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Huang T, Li R, Li Y, Zhang X, Liao H. Augmented reality-based autostereoscopic surgical visualization system for telesurgery. Int J Comput Assist Radiol Surg 2021; 16:1985-1997. [PMID: 34363583 DOI: 10.1007/s11548-021-02463-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The visualization of remote surgical scenes is the key to realizing the remote operation of surgical robots. However, current non-endoscopic surgical robot systems lack an effective visualization tool to offer sufficient surgical scene information and depth perception. METHODS We propose a novel autostereoscopic surgical visualization system integrating 3D intraoperative scene reconstruction, autostereoscopic 3D display, and augmented reality-based image fusion. The preoperative organ structure and the intraoperative surface point cloud are obtained from medical imaging and the RGB-D camera, respectively, and aligned by an automatic marker-free intraoperative registration algorithm. After registration, preoperative meshes with precalculated illumination and intraoperative textured point cloud are blended in real time. Finally, the fused image is shown on a 3D autostereoscopic display device to achieve depth perception. RESULTS A prototype of the autostereoscopic surgical visualization system was built. The system had a horizontal image resolution of 1.31 mm, a vertical image resolution of 0.82 mm, an average rendering rate of 33.1 FPS, an average registration rate of 20.5 FPS, and average registration errors of approximately 3 mm. A telesurgical robot prototype based on 3D autostereoscopic display was built. The quantitative evaluation experiments showed that our system achieved similar operational accuracy (1.79 ± 0.87 mm) as the conventional system (1.95 ± 0.71 mm), while having advantages in terms of completion time (with 34.11% reduction) and path length (with 35.87% reduction). Post-experimental questionnaires indicated that the system was user-friendly for novices and experts. CONCLUSION We propose a 3D surgical visualization system with augmented instruction and depth perception for telesurgery. The qualitative and quantitative evaluation results illustrate the accuracy and efficiency of the proposed system. Therefore, it shows great prospects in robotic surgery and telesurgery.
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Affiliation(s)
- Tianqi Huang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Ruiyang Li
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Yangxi Li
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xinran Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Hongen Liao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
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Novel anatomical apical dissection utilizing puboprostatic "open-collar" technique: Impact on apical surgical margin and early continence recovery. PLoS One 2021; 16:e0249991. [PMID: 33857230 PMCID: PMC8049266 DOI: 10.1371/journal.pone.0249991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the impact of modifications to anatomical apical dissection including a puboprostatic open-collar technique, which visualizes the lateral aspect of the apex and dorsal vein complex (DVC) covering the rhabdosphincter while preserving the puboprostatic collar, on positive surgical margin (PSM) and continence recovery. Methods One-hundred-and-sixty-seven patients underwent gasless single-port retroperitoneoscopic radical prostatectomy using a three-dimensional head-mounted display system. Sequentially modified surgical techniques comprised puboprostatic open-collar technique, sutureless transection of the DVC, retrograde urethral dissection, and anterior reconstruction. The associations of these modifications with PSM and continence recovery were assessed. Results The puboprostatic open-collar technique, sutureless DVC transection, and retrograde urethral dissection were significantly associated with lower apical PSM (P = 0.003, 0.003, and 0.010, respectively). The former two also showed similar associations in 84 patients with anterior apical tumor (P = 0.021 and 0.030, respectively). Among 92 patients undergoing all of these three procedures, overall and apical PSM rates were 13.0% and 3.3%, respectively. Retrograde urethral dissection (odds ratio [OR] 2.73, P = 0.004) together with nerve sparing (OR 2.77, P = 0.003) and anterior apical tumor (OR 0.45, P = 0.017) were independently associated with immediate continence recovery. A multivariable model for 3-month continence recovery included anterior apical tumor (OR 0.28, P = 0.003) and puboprostatic open-collar technique (OR 3.42, P = 0.062). Immediate and 3-month continence recovery rates were 56.3% and 85.4%, respectively, in 103 patients undergoing both the puboprostatic open-collar technique and retrograde urethral dissection. Conclusion Novel anatomical apical dissection utilizing a puboprostatic open-collar technique may favorably impact on both apical surgical margin and continence recovery.
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Johnson AA, Reidler JS, Speier W, Fuerst B, Wang J, Osgood GM. Visualization of Fluoroscopic Imaging in Orthopedic Surgery: Head-Mounted Display vs Conventional Monitor. Surg Innov 2021; 29:353-359. [PMID: 33517863 DOI: 10.1177/1553350620987978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose. See-through head-mounted displays (HMDs) can be used to view fluoroscopic imaging during orthopedic surgical procedures. The goals of this study were to determine whether HMDs reduce procedure time, number of fluoroscopic images required, or number of head turns by the surgeon compared with standard monitors. Methods. Sixteen orthopedic surgery residents each performed fluoroscopy-guided drilling of 8 holes for placement of tibial nail distal interlocking screws in an anatomical model, with 4 holes drilled while using HMD and 4 holes drilled while using a standard monitor. Procedure time, number of fluoroscopic images needed, and number of head turns by the resident during the procedure were compared between the 2 modalities. Statistical significance was set at P < .05. Results. Mean (SD) procedure time did not differ significantly between attempts using the standard monitor (55 [37] seconds) vs the HMD (56 [31] seconds) (P = .73). Neither did mean number of fluoroscopic images differ significantly between attempts using the standard monitor vs the HMD (9 [5] images for each) (P = .84). Residents turned their heads significantly more times when using the standard monitor (9 [5] times) vs the HMD (1 [2] times) (P < .001). Conclusions. Head-mounted displays lessened the need for residents to turn their heads away from the surgical field while drilling holes for tibial nail distal interlocking screws in an anatomical model; however, there was no difference in terms of procedure time or number of fluoroscopic images needed using the HMD compared with the standard monitor.
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Affiliation(s)
- Alex A Johnson
- The American Sports Medicine Institute, Birmingham, AL, USA
| | - Jay S Reidler
- The Och Spine Hospital at Columbia University, New York, NY, USA
| | - William Speier
- Department of Radiology, 8783University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Jiangxia Wang
- The Johns Hopkins Biostatistics Center, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Greg M Osgood
- Department of Orthopedic Surgery, 1466Johns Hopkins School of Medicine, Baltimore, MD, USA
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Zorzal ER, Campos Gomes JM, Sousa M, Belchior P, da Silva PG, Figueiredo N, Lopes DS, Jorge J. Laparoscopy with augmented reality adaptations. J Biomed Inform 2020; 107:103463. [PMID: 32562897 DOI: 10.1016/j.jbi.2020.103463] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 11/29/2022]
Abstract
One of the most promising applications of Optical See-Through Augmented Reality is minimally laparoscopic surgery, which currently suffers from problems such as surgeon discomfort and fatigue caused by looking at a display positioned outside the surgeon's visual field, made worse by the length of the procedure. This fatigue is especially felt on the surgeon's neck, as it is strained from adopting unnatural postures in order to visualise the laparoscopic video feed. Throughout this paper, we will present work in Augmented Reality, as well as developments in surgery and Augmented Reality applied to both surgery in general and laparoscopy in particular to address these issues. We applied user and task analysis methods to learn about practices performed in the operating room by observing surgeons in their working environment in order to understand, in detail, how they performed their tasks and achieved their intended goals. Drawing on observations and analysis of video recordings of laparoscopic surgeries, we identified relevant constraints and design requirements. Besides proposals to approach the ergonomic issues, we present a design and implementation of a multimodal interface to enhance the laparoscopic procedure. Our method makes it more comfortable for surgeons by allowing them to keep the laparoscopic video in their viewing area regardless of neck posture. Also, our interface makes it possible to access patient imaging data without interrupting the operation. It also makes it possible to communicate with team members through a pointing reticle. We evaluated how surgeons perceived the implemented prototype, in terms of usefulness and usability, via a think-aloud protocol to conduct qualitative evaluation sessions which we describe in detail in this paper. In addition to checking the advantages of the prototype as compared to traditional laparoscopic settings, we also conducted a System Usability Scale questionnaire for measuring its usability, and a NASA Task Load Index questionnaire to rate perceived workload and to assess the prototype effectiveness. Our results show that surgeons consider that our prototype can improve surgeon-to-surgeon communication using head pose as a means of pointing. Also, surgeons believe that our approach can afford a more comfortable posture throughout the surgery and enhance hand-eye coordination, as physicians no longer need to twist their necks to look at screens placed outside the field of operation.
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Affiliation(s)
- Ezequiel Roberto Zorzal
- ICT/UNIFESP, Instituto de Ciência e Tecnologia, Universidade Federal de São Paulo, Brazil; INESC-ID Lisboa, Instituto Superior Técnico, Universidade de Lisboa, Portugal.
| | | | - Maurício Sousa
- INESC-ID Lisboa, Instituto Superior Técnico, Universidade de Lisboa, Portugal; Champalimaud Foundation, Lisbon, Portugal
| | - Pedro Belchior
- INESC-ID Lisboa, Instituto Superior Técnico, Universidade de Lisboa, Portugal
| | | | | | - Daniel Simões Lopes
- INESC-ID Lisboa, Instituto Superior Técnico, Universidade de Lisboa, Portugal
| | - Joaquim Jorge
- INESC-ID Lisboa, Instituto Superior Técnico, Universidade de Lisboa, Portugal.
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Viehöfer AF, Wirth SH, Zimmermann SM, Jaberg L, Dennler C, Fürnstahl P, Farshad M. Augmented reality guided osteotomy in hallux Valgus correction. BMC Musculoskelet Disord 2020; 21:438. [PMID: 32631342 PMCID: PMC7336637 DOI: 10.1186/s12891-020-03373-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background An optimal osteotomy angle avoids shortening of the first metatarsal bone after hallux valgus surgery and therefore reduces the risk of transfer-metatarsalgia. The purpose of the present ex-vivo study was to investigate whether augmented reality (AR) would improve accuracy of the distal osteotomy during hallux valgus surgery. Methods Distal osteotomies of the first metatarsals were performed on a foot model by two surgeons with different levels of surgical experience each with (AR, n = 15 × 2) or without (controls, n = 15 × 2) overlay of a hologram depicting an angle of osteotomy perpendicular to the second metatarsal. Subsequently, the deviation of the osteotomy angle in the transverse plane was analyzed. Results Overall, AR decreased the extent of deviation and the AR guided osteotomies were more accurate (4.9 ± 4.2°) compared to the freehand cuts (6.7 ± 6.1°) by tendency (p = 0.2). However, while the inexperienced surgeon performed more accurate osteotomies with AR with a mean angle of 6.4 ± 3.5° compared to freehand 10.5 ± 5.5° (p = 0.02), no significant difference was noticed for the experienced surgeon with an osteotomy angle of around 3° in both cases. Conclusion This pilot-study suggests that AR guided osteotomies can potentially improve accuracy during hallux valgus correction, particularly for less experienced surgeons.
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Affiliation(s)
- Arnd Fredrik Viehöfer
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland.
| | - Stephan Hermann Wirth
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland.,Computer-Assisted Research and Development Group, Balgrist University Hospital, Zurich, Switzerland
| | - Stefan Michael Zimmermann
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Laurenz Jaberg
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Cyrill Dennler
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Philipp Fürnstahl
- Computer-Assisted Research and Development Group, Balgrist University Hospital, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland
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Clinically node-positive micropapillary bladder cancer in a young female desiring to spare functional bladder and fertility. Int Cancer Conf J 2020; 9:151-154. [PMID: 32582521 DOI: 10.1007/s13691-020-00415-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022] Open
Abstract
A 38-year-old female developing pelvic lymph node recurrence (cN2) of bladder cancer was referred to our hospital. Eighteen months earlier, she had received complete transurethral resection of bladder tumor and pathological diagnosis of muscle-invasive urothelial carcinoma with micropapillary variant had been made. She had declined radical cystectomy or chemoradiation because of a strong desire to spare the bladder and fertility. She received induction gemcitabine/cisplatin therapy. After three cycles, she achieved a clinically complete response. Then, she underwent transumbilical gasless retroperitoneoscopic super-extended pelvic lymph node dissection up to the inferior mesenteric artery trunk using the three-dimensional head-mounted display system. Pathologically, one of 42 resected lymph nodes was positive for metastasis. She is alive with no evidence of disease 5 years after lymph node dissection, retaining functional bladder and normal ovarian functions.
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Bracale U, Merola G, Rizzuto A, Pontecorvi E, Silvestri V, Pignata G, Pirozzi F, Cuccurullo D, Sciuto A, Corcione F. Does a 3D laparoscopic approach improve surgical outcome of mininvasive right colectomy? A retrospective case-control study. Updates Surg 2020; 72:445-451. [PMID: 32232743 DOI: 10.1007/s13304-020-00755-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/20/2020] [Indexed: 12/16/2022]
Abstract
Laparoscopy has gained wide acceptance due its benefits for patients. However, advanced laparoscopic procedures are still challenging. One critical issue is lack of stereoscopic vision. Despite its diffusion, the totally laparoscopic approach for right hemicolectomy (TLRC) is still debated due to its difficulty, particularly for fashioning of the ileocolic anastomosis. The aim of this multicenter study is to investigate whether 3D vision offers any advantages on surgical performance over 2D vision during TLRC. All data of consecutive patients who underwent elective TLRC for cancer at three Italian surgical centers with either 2D or 3D technology from January 2013 to December 2018 were retrieved from a computer-maintained database. A case-matched analysis using the Mantel-Haenszel method was performed. After matching, a total of 106 patients were analyzed with 53 patients in each group. Mean operative time was significantly longer for 2D-TLRC than for 3D-TLRC (153.2 ± 52.4 vs. 131 ± 51 min, p = 0.029) and a statistically significant difference in anastomosing time (p = 0.032, 19.2 ± 5.9 min vs. 21.7 ± 6.2 min for 3D and 2D group, respectively) was also recorded. No difference in the median number of harvested nodes (23 ± 11 vs. 21 ± 7 for 3D and 2D group, respectively; p = 0.48) was found. Neither intraoperative complications nor conversions occurred in the two groups. In conclusion, 3D vision appears to improve the performance of a TLRC by reducing operative time and making intracorporeal anastomosis easier. Prospective randomized studies are required to determine the real beneficial effects.
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Affiliation(s)
- Umberto Bracale
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy.
| | - Giovanni Merola
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy
| | - Antonia Rizzuto
- Medical and Surgical Science, University "Magna Graecia" of Catanzaro Medical School, Catanzaro, Italy
| | - Emanuele Pontecorvi
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy
| | - Vania Silvestri
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy
| | - Giusto Pignata
- Department of General Surgery II, Spedali Civili of Brescia, Brescia, Italy
| | - Felice Pirozzi
- Department of General Surgery, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Diego Cuccurullo
- Department of General Surgery, Ospedali dei Colli Monaldi Hospital, Naples, Italy
| | - Antonio Sciuto
- Department of General Surgery, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Francesco Corcione
- Department of General Surgery and Specialities, School of Medecine Federico II of Naples, Via Pansini 5, 7th Building, Naples, Italy
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Hanani M, Cernat V, Beyer K, Walschus U, Schulze T, Heidecke CD, Patrzyk M. Comparison of a 3D head-mounted display (HMS-3000MT) and 3D passive polarizing display with 2D technique for first laparoscopic inguinal hernia repair by novice surgeons. Hernia 2019; 24:661-668. [PMID: 31745653 DOI: 10.1007/s10029-019-02065-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/27/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Three-dimensional (3D) laparoscopy improves the surgical skills of novice surgeons and positively affects the learning curve in experimental settings. This study aimed to investigate the effect of a 3D passive polarizing display (3DPPD) and a novel 3D head-mounted display (3DHMD; HMS-3000MT) on the performance of the first laparoscopic inguinal hernia repair by novices and compare both systems with standard high-definition 2D (HD2D) laparoscopy. METHODS Patients with symptomatic inguinal hernia underwent transabdominal preperitoneal (TAPP) approach hernia repair using 3DHMD, 3DPPD, or a conventional HD2D laparoscopic system. All surgeries were performed for the first time by three laparoscopically novice surgeons. Operative performance was compared in terms of the time taken for mesh placement and peritoneal suturing under standardized conditions. Additionally, visual perception parameters and adverse effects were assessed. RESULTS The use of both 3D techniques shortened the time required for mesh placement and peritoneal suturing compared with the conventional HD2D approach. Generally, 3D laparoscopy was superior to HD2D laparoscopy in terms of visual perception parameters such as depth perception, sharpness, ghosting, and contrast. However, compared with the use of HD2D laparoscopy, the use of 3DHMD significantly impaired a surgeon's comfort, with the greatest impairment caused by ear discomfort, headaches, and facial and physical discomforts. CONCLUSIONS The 3DHMD and 3DPPD systems showed clear improvement in first hernia repair laparoscopy by novice surgeons in terms of surgical performance, as well as visual perception; however, the 3DHMD system was not superior to the 3DPPD system. The reduction in training time for new surgeons is obviously advantageous. In this respect, the 3D equipment may be a worthwhile investment.
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Affiliation(s)
- M Hanani
- Department of Surgery, Clinic of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - V Cernat
- Department of Surgery, Clinic of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - K Beyer
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - U Walschus
- Department of Surgery, Clinic of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - T Schulze
- Department of Surgery, Clinic of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - C D Heidecke
- Department of Surgery, Clinic of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - M Patrzyk
- Department of Surgery, Clinic of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
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Ma C, Chen G, Zhang X, Ning G, Liao H. Moving-Tolerant Augmented Reality Surgical Navigation System Using Autostereoscopic Three-Dimensional Image Overlay. IEEE J Biomed Health Inform 2019; 23:2483-2493. [DOI: 10.1109/jbhi.2018.2885378] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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10
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Rahman R, Wood ME, Qian L, Price CL, Johnson AA, Osgood GM. Head-Mounted Display Use in Surgery: A Systematic Review. Surg Innov 2019; 27:88-100. [DOI: 10.1177/1553350619871787] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose. We analyzed the literature to determine (1) the surgically relevant applications for which head-mounted display (HMD) use is reported; (2) the types of HMD most commonly reported; and (3) the surgical specialties in which HMD use is reported. Methods. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched through August 27, 2017, for publications describing HMD use during surgically relevant applications. We identified 120 relevant English-language, non-opinion publications for inclusion. HMD types were categorized as “heads-up” (nontransparent HMD display and direct visualization of the real environment), “see-through” (visualization of the HMD display overlaid on the real environment), or “non–see-through” (visualization of only the nontransparent HMD display). Results. HMDs were used for image guidance and augmented reality (70 publications), data display (63 publications), communication (34 publications), and education/training (18 publications). See-through HMDs were described in 55 publications, heads-up HMDs in 41 publications, and non–see-through HMDs in 27 publications. Google Glass, a see-through HMD, was the most frequently used model, reported in 32 publications. The specialties with the highest frequency of published HMD use were urology (20 publications), neurosurgery (17 publications), and unspecified surgical specialty (20 publications). Conclusion. Image guidance and augmented reality were the most commonly reported applications for which HMDs were used. See-through HMDs were the most commonly reported type used in surgically relevant applications. Urology and neurosurgery were the specialties with greatest published HMD use.
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Affiliation(s)
- Rafa Rahman
- The Johns Hopkins University, Baltimore, MD, USA
| | | | - Long Qian
- The Johns Hopkins University, Baltimore, MD, USA
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Al Janabi HF, Aydin A, Palaneer S, Macchione N, Al-Jabir A, Khan MS, Dasgupta P, Ahmed K. Effectiveness of the HoloLens mixed-reality headset in minimally invasive surgery: a simulation-based feasibility study. Surg Endosc 2019; 34:1143-1149. [PMID: 31214807 PMCID: PMC7012955 DOI: 10.1007/s00464-019-06862-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/18/2019] [Indexed: 11/29/2022]
Abstract
Background The advent of Virtual Reality technologies presents new opportunities for enhancing current surgical practice. Studies suggest that current techniques in endoscopic surgery are prone to disturbance of a surgeon’s visual-motor axis, influencing performance, ergonomics and iatrogenic injury rates. The Microsoft® HoloLens is a novel head-mounted display that has not been explored within surgical innovation research. This study aims to evaluate the HoloLens as a potential alternative to conventional monitors in endoscopic surgery. Materials and methods This prospective, observational and comparative study recruited 72 participants consisting of novices (n = 28), intermediate-level (n = 24) and experts (n = 20). Participants performed ureteroscopy, within an inflatable operating environment, using a validated training model and the HoloLens mixed-reality device as a monitor. Novices also completed the assigned task using conventional monitors; whilst the experienced groups did not, due to their extensive familiarity. Outcome measures were procedural completion time and performance evaluation (OSATS) score. A final evaluation survey was distributed amongst all participants. Results The HoloLens facilitated improved outcomes for procedural times (absolute difference, − 73 s; 95% CI − 115 to − 30; P = 0.0011) and OSAT scores (absolute difference, 4.1 points; 95% CI 2.9–5.3; P < 0.0001) compared to conventional monitors. Feedback evaluation demonstrated 97% of participants agreed or strongly agreed that the HoloLens will have a role in surgical education (mean rating, 4.6 of 5; 95% CI 4.5–4.8). Furthermore, 95% of participants agreed or strongly agreed that the HoloLens is feasible to introduce clinically and will have a role within surgery (mean rating, 4.4 of 5; 95% CI 4.2–4.5). Conclusion This study demonstrates that the device facilitated improved outcomes of performance in novices and was widely accepted as a surgical visual aid by all groups. The HoloLens represents a feasible alternative to the conventional setup, possibly by aligning the surgeon’s visual-motor axis.
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Affiliation(s)
- Hasaneen Fathy Al Janabi
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Sharanya Palaneer
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Nicola Macchione
- ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Ahmed Al-Jabir
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK.,Department of Urology, Guy's and St, Thomas' NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK.,Department of Urology, Guy's and St, Thomas' NHS Foundation Trust, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK. .,Department of Urology, King's College Hospital NHS Foundation Trust, London, UK.
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Yoshida S, Maeda T, Yokoyama M, Toide M, Saito K, Fujii Y. Application of eye tracking as a user interface for urological surgery. Int J Urol 2019; 26:680-681. [DOI: 10.1111/iju.13949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Soichiro Yoshida
- Department of Urology Tokyo Medical and Dental University Tokyo Japan
| | - Takeshi Maeda
- Medical Business Group Sony Imaging Products & Solutions Inc. Tokyo Japan
| | - Minato Yokoyama
- Department of Urology Tokyo Medical and Dental University Tokyo Japan
| | - Masahiro Toide
- Department of Urology Tokyo Medical and Dental University Tokyo Japan
| | - Kazutaka Saito
- Department of Urology Tokyo Medical and Dental University Tokyo Japan
| | - Yasuhisa Fujii
- Department of Urology Tokyo Medical and Dental University Tokyo Japan
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Kim CH, Ryu SY, Yoon JY, Lee HK, Choi NG, Park IH, Choi HY. See-Through Type 3D Head-Mounted Display-Based Surgical Microscope System for Microsurgery: A Feasibility Study. JMIR Mhealth Uhealth 2019; 7:e11251. [PMID: 30843867 PMCID: PMC6427099 DOI: 10.2196/11251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/26/2018] [Accepted: 11/13/2018] [Indexed: 12/26/2022] Open
Abstract
Background The surgical microscope is used primarily for microsurgeries, which are more complicated than other surgical procedures and require delicate tasks for a long time. Therefore, during these surgical procedures, surgeons experience back and neck pain. To solve this problem, new technology, such as wearable displays, is required to help surgeons maintain comfortable postures and enjoy advanced functionality during microsurgery. Objective The objective of this study was to develop a surgical microscope system that would work with wearable devices. It would include a head-mounted display (HMD) that can offer 3D surgical images and allow a flexible and comfortable posture instead of fixed eyepieces of surgical microscope and can also provide peripheral visual field with its optical see-through function. Methods We designed and fabricated a surgical microscope system that incorporates a see-through type 3D HMD, and we developed an image processing software to provide better image quality. The usability of the proposed system was confirmed with preclinical examination. Seven ENT (ear, nose, and throat) surgical specialists and 8 residents performed a mock surgery—axillary lymph node dissection on a rat. They alternated between looking through the eyepieces of the surgical microscope and viewing a 3D HMD screen connected to the surgical microscope. We examined the success of the surgery and asked the specialists and residents to grade eye fatigue on a scale of 0 (none) to 6 (severe) and posture discomfort on a scale of 1 (none) to 5 (severe). Furthermore, a statistical comparison was performed using 2-tailed paired t test, and P=.00083 was considered significant. Results Although 3D HMD case showed a slightly better result regarding visual discomfort (P=.097), the average eye fatigue was not significantly different between eyepiece and 3D HMD cases (P=.79). However, the average posture discomfort, especially in neck and shoulder, was lower with 3D HMD display use than with eyepiece use (P=.00083). Conclusions We developed a see-through type 3D HMD–based surgical microscope system and showed through preclinical testing that the system could help reduce posture discomfort. The proposed system, with its advanced functions, could be a promising new technique for microsurgery.
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Affiliation(s)
- Cheol-Hwan Kim
- Institute of Advanced Convergence Technology, Kyungpook National University, Daegu, Republic of Korea
| | - Seon-Young Ryu
- Department of Creative IT Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Ji-Young Yoon
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Republic of Korea
| | - Hyoung-Kwon Lee
- Research Laboratory, Green Optics CO, Cheongju, Republic of Korea
| | - Nak-Gu Choi
- Research Lab, Hulust CO, Wonju, Republic of Korea
| | - Il-Ho Park
- Department of Otorhinolaryngology, Korea University Medical College, Seoul, Republic of Korea
| | - Hae-Young Choi
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Republic of Korea
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The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018. Surg Endosc 2018. [PMID: 30515610 DOI: 10.1007/s00464-018-06612-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND The use of 3D laparoscopic systems is expanding. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS Systematic reviews of the PubMed and Embase libraries were performed to identify evidence on potential benefits of 3D on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by an international surgical and engineering expert panel which were presented and voted at the EAES annual congress, London, May 2018. RESULTS 9967 abstracts were screened with 138 articles included. 18 statements and two recommendations were generated and approved. 3D significantly shortened operative time (mean difference 11 min (8% [95% CI 20.29-1.72], I2 96%)). A significant reduction in complications was observed when 3D systems were used (RR 0.75, [95 CI% 0.60-0.94], I2 0%) particularly for cases involving laparoscopic suturing (RR 0.57 [95% CI 0.35-0.90], I2 0%). In 69 box trainer or simulator studies, 64% concluded trainees were significant faster and 62% performed fewer errors when using 3D. CONCLUSION We recommend the use of 3D vision in laparoscopy to reduce the operative time (grade of recommendation: low). Future robust clinical research is required to specifically investigate the potential benefit of 3D laparoscopy system on complication rates (grade of recommendation: high).
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Arezzo A, Vettoretto N, Francis NK, Bonino MA, Curtis NJ, Amparore D, Arolfo S, Barberio M, Boni L, Brodie R, Bouvy N, Cassinotti E, Carus T, Checcucci E, Custers P, Diana M, Jansen M, Jaspers J, Marom G, Momose K, Müller-Stich BP, Nakajima K, Nickel F, Perretta S, Porpiglia F, Sánchez-Margallo F, Sánchez-Margallo JA, Schijven M, Silecchia G, Passera R, Mintz Y. The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018. Surg Endosc 2018; 33:3251-3274. [PMID: 30515610 DOI: 10.1007/s00464-018-06612-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of 3D laparoscopic systems is expanding. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS Systematic reviews of the PubMed and Embase libraries were performed to identify evidence on potential benefits of 3D on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by an international surgical and engineering expert panel which were presented and voted at the EAES annual congress, London, May 2018. RESULTS 9967 abstracts were screened with 138 articles included. 18 statements and two recommendations were generated and approved. 3D significantly shortened operative time (mean difference 11 min (8% [95% CI 20.29-1.72], I2 96%)). A significant reduction in complications was observed when 3D systems were used (RR 0.75, [95 CI% 0.60-0.94], I2 0%) particularly for cases involving laparoscopic suturing (RR 0.57 [95% CI 0.35-0.90], I2 0%). In 69 box trainer or simulator studies, 64% concluded trainees were significant faster and 62% performed fewer errors when using 3D. CONCLUSION We recommend the use of 3D vision in laparoscopy to reduce the operative time (grade of recommendation: low). Future robust clinical research is required to specifically investigate the potential benefit of 3D laparoscopy system on complication rates (grade of recommendation: high).
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Affiliation(s)
- Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy.
| | - Nereo Vettoretto
- Montichiari Surgery, ASST Spedali Civili Brescia, Montichiari, Italy
| | - Nader K Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK
| | - Marco Augusto Bonino
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Nathan J Curtis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK.,Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - Daniele Amparore
- Division of Urology, ESUT Research Group, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | - Simone Arolfo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Manuel Barberio
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Cà Granda, Policlinico Hospital, University of Milan, Milan, Italy
| | - Ronit Brodie
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nicole Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Cà Granda, Policlinico Hospital, University of Milan, Milan, Italy
| | - Thomas Carus
- Department of Surgery, Center for Minimally Invasive Surgery, Asklepios Westklinikum Hamburg, Hamburg, Germany
| | - Enrico Checcucci
- Division of Urology, ESUT Research Group, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | - Petra Custers
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Marilou Jansen
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Joris Jaspers
- Department of Medical Technology and Clinical Physics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Gadi Marom
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Kota Momose
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Beat P Müller-Stich
- General-, Visceral-and Transplant Surgery, University of Heidelberg Hospital, Heidelberg, Germany
| | - Kyokazu Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Felix Nickel
- General-, Visceral-and Transplant Surgery, University of Heidelberg Hospital, Heidelberg, Germany
| | - Silvana Perretta
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Francesco Porpiglia
- Division of Urology, ESUT Research Group, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | | | | | - Marlies Schijven
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | - Roberto Passera
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Yoav Mintz
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Randomized study of the influence of two-dimensional versus three-dimensional imaging using a novel 3D head-mounted display (HMS-3000MT) on performance of laparoscopic inguinal hernia repair. Surg Endosc 2018; 32:4624-4631. [PMID: 29777354 DOI: 10.1007/s00464-018-6215-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND 3D laparoscopy has proven to be superior to the 2D approach in experimental settings. The aim of the present study was to investigate the influence of 3D laparoscopy using a novel head-mounted display on the performance of defined steps within a laparoscopic inguinal hernia repair. This effect was investigated both in laparoscopically advanced surgeons and in beginners. METHODS Patients suffering from symptomatic inguinal hernia were randomly assigned to laparoscopic hernia repair using either a head-mounted 3D display or a conventional 2D laparoscopic approach. Operative performance of both groups was compared in terms of the time taken for mesh placement and for peritoneal suturing. Additionally, quality of imaging and physical discomfort were assessed. RESULTS The use of a head-mounted 3D display was able to shorten the time required for placement of the mesh as well as that for peritoneal suturing, both for experienced and novice surgeons when compared to the conventional 2D approach. 3D laparoscopy was significantly superior to 2D laparoscopy in terms of depth perception, image sharpness and image contrast. Additionally, increased impairment caused by ghosting effects could not be detected in 3D laparoscopy. Evaluation of image quality was independent of experience in laparoscopic surgery. However, use of a head-mounted 3D display resulted in a significant impairment of surgeon's comfort when compared to 2D laparoscopy. Thereby, the greatest impairment was caused by ear discomfort. CONCLUSIONS This is the first study examining the effect of a head-mounted 3D system on the performance of laparoscopy in a randomized controlled trial (RCT) showing a clear advantage of this system in surgical performance as well as in depth perception and image quality.
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Yoon JW, Chen RE, Kim EJ, Akinduro OO, Kerezoudis P, Han PK, Si P, Freeman WD, Diaz RJ, Komotar RJ, Pirris SM, Brown BL, Bydon M, Wang MY, Wharen RE, Quinones-Hinojosa A. Augmented reality for the surgeon: Systematic review. Int J Med Robot 2018; 14:e1914. [DOI: 10.1002/rcs.1914] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Jang W. Yoon
- Department of Neurological Surgery; Mayo Clinic; Jacksonville Florida USA
| | - Robert E. Chen
- Emory University School of Medicine; Atlanta Georgia USA
- Georgia Institute of Technology; Atlanta Georgia USA
| | | | | | | | | | - Phong Si
- Georgia Institute of Technology; Atlanta Georgia USA
| | | | - Roberto J. Diaz
- Department of Neurosurgery and Neurology; Montreal Neurological Institute and Hospital, McGill University; Montreal Quebec Canada
| | - Ricardo J. Komotar
- Department of Neurological Surgery; University of Miami Miller School of Medicine, University of Miami Hospital, University of Miami Brain Tumor Initiative; Miami Florida USA
| | - Stephen M. Pirris
- Department of Neurological Surgery; Mayo Clinic; Jacksonville Florida USA
- St. Vincent's Spine and Brain Institute; Jacksonville Florida USA
| | - Benjamin L. Brown
- Department of Neurological Surgery; Mayo Clinic; Jacksonville Florida USA
| | - Mohamad Bydon
- Department of Neurological Surgery; Mayo Clinic; Rochester Minnesota USA
| | - Michael Y. Wang
- Department of Neurological Surgery; University of Miami Miller School of Medicine, University of Miami Hospital, University of Miami Brain Tumor Initiative; Miami Florida USA
| | - Robert E. Wharen
- Department of Neurological Surgery; Mayo Clinic; Jacksonville Florida USA
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Zhang X, Chen G, Liao H. High-Quality See-Through Surgical Guidance System Using Enhanced 3-D Autostereoscopic Augmented Reality. IEEE Trans Biomed Eng 2017; 64:1815-1825. [DOI: 10.1109/tbme.2016.2624632] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Baum S, Sillem M, Ney JT, Baum A, Friedrich M, Radosa J, Kramer KM, Gronwald B, Gottschling S, Solomayer EF, Rody A, Joukhadar R. What Are the Advantages of 3D Cameras in Gynaecological Laparoscopy? Geburtshilfe Frauenheilkd 2017; 77:45-51. [PMID: 28190888 DOI: 10.1055/s-0042-120845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction Minimally invasive operative techniques are being used increasingly in gynaecological surgery. The expansion of the laparoscopic operation spectrum is in part the result of improved imaging. This study investigates the practical advantages of using 3D cameras in routine surgical practice. Materials and Methods Two different 3-dimensional camera systems were compared with a 2-dimensional HD system; the operating surgeon's experiences were documented immediately postoperatively using a questionnaire. Results Significant advantages were reported for suturing and cutting of anatomical structures when using the 3D compared to 2D camera systems. There was only a slight advantage for coagulating. The use of 3D cameras significantly improved the general operative visibility and in particular the representation of spacial depth compared to 2-dimensional images. There was not a significant advantage for image width. Depiction of adhesions and retroperitoneal neural structures was significantly improved by the stereoscopic cameras, though this did not apply to blood vessels, ureter, uterus or ovaries. Conclusion 3-dimensional cameras were particularly advantageous for the depiction of fine anatomical structures due to improved spacial depth representation compared to 2D systems. 3D cameras provide the operating surgeon with a monitor image that more closely resembles actual anatomy, thus simplifying laparoscopic procedures.
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Affiliation(s)
- S Baum
- Klinik für Frauenheilkunde und Geburtshilfe, UKSH Klinik für Frauenheilkunde und Geburtshilfe Campus Lübeck, Lübeck, Germany; Universitätsklinikum des Saarlandes, Klinik für Frauenheilkunde und Geburtshilfe, Homburg/Saar, Germany
| | - M Sillem
- Praxisklinik am Rosengarten, Mannheim, Germany
| | - J T Ney
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - A Baum
- Praxis Prof. Dr. Dhom & Partner, Ludwigshafen, Germany
| | - M Friedrich
- Frauenklinik, HELIOS-Klinikum Krefeld, Krefeld, Germany
| | - J Radosa
- Universitätsklinikum des Saarlandes, Klinik für Frauenheilkunde und Geburtshilfe, Homburg/Saar, Germany
| | - K M Kramer
- Viszera Chirurgie-Zentrum, Munich, Germany
| | - B Gronwald
- Zentrum für Palliativmedizin und Kinderschmerztherapie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - S Gottschling
- Universitätsklinikum des Saarlandes, Zentrum für Palliativmedizin und Kinderschmerztherapie, Homburg/Saar
| | - E F Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - A Rody
- Klinik für Frauenheilkunde und Geburtshilfe, UKSH Klinik für Frauenheilkunde und Geburtshilfe Campus Lübeck, Lübeck, Germany
| | - R Joukhadar
- Universitätsfrauenklinik Würzburg, Würzburg, Germany
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Kolodzey L, Grantcharov PD, Rivas H, Schijven MP, Grantcharov TP. Wearable technology in the operating room: a systematic review. ACTA ACUST UNITED AC 2016. [DOI: 10.1136/bmjinnov-2016-000133] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Retroperitoneal Teratoma in an Adult: A Potential Pitfall in the Differential Diagnosis of Adrenal Myelolipoma. Case Rep Urol 2016; 2016:5141769. [PMID: 27840764 PMCID: PMC5093286 DOI: 10.1155/2016/5141769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/03/2016] [Indexed: 11/23/2022] Open
Abstract
We report a 32-year-old female case of a right adrenal gland mass detected on CT scan at medical checkup. CT and MRI showed a mass of 5.1 cm made of fat and calcification in the right adrenal gland, leading to the clinical diagnosis of adrenal myelolipoma. Because of its relatively large size and the patient's desire, the patient underwent gasless single-port retroperitoneoscopic adrenalectomy using the RoboSurgeon system. Histopathological examination revealed that the cystic tumor is composed of keratinized epidermis, mature fat, nerve, cartilage, bone, and sebaceous glands compressing the normal adrenal gland, leading to the diagnosis of retroperitoneal mature cystic teratoma. The patient remains free of recurrence 29 months after surgery. Retroperitoneal teratoma is relatively rare but clinically important because of high possibility of malignancy. In a case of an adrenal mass difficult to clinically distinguish retroperitoneal teratoma from adrenal myelolipoma, surgical resection via a minimally invasive approach would be the best therapeutic option.
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Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography. Sci Rep 2016; 6:31689. [PMID: 27538478 PMCID: PMC4990849 DOI: 10.1038/srep31689] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/25/2016] [Indexed: 02/07/2023] Open
Abstract
Minimally-invasive microsurgery has resulted in improved outcomes for patients. However, operating through a microscope limits depth perception and fixes the visual perspective, which result in a steep learning curve to achieve microsurgical proficiency. We introduce a surgical imaging system employing four-dimensional (live volumetric imaging through time) microscope-integrated optical coherence tomography (4D MIOCT) capable of imaging at up to 10 volumes per second to visualize human microsurgery. A custom stereoscopic heads-up display provides real-time interactive volumetric feedback to the surgeon. We report that 4D MIOCT enhanced suturing accuracy and control of instrument positioning in mock surgical trials involving 17 ophthalmic surgeons. Additionally, 4D MIOCT imaging was performed in 48 human eye surgeries and was demonstrated to successfully visualize the pathology of interest in concordance with preoperative diagnosis in 93% of retinal surgeries and the surgical site of interest in 100% of anterior segment surgeries. In vivo 4D MIOCT imaging revealed sub-surface pathologic structures and instrument-induced lesions that were invisible through the operating microscope during standard surgical maneuvers. In select cases, 4D MIOCT guidance was necessary to resolve such lesions and prevent post-operative complications. Our novel surgical visualization platform achieves surgeon-interactive 4D visualization of live surgery which could expand the surgeon’s capabilities.
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Shen L, Carrasco-Zevallos O, Keller B, Viehland C, Waterman G, Hahn PS, Kuo AN, Toth CA, Izatt JA. Novel microscope-integrated stereoscopic heads-up display for intrasurgical optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2016; 7:1711-26. [PMID: 27231616 PMCID: PMC4871076 DOI: 10.1364/boe.7.001711] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 05/22/2023]
Abstract
Intra-operative optical coherence tomography (OCT) requires a display technology which allows surgeons to visualize OCT data without disrupting surgery. Previous research and commercial intrasurgical OCT systems have integrated heads-up display (HUD) systems into surgical microscopes to provide monoscopic viewing of OCT data through one microscope ocular. To take full advantage of our previously reported real-time volumetric microscope-integrated OCT (4D MIOCT) system, we describe a stereoscopic HUD which projects a stereo pair of OCT volume renderings into both oculars simultaneously. The stereoscopic HUD uses a novel optical design employing spatial multiplexing to project dual OCT volume renderings utilizing a single micro-display. The optical performance of the surgical microscope with the HUD was quantitatively characterized and the addition of the HUD was found not to substantially effect the resolution, field of view, or pincushion distortion of the operating microscope. In a pilot depth perception subject study, five ophthalmic surgeons completed a pre-set dexterity task with 50.0% (SD = 37.3%) higher success rate and in 35.0% (SD = 24.8%) less time on average with stereoscopic OCT vision compared to monoscopic OCT vision. Preliminary experience using the HUD in 40 vitreo-retinal human surgeries by five ophthalmic surgeons is reported, in which all surgeons reported that the HUD did not alter their normal view of surgery and that live surgical maneuvers were readily visible in displayed stereoscopic OCT volumes.
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Affiliation(s)
- Liangbo Shen
- Duke University, Dept. of Biomedical Engineering, Durham, NC, 27708, USA
| | | | - Brenton Keller
- Duke University, Dept. of Biomedical Engineering, Durham, NC, 27708, USA
| | - Christian Viehland
- Duke University, Dept. of Biomedical Engineering, Durham, NC, 27708, USA
| | - Gar Waterman
- Duke University, Dept. of Biomedical Engineering, Durham, NC, 27708, USA
| | - Paul S. Hahn
- Duke University Medical Center, Dept. of Ophthalmology, Durham, NC, 27710, USA
| | - Anthony N. Kuo
- Duke University Medical Center, Dept. of Ophthalmology, Durham, NC, 27710, USA
| | - Cynthia A. Toth
- Duke University, Dept. of Biomedical Engineering, Durham, NC, 27708, USA
- Duke University Medical Center, Dept. of Ophthalmology, Durham, NC, 27710, USA
| | - Joseph A. Izatt
- Duke University, Dept. of Biomedical Engineering, Durham, NC, 27708, USA
- Duke University Medical Center, Dept. of Ophthalmology, Durham, NC, 27710, USA
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Nakayama T, Numao N, Yoshida S, Ishioka J, Matsuoka Y, Saito K, Fujii Y, Kihara K. A novel interactive educational system in the operating room--the IE system. BMC MEDICAL EDUCATION 2016; 16:44. [PMID: 26842063 PMCID: PMC4738794 DOI: 10.1186/s12909-016-0561-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 01/26/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The shortage of surgeon is one of the serious problems in Japan. To solve the problem, various efforts have been undertaken to improve surgical education and training. However, appropriate teaching methods in the operating room have not been well established. The aim of this study is to assess the utility of a novel interactive educational (IE) system for surgical education on urologic surgeries in the operating room. METHODS A total of 20 Japanese medical students were educated on urologic surgery using the IE system in the operating room. The IE system consists of two parts. The first is three-dimensional (3D) magnified vision of the operative field using a 3D head-mounted display and a 3D endoscope. The second is interactive educative communication between medical students and surgeons using a small-sized wireless communication device. The satisfaction level with the IE system and the physical burden on medical students was examined via questionnaire. RESULTS All students utilized the IE system in urologic surgery and responded to the survey. Most students were satisfied with the IE system. They also felt more welcomed by the surgeon when using the IE system than when not using it. No major unpleasant symptoms were observed but five students (25 %) experienced mild eye fatigue as a result of viewing the medical images. CONCLUSIONS The IE system has the potential to motivate students to become interested in surgery and could be an efficient method of surgical education in the operating room.
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Affiliation(s)
- Takayuki Nakayama
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Noboru Numao
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
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Mondal SB, Gao S, Zhu N, Sudlow GP, Liang K, Som A, Akers WJ, Fields RC, Margenthaler J, Liang R, Gruev V, Achilefu S. Binocular Goggle Augmented Imaging and Navigation System provides real-time fluorescence image guidance for tumor resection and sentinel lymph node mapping. Sci Rep 2015; 5:12117. [PMID: 26179014 PMCID: PMC4503986 DOI: 10.1038/srep12117] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/01/2015] [Indexed: 12/21/2022] Open
Abstract
The inability to identify microscopic tumors and assess surgical margins in real-time during oncologic surgery leads to incomplete tumor removal, increases the chances of tumor recurrence, and necessitates costly repeat surgery. To overcome these challenges, we have developed a wearable goggle augmented imaging and navigation system (GAINS) that can provide accurate intraoperative visualization of tumors and sentinel lymph nodes in real-time without disrupting normal surgical workflow. GAINS projects both near-infrared fluorescence from tumors and the natural color images of tissue onto a head-mounted display without latency. Aided by tumor-targeted contrast agents, the system detected tumors in subcutaneous and metastatic mouse models with high accuracy (sensitivity = 100%, specificity = 98% ± 5% standard deviation). Human pilot studies in breast cancer and melanoma patients using a near-infrared dye show that the GAINS detected sentinel lymph nodes with 100% sensitivity. Clinical use of the GAINS to guide tumor resection and sentinel lymph node mapping promises to improve surgical outcomes, reduce rates of repeat surgery, and improve the accuracy of cancer staging.
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Affiliation(s)
- Suman B Mondal
- 1] Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA [2] Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
| | - Shengkui Gao
- Department of Computer Science and Engineering, Washington University, St. Louis, MO, USA
| | - Nan Zhu
- College of Optical Sciences, The University of Arizona, Tuscon, AZ, USA
| | - Gail P Sudlow
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kexian Liang
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Avik Som
- 1] Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA [2] Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
| | - Walter J Akers
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital, and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie Margenthaler
- Department of Surgery, Barnes-Jewish Hospital, and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Rongguang Liang
- College of Optical Sciences, The University of Arizona, Tuscon, AZ, USA
| | - Viktor Gruev
- Department of Computer Science and Engineering, Washington University, St. Louis, MO, USA
| | - Samuel Achilefu
- 1] Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA [2] Department of Biomedical Engineering, Washington University, St. Louis, MO, USA [3] Department of Biochemistry &Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA
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26
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Yoshida S, Kihara K, Fukuyo T, Ishioka J, Saito K, Fujii Y. Novel three-dimensional image system for transurethral surgery. Int J Urol 2015; 22:714-5. [PMID: 25881683 DOI: 10.1111/iju.12768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/21/2015] [Accepted: 02/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
| | | | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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27
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Sørensen SMD, Savran MM, Konge L, Bjerrum F. Three-dimensional versus two-dimensional vision in laparoscopy: a systematic review. Surg Endosc 2015; 30:11-23. [PMID: 25840896 DOI: 10.1007/s00464-015-4189-7] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/23/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Laparoscopic surgery is widely used, and results in accelerated patient recovery time and hospital stay were compared with laparotomy. However, laparoscopic surgery is more challenging compared with open surgery, in part because surgeons must operate in a three-dimensional (3D) space through a two-dimensional (2D) projection on a monitor, which results in loss of depth perception. To counter this problem, 3D imaging for laparoscopy was developed. A systematic review of the literature was performed to assess the effect of 3D laparoscopy. METHODS A systematic search of the literature was conducted to identify randomized controlled trials that compared 3D with 2D laparoscopy. The search was accomplished in accordance with the PRISMA guidelines using the PubMed, EMBASE, and The Cochrane Library electronic databases. No language or year of publication restrictions was applied. Data extracted were cohort size and characteristics, skill trained or operation performed, instrument used, outcome measures, and conclusions. Two independent authors performed the search and data extraction. RESULTS Three hundred and forty articles were screened for eligibility, and 31 RCTs were included in the review. Three trials were carried out in a clinical setting, and 28 trials used a simulated setting. Time was used as an outcome measure in all of the trials, and number of errors was used in 19 out of 31 trials. Twenty-two out of 31 trials (71%) showed a reduction in performance time, and 12 out of 19 (63%) showed a significant reduction in error when using 3D compared to 2D. CONCLUSIONS Overall, 3D laparoscopy appears to improve speed and reduce the number of performance errors when compared to 2D laparoscopy. Most studies to date assessed 3D laparoscopy in simulated settings, and the impact of 3D laparoscopy on clinical outcomes has yet to be examined.
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Affiliation(s)
- Stine Maya Dreier Sørensen
- Centre for Clinical Education, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region, Denmark.
| | - Mona Meral Savran
- Centre for Clinical Education, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region, Denmark
| | - Lars Konge
- Centre for Clinical Education, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region, Denmark
| | - Flemming Bjerrum
- Department of Gynecology, The Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Yoshida S, Fukui N, Saito K, Fujii Y, Kageyama Y, Kihara K. Novel image monitoring system using a head-mounted display for assistants in da Vinci surgery. Int J Urol 2015; 22:520-1. [DOI: 10.1111/iju.12735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/03/2015] [Accepted: 01/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Soichiro Yoshida
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo and
| | - Naotaka Fukui
- Department of Urology; Saitama Cancer Center; Saitama Japan
| | - Kazutaka Saito
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo and
| | - Yasuhisa Fujii
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo and
| | - Yukio Kageyama
- Department of Urology; Saitama Cancer Center; Saitama Japan
| | - Kazunori Kihara
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo and
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Kihara K, Koga F, Fujii Y, Masuda H, Tatokoro M, Yokoyama M, Matsuoka Y, Numao N, Ishioka J, Saito K. Gasless laparoendoscopic single-port clampless sutureless partial nephrectomy for peripheral renal tumors: Perioperative outcomes. Int J Urol 2015; 22:349-55. [DOI: 10.1111/iju.12687] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 10/19/2014] [Accepted: 11/04/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Kazunori Kihara
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Fumitaka Koga
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Yasuhisa Fujii
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Hitoshi Masuda
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Manabu Tatokoro
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Minato Yokoyama
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Yoh Matsuoka
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Noboru Numao
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Junichiro Ishioka
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Kazutaka Saito
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
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30
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Ito M, Kihara K, Yoshida S, Tatokoro M, Yokoyama M, Ishioka J, Matsuoka Y, Numao N, Saito K, Fujii Y. Patient's Self-monitoring of Transurethral Surgical Images Using a Head-mounted Display. Urol Case Rep 2015; 3:27-9. [PMID: 26793491 PMCID: PMC4714270 DOI: 10.1016/j.eucr.2014.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022] Open
Abstract
We present an application of head-mounted display (HMD) to patient's self-monitoring of transurethral resection of bladder tumor (TURB). Six patients wore the HMD as an imaging monitor to view the operation in real-time during their TURB. Following the operation, the patients completed a questionnaire that evaluates understanding of the state of their disease and satisfaction with the HMD. As a result, monitoring the operation in real time through the HMD helped to increase patients' understanding of the state of their disease and satisfaction. For selected patients, the use of HMD could help to increase the patient's understanding of their disease.
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Affiliation(s)
- Masaya Ito
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Manabu Tatokoro
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Noboru Numao
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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31
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Inoue M, Kihara K, Yoshida S, Ito M, Takeshita H, Ishioka J, Matsuoka Y, Numao N, Saito K, Fujii Y. A novel approach to patient self-monitoring of sonographic examinations using a head-mounted display. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:29-35. [PMID: 25542936 DOI: 10.7863/ultra.34.1.29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Patients' use of a head-mounted display during their sonographic examinations could provide them with information about their diseases in real time and might help improve "patient-centered care." We conducted this prospective study to evaluate the feasibility of a modern head-mounted display for patient self-monitoring of sonographic examinations. METHODS In November and December 2013, 58 patients were enrolled. Patients wore a head-mounted display (HMZ-T2; Sony Corporation, Tokyo, Japan) during their sonographic examinations and watched their own images in real time. After the sonographic examinations, the patients completed a questionnaire, in which they evaluated the utility of the head-mounted display, their understanding of their diseases, their satisfaction with using the head-mounted display, and any adverse events. Until November 26, 2013, patients' names were requested on the questionnaire; after that date, the questionnaire was changed to be anonymous. RESULTS Of the 58 patients, 56 (97%) elected to participate in this study. The head-mounted display was reported to have good image quality by 42 patients (75%) and good wearability by 39 (70%). Thirty-six patients (64%) reported they had deepened their understanding of their diseases. There were no major complications, and only 2 patients (4%) had mild eye fatigue. There was no significant association between questionnaire results and patient characteristics. None of the questionnaire results changed significantly after the questionnaire was made anonymous. CONCLUSIONS The use of a modern head-mounted display by patients during sonographic examinations provided good image quality with acceptable wearability. It could deepen their understanding of their diseases and help develop patient-centered care.
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Affiliation(s)
- Masaharu Inoue
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.).
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Masaya Ito
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Hideki Takeshita
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Noboru Numao
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
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32
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Ishioka J, Kihara K, Higuchi S, Nakayama T, Takeshita H, Yoshida S, Nakanishi Y, Kijima T, Matsuoka Y, Numao N, Saito K, Fujii Y. New head-mounted display system applied to endoscopic management of upper urinary tract carcinomas. Int Braz J Urol 2014; 40:842-5. [DOI: 10.1590/s1677-5538.ibju.2014.06.17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/06/2014] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | - Saori Higuchi
- Tokyo Medical and Dental University Graduate School, Japan
| | | | | | | | | | - Toshiki Kijima
- Tokyo Medical and Dental University Graduate School, Japan
| | - Yoh Matsuoka
- Tokyo Medical and Dental University Graduate School, Japan
| | - Noboru Numao
- Tokyo Medical and Dental University Graduate School, Japan
| | - Kazutaka Saito
- Tokyo Medical and Dental University Graduate School, Japan
| | - Yasuhisa Fujii
- Tokyo Medical and Dental University Graduate School, Japan
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33
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Tadano K, Kawashima K. A pneumatic laparoscope holder controlled by head movement. Int J Med Robot 2014; 11:331-340. [PMID: 25156175 DOI: 10.1002/rcs.1606] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND In traditional laparoscopic surgery, the laparoscope is handled by a camera assistant according to verbal instructions from the surgeon. Thus there is a strong need for a laparoscope holder who intuitively provides the appropriate view with excellent stability. METHODS A pneumatically driven robotic arm was developed to hold and manipulate a laparoscope. The robotic arm is operated by the user's head movement, which is measured with gyroscopes attached to the operator's head and body. RESULTS We confirmed experimentally that head tracking can be performed accurately using the proposed method. The experimental results indicated that the robotic camera holder has sufficient dynamic characteristics to quickly follow the operator's head movement. CONCLUSIONS A laparoscope holder control system has been developed. In this system, a laparoscope is held by a pneumatically driven robotic arm that is controlled to follow the operator's head movement. The experimental results prove the effectiveness of the system. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Kotaro Tadano
- Precision and Intelligence Laboratory, Tokyo Institute of Technology, 4259 Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa, 226-8503, Japan
| | - Kenji Kawashima
- Precision and Intelligence Laboratory, Tokyo Institute of Technology, 4259 Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa, 226-8503, Japan
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34
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Yoshida S, Kihara K, Takeshita H, Nakanishi Y, Kijima T, Ishioka J, Matsuoