimensional, preoperative simulation can be generated by adding the rotation axis to the one-position, three-dimensional computed tomography image of the affected arm. This method is feasible for elbow debridement arthroplasty.
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Affiliation(s)
- Michiro Yamamoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yukimi Murakami
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Katsuyuki Iwatsuki
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shigeru Kurimoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Liu M, Curet M. A review of training research and virtual reality simulators for the da Vinci surgical system. TEACHING AND LEARNING IN MEDICINE 2015; 27:12-26. [PMID: 25584468 DOI: 10.1080/10401334.2014.979181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED PHENOMENON: Virtual reality simulators are the subject of several recent studies of skills training for robot-assisted surgery. Yet no consensus exists regarding what a core skill set comprises or how to measure skill performance. Defining a core skill set and relevant metrics would help surgical educators evaluate different simulators. APPROACH This review draws from published research to propose a core technical skill set for using the da Vinci surgeon console. Publications on three commercial simulators were used to evaluate the simulators' content addressing these skills and associated metrics. FINDINGS An analysis of published research suggests that a core technical skill set for operating the surgeon console includes bimanual wristed manipulation, camera control, master clutching to manage hand position, use of third instrument arm, activating energy sources, appropriate depth perception, and awareness of forces applied by instruments. Validity studies of three commercial virtual reality simulators for robot-assisted surgery suggest that all three have comparable content and metrics. However, none have comprehensive content and metrics for all core skills. INSIGHTS: Virtual reality simulation remains a promising tool to support skill training for robot-assisted surgery, yet existing commercial simulator content is inadequate for performing and assessing a comprehensive basic skill set. The results of this evaluation help identify opportunities and challenges that exist for future developments in virtual reality simulation for robot-assisted surgery. Specifically, the inclusion of educational experts in the development cycle alongside clinical and technological experts is recommended.
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Affiliation(s)
- May Liu
- a Medical Research Department , Intuitive Surgical, Inc. , Sunnyvale , California , USA
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Schoenhagen P, Hill A. Transcatheter aortic valve implantation and potential role of 3D imaging. Expert Rev Med Devices 2014; 6:411-21. [DOI: 10.1586/erd.09.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery. Med Image Anal 2013; 17:974-96. [DOI: 10.1016/j.media.2013.04.003] [Citation(s) in RCA: 182] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 04/05/2013] [Accepted: 04/12/2013] [Indexed: 12/16/2022]
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Cho DS, Linte C, Chen ECS, Bainbridge D, Wedlake C, Moore J, Barron J, Patel R, Peters T. Predicting target vessel location on robot-assisted coronary artery bypass graft using CT to ultrasound registration. Med Phys 2013; 39:1579-87. [PMID: 22380390 DOI: 10.1118/1.3684958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Although robot-assisted coronary artery bypass grafting (RA-CABG) has gained more acceptance worldwide, its success still depends on the surgeon's experience and expertise, and the conversion rate to full sternotomy is in the order of 15%-25%. One of the reasons for conversion is poor pre-operative planning, which is based solely on pre-operative computed tomography (CT) images. In this paper, the authors propose a technique to estimate the global peri-operative displacement of the heart and to predict the intra-operative target vessel location, validated via both an in vitro and a clinical study. METHODS As the peri-operative heart migration during RA-CABG has never been reported in the literatures, a simple in vitro validation study was conducted using a heart phantom. To mimic the clinical workflow, a pre-operative CT as well as peri-operative ultrasound images at three different stages in the procedure (Stage(0)-following intubation; Stage(1)-following lung deflation; and Stage(2)-following thoracic insufflation) were acquired during the experiment. Following image acquisition, a rigid-body registration using iterative closest point algorithm with the robust estimator was employed to map the pre-operative stage to each of the peri-operative ones, to estimate the heart migration and predict the peri-operative target vessel location. Moreover, a clinical validation of this technique was conducted using offline patient data, where a Monte Carlo simulation was used to overcome the limitations arising due to the invisibility of the target vessel in the peri-operative ultrasound images. RESULTS For the in vitro study, the computed target registration error (TRE) at Stage(0), Stage(1), and Stage(2) was 2.1, 3.3, and 2.6 mm, respectively. According to the offline clinical validation study, the maximum TRE at the left anterior descending (LAD) coronary artery was 4.1 mm at Stage(0), 5.1 mm at Stage(1), and 3.4 mm at Stage(2). CONCLUSIONS The authors proposed a method to measure and validate peri-operative shifts of the heart during RA-CABG. In vitro and clinical validation studies were conducted and yielded a TRE in the order of 5 mm for all cases. As the desired clinical accuracy imposed by this procedure is on the order of one intercostal space (10-15 mm), our technique suits the clinical requirements. The authors therefore believe this technique has the potential to improve the pre-operative planning by updating peri-operative migration patterns of the heart and, consequently, will lead to reduced conversion to conventional open thoracic procedures.
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Affiliation(s)
- Daniel S Cho
- The University of Western Ontario, Ontario, Canada.
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Vitiello V, Lee SL, Cundy TP, Yang GZ. Emerging robotic platforms for minimally invasive surgery. IEEE Rev Biomed Eng 2012; 6:111-26. [PMID: 23288354 DOI: 10.1109/rbme.2012.2236311] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recent technological advances in surgery have resulted in the development of a range of new techniques that have reduced patient trauma, shortened hospitalization, and improved diagnostic accuracy and therapeutic outcome. Despite the many appreciated benefits of minimally invasive surgery (MIS) compared to traditional approaches, there are still significant drawbacks associated with conventional MIS including poor instrument control and ergonomics caused by rigid instrumentation and its associated fulcrum effect. The use of robot assistance has helped to realize the full potential of MIS with improved consistency, safety and accuracy. The development of articulated, precision tools to enhance the surgeon's dexterity has evolved in parallel with advances in imaging and human-robot interaction. This has improved hand-eye coordination and manual precision down to micron scales, with the capability of navigating through complex anatomical pathways. In this review paper, clinical requirements and technical challenges related to the design of robotic platforms for flexible access surgery are discussed. Allied technical approaches and engineering challenges related to instrument design, intraoperative guidance, and intelligent human-robot interaction are reviewed. We also highlight emerging designs and research opportunities in the field by assessing the current limitations and open technical challenges for the wider clinical uptake of robotic platforms in MIS.
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Athanasiou T, Ashrafian H, Rowland SP, Casula R. Robotic cardiac surgery: advanced minimally invasive technology hindered by barriers to adoption. Future Cardiol 2012; 7:511-22. [PMID: 21797747 DOI: 10.2217/fca.11.40] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Robotic cardiac surgery utilizes the most advanced surgical technology to offer patients a minimally invasive alternative to open surgery in the treatment of a broad range of cardiac pathologies. Although robotics may offer substantial benefits to physicians, patients and healthcare institutions, there are important barriers to its adoption that includes inadequate funding, competition from alternate therapies and challenges in training. There is a growing body of evidence to demonstrate the efficacy of robotic cardiac surgery. Technological innovations are improving patient safety and expanding the indications for robotic cardiac surgery beyond the treatment of mitral valve and coronary artery disease. Robotic cardiac surgery is rapidly becoming a feasible, safe and effective option for the definitive treatment of cardiac disease in the context of 21st century challenges to healthcare provision such as diabetes, obesity and an aging population.
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Affiliation(s)
- Thanos Athanasiou
- Department of Surgery & Cancer, Imperial College London, London W2 1NY, UK.
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Schoenhagen P, Numburi U, Halliburton SS, Aulbach P, von Roden M, Desai MY, Rodriguez LL, Kapadia SR, Tuzcu EM, Lytle BW. Three-dimensional imaging in the context of minimally invasive and transcatheter cardiovascular interventions using multi-detector computed tomography: from pre-operative planning to intra-operative guidance. Eur Heart J 2010; 31:2727-2740. [DOI: 10.1093/eurheartj/ehq302] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Cleary K, Peters TM. Image-guided interventions: technology review and clinical applications. Annu Rev Biomed Eng 2010; 12:119-42. [PMID: 20415592 DOI: 10.1146/annurev-bioeng-070909-105249] [Citation(s) in RCA: 220] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Image-guided interventions are medical procedures that use computer-based systems to provide virtual image overlays to help the physician precisely visualize and target the surgical site. This field has been greatly expanded by the advances in medical imaging and computing power over the past 20 years. This review begins with a historical overview and then describes the component technologies of tracking, registration, visualization, and software. Clinical applications in neurosurgery, orthopedics, and the cardiac and thoracoabdominal areas are discussed, together with a description of an evolving technology named Natural Orifice Transluminal Endoscopic Surgery (NOTES). As the trend toward minimally invasive procedures continues, image-guided interventions will play an important role in enabling new procedures, while improving the accuracy and success of existing approaches. Despite this promise, the role of image-guided systems must be validated by clinical trials facilitated by partnerships between scientists and physicians if this field is to reach its full potential.
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Affiliation(s)
- Kevin Cleary
- Imaging Science and Information Systems (ISIS) Center, Department of Radiology, Georgetown University Medical Center, Washington, DC 20007, USA.
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Kockro RA, Tsai YT, Ng I, Hwang P, Zhu C, Agusanto K, Hong LX, Serra L. Dex-ray: augmented reality neurosurgical navigation with a handheld video probe. Neurosurgery 2010; 65:795-807; discussion 807-8. [PMID: 19834386 DOI: 10.1227/01.neu.0000349918.36700.1c] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We developed an augmented reality system that enables intraoperative image guidance by using 3-dimensional (3D) graphics overlaid on a video stream. We call this system DEX-Ray and report on its development and the initial intraoperative experience in 12 cases. METHODS DEX-Ray consists of a tracked handheld probe that integrates a lipstick-size video camera. The camera looks over the probe's tip into the surgical field. The camera's video stream is augmented with coregistered, multimodality 3D graphics and landmarks obtained during neurosurgical planning with 3D workstations. The handheld probe functions as a navigation device to view and point and as an interaction device to adjust the 3D graphics. We tested the system's accuracy in the laboratory and evaluated it intraoperatively with a series of tumor and vascular cases. RESULTS DEX-Ray provided accurate and real-time video-based augmented reality display. The system could be seamlessly integrated into the surgical workflow. The see-through effect revealing 3D information below the surgically exposed surface proved to be of significant value, especially during the macroscopic phase of an operation, providing easily understandable structural navigational information. Navigation in deep and narrow surgical corridors was limited by the camera resolution and light sensitivity. CONCLUSION The system was perceived as an improved navigational experience because the augmented see-through effect allowed direct understanding of the surgical anatomy beyond the visible surface and direct guidance toward surgical targets.
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Affiliation(s)
- Ralf A Kockro
- Department of Neurosurgery, University Hospital Zürich, Zürich, Switzerland.
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Figl M, Rueckert D, Hawkes D, Casula R, Hu M, Pedro O, Zhang DP, Penney G, Bello F, Edwards P. Image guidance for robotic minimally invasive coronary artery bypass. Comput Med Imaging Graph 2010; 34:61-8. [DOI: 10.1016/j.compmedimag.2009.08.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 07/25/2009] [Accepted: 08/07/2009] [Indexed: 11/16/2022]
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Joshi SB, Mendoza DD, Steinberg DH, Goldstein MA, Lopez CF, Raizon A, Weissman G, Satler LF, Pichard AD, Weigold WG. Ultra-Low-Dose Intra-Arterial Contrast Injection for Iliofemoral Computed Tomographic Angiography. JACC Cardiovasc Imaging 2009; 2:1404-11. [DOI: 10.1016/j.jcmg.2009.08.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 07/30/2009] [Accepted: 08/05/2009] [Indexed: 10/20/2022]
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Kurra V, Schoenhagen P, Roselli EE, Kapadia SR, Tuzcu EM, Greenberg R, Akhtar M, Desai MY, Flamm SD, Halliburton SS, Svensson LG, Sola S. Prevalence of significant peripheral artery disease in patients evaluated for percutaneous aortic valve insertion: Preprocedural assessment with multidetector computed tomography. J Thorac Cardiovasc Surg 2009; 137:1258-64. [PMID: 19380001 DOI: 10.1016/j.jtcvs.2008.12.013] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 11/14/2008] [Accepted: 12/19/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Vikram Kurra
- Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Afthinos JN, Latif MJ, Bhora FY, Connery CP, McGinty JJ, Burra A, Attiyeh M, Todd GJ, Belsley SJ. What technical barriers exist for real-time fluoroscopic and video image overlay in robotic surgery? Int J Med Robot 2008; 4:368-72. [DOI: 10.1002/rcs.221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kappert U, Tugtekin SM, Cichon R, Braun M, Matschke K. Robotic totally endoscopic coronary artery bypass: A word of caution implicated by a five-year follow-up. J Thorac Cardiovasc Surg 2008; 135:857-62. [PMID: 18374767 DOI: 10.1016/j.jtcvs.2007.11.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 11/07/2007] [Accepted: 11/13/2007] [Indexed: 11/16/2022]
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Baumhauer M, Feuerstein M, Meinzer HP, Rassweiler J. Navigation in Endoscopic Soft Tissue Surgery: Perspectives and Limitations. J Endourol 2008; 22:751-66. [PMID: 18366319 DOI: 10.1089/end.2007.9827] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Matthias Baumhauer
- Division of Medical and Biological Informatics, German Cancer Research Center, Heidelberg, Germany
| | - Marco Feuerstein
- Computer Aided Medical Procedures (CAMP), Technical University Munich (TUM), Munich, Germany
| | - Hans-Peter Meinzer
- Division of Medical and Biological Informatics, German Cancer Research Center, Heidelberg, Germany
| | - J. Rassweiler
- Department of Urology, Clinic Heilbronn, University of Heidelberg, Heilbronn, Germany
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Bumm K, Federspil PA, Klenzner T, Majdani O, Raczkowsky J, Strauss G, Schipper J. [Update on computer- and mechatronic-assisted head and neck surgery in Germany]. HNO 2008; 56:908-15. [PMID: 18340419 DOI: 10.1007/s00106-008-1697-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A consequence of the ongoing advances in medical navigation is the development of so-called mechatronic assistant systems. Up to now, medical navigation had been used only for additional intrasurgical orientation. But improvements in accuracy in imaging and medical navigation can exceed the surgeon's possible manual accuracy of surgical manipulation. In such cases, mechatronic assistant systems can supplement certain surgical procedures in order to obtain the required precision, such as for positioning of implants. The development and possible use of such mechatronic assistant systems in the head and neck, as well as improvements in the accuracy of medical navigation, are the focus of several working groups. For coordinating and adapting the various research projects, different research groups were called to present their current projects and results in the context of ASKRA (working group for skull-base and craniofacial surgery of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery) workshops at the German Society for Computer- and Robot-Assisted Surgery (CURAC) convention on 14 October 2006 in Hanover. Different projects were presented, with topics including navigated controlled assistant systems for the frontal and lateral skull base, possibilities for sonographic-induced bone measurement, and requirements for high-precision surgery of the skull base.
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Affiliation(s)
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- Universitäts-HNO-Klinik, Düsseldorf, Deutschland
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Feuerstein M, Mussack T, Heining SM, Navab N. Intraoperative laparoscope augmentation for port placement and resection planning in minimally invasive liver resection. IEEE TRANSACTIONS ON MEDICAL IMAGING 2008; 27:355-369. [PMID: 18334431 DOI: 10.1109/tmi.2007.907327] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In recent years, an increasing number of liver tumor indications were treated by minimally invasive laparoscopic resection. Besides the restricted view, two major intraoperative issues in laparoscopic liver resection are the optimal planning of ports as well as the enhanced visualization of (hidden) vessels, which supply the tumorous liver segment and thus need to be divided (e.g., clipped) prior to the resection. We propose an intuitive and precise method to plan the placement of ports. Preoperatively, self-adhesive fiducials are affixed to the patient's skin and a computed tomography (CT) data set is acquired while contrasting the liver vessels. Immediately prior to the intervention, the laparoscope is moved around these fiducials, which are automatically reconstructed to register the patient to its preoperative imaging data set. This enables the simulation of a camera flight through the patient's interior along the laparoscope's or instruments' axes to easily validate potential ports. Intraoperatively, surgeons need to update their surgical planning based on actual patient data after organ deformations mainly caused by application of carbon dioxide pneumoperitoneum. Therefore, preoperative imaging data can hardly be used. Instead, we propose to use an optically tracked mobile C-arm providing cone-beam CT imaging capability intraoperatively. After patient positioning, port placement, and carbon dioxide insufflation, the liver vessels are contrasted and a 3-D volume is reconstructed during patient exhalation. Without any further need for patient registration, the reconstructed volume can be directly augmented on the live laparoscope video, since prior calibration enables both the volume and the laparoscope to be positioned and oriented in the tracking coordinate frame. The augmentation provides the surgeon with advanced visual aid for the localization of veins, arteries, and bile ducts to be divided or sealed.
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Affiliation(s)
- Marco Feuerstein
- Department of Media Science, Graduate School of Information Science, Nagoya University, Nagoya 464-8603, Japan.
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26
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Dervaderics J. [The beginnings of robotic surgery--from the roots up to the da Vinci telemanipulator system]. Orv Hetil 2007; 148:2307-13. [PMID: 18048110 DOI: 10.1556/oh.2007.28225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The history of the robotic surgery is only 22 years old. The article gives a short overview regarding the history of robotics, the surgical robots, the da Vinci telemanipulator system and some further commercial and experimental surgical robotic surgical simulation is also emphasized. Robotic surgery has its own place within the following concepts: 1. computer assisted surgery (CAS), 2. computer integrated surgery (CIS), 3. surgical automation, 4. surgical system integration and 5. artificial intelligence (AI). At the end of the paper there are some important sources of informations regarding robotic surgery.
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Albers J, Schmidt T, Hassfeld S, Heid F, Vahl CF. Sternotomie und Kraniotomie mithilfe autonomer Roboter. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2007. [DOI: 10.1007/s00398-007-0599-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Schoenhagen P, Greenberg RK. 3-Dimensional planning of endovascular procedures with multi-detector computed tomography (MDCT). Int J Cardiovasc Imaging 2007; 24:211-3. [PMID: 17703292 DOI: 10.1007/s10554-007-9254-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 07/18/2007] [Indexed: 11/29/2022]
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Klein MD, Langenburg SE, Kabeer M, Lorincz A, Knight CG. Pediatric Robotic Surgery: Lessons from a Clinical Experience. J Laparoendosc Adv Surg Tech A 2007; 17:265-71. [PMID: 17484664 DOI: 10.1089/lap.2006.0034] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Robotic surgery may improve minimally invasive surgery at high magnification by tremor filtration, motion-scaling, and improved dexterity with the provision of a wrist at the end of the robotic instrument. MATERIALS AND METHODS We chose the Zeus Microwrist robotic surgical system as more applicable to small children than the competing da Vinci surgical system. We attempted 57 surgical procedures and completed 54. RESULTS Completed procedures included Nissen fundoplication (n = 25), cholecystectomy (n = 18), Heller myotomy (n = 2), splenectomy (n = 2), Morgagni hernia repair (n = 2), and single cases of complex pyloroplasty in the chest, bowel resection, left Bochdalek congenital diaphragmatic hernia repair, esophageal atresia and tracheoesophageal fistula repair, and choledochal cyst excision. There were no complications related to the use of the robot. The mean time for the surgeon at the console using the robot was 117 +/- 39 minutes for Nissen fundoplication, and the total operating room time was 250 +/- 60 minutes. Surgeons found dissection, suturing, and knot tying easier than with conventional laparoscopy. None of the surgeons thought the lack of touch feedback (haptics) was crucial. CONCLUSION Robotic surgery offers increased dexterity to the pediatric minimally invasive surgeon, but procedures require more time, and there is no defined patient benefit. The fact that robotic surgery digitalizes minimally invasive surgery creates exciting possibilities for training surgeons, planning operations, and performing surgery at great distances from the operator.
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Affiliation(s)
- Michael D Klein
- Wayne State University School of Medicine and the Maxine and Stuart Frankel Foundation Computer-Assisted Robot-Enhanced Surgery Program, Children's Hospital of Michigan, Detroit, MI 48201, USA.
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30
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Choi SI. Application of Coronary MDCT Angiography for the Evaluation of Coronary Artery Disease. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2007. [DOI: 10.5124/jkma.2007.50.2.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sang Il Choi
- Department of Diagnostic Radiology, Seoul National University College of Medicine, Korea.
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Abstract
Cardiovascular surgery has traditionally been performed through a median sternotomy, allowing the surgeon generous access to the heart and surrounding great vessels. Recently, less invasive methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart, thus resulting in a paradigm shift in cardiac surgery. Originally, long instruments without pivot points were used, however; with the application of robotic telemanipulation systems that allow for improved dexterity, the surgeon is able to perform cardiac surgery from a distance not previously possible. In this rapidly evolving field, this article reviews the recent history and clinical results of robotics in cardiovascular surgery.
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Affiliation(s)
- Alan P Kypson
- Brody School of Medicine, Division of Cardiothoracic and Vascular Surgery, East Carolina University, Life Sciences Building, Room 177, Greenville, NC 27834, USA
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Stein H, Smith JM, Robinson JR, Katz MR. Target Vessel Detection and Coronary Anastomosis Assessment by Intraoperative 12-MHz Ultrasound. Ann Thorac Surg 2006; 82:1078-84. [PMID: 16928542 DOI: 10.1016/j.athoracsur.2006.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 01/05/2006] [Accepted: 03/15/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE Our aim was to assess whether the left internal mammary artery, left anterior descending artery, and anastomosis could be visualized by intraoperative ultrasound for safe graft harvesting, optimal anastomotic target selection, and quality control. DESCRIPTION In 10 patients, the left internal mammary artery, the left anterior descending artery, and the constructed anastomosis were scanned with 12-MHz epicardial ultrasound. Anastomosis quality was assessed on ultrasound and compared with surgeon score. EVALUATION All left internal mammary arteries and left anterior descending arteries could be identified, and pathways could be followed on the ultrasound. Plaque and calcifications were detectable. Deviation from initial coronary anastomotic target was necessary in 2 of 10 patients. None of the constructed anastomoses needed revision. On the anastomotic scans, six anastomoses scored satisfactory and four scored good. CONCLUSIONS Epicardial ultrasound was able to evaluate vessel characteristics and coronary anastomosis patency. This can lead to correction of surgical technique related problems in the operating room, possibly improving graft patency. Further advancements could make epicardial ultrasound a cost effective standard for anastomotic quality control. Applying it during robotic-assisted bypass surgery could make this procedure appropriate for more patients.
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Affiliation(s)
- Hubert Stein
- Intuitive Surgical, Inc, Sunnyvale, California 94086, USA.
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Affiliation(s)
- Timothy P Martens
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY, USA.
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Hayashibe M, Suzuki N, Hashizume M, Konishi K, Hattori A. Robotic surgery setup simulation with the integration of inverse-kinematics computation and medical imaging. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2006; 83:63-72. [PMID: 16828195 DOI: 10.1016/j.cmpb.2006.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 04/03/2006] [Accepted: 04/18/2006] [Indexed: 05/10/2023]
Abstract
At present, there are representative robot operation systems such as da Vinci and ZEUS which have realized minimally invasive surgery by the use of dexterous manipulators. In the operating room, medical staff must prepare and set up an environment in which the robot has optimal freedom of motion and its functions can be fully demonstrated for every case. The range of motion in which the robot can reach and be maneuvered is restricted by the fixed point of the trocar site. We have developed a preoperative planning system with the function of volume rendering of medical images and automatic positioning by applying an inverse-kinematics computation of surgical robot. The motion of a surgical robot can be simulated in advance with the intuitive interface and kinematics computation program running in the background of the system. If robotic surgery planning with volume rendering of DICOM images is possible, the discussion of a surgical plan can be directly made just after the diagnosis considering the patient-specific structure. This kind of setup platform would be essential for the future introduction of surgical robotics into an operating room.
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Affiliation(s)
- Mitsuhiro Hayashibe
- Institute for High Dimensional Medical Imaging, The Jikei University School of Medicine, Izumihoncho, Komae-shi, Tokyo, Japan
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Falk V, Jacobs S, Mohr FWW. Closed-chest, robotically assisted CABG. Multimed Man Cardiothorac Surg 2006; 2006:mmcts.2004.000935. [PMID: 24415523 DOI: 10.1510/mmcts.2004.000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Total endoscopic coronary artery bypass grafting is a robotic assisted procedure to graft the left internal thoracic artery to the left anterior descending coronary artery without opening the chest. Through four 1-cm port incisions the procedure can be performed on the beating heart using a telemanipulation system and an endoscopic vacuum stabilizer to locally immobilize the heart.
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Affiliation(s)
- Volkmar Falk
- Department of Cardiac Surgery, Heartcenter, University of Leipzig, Germany
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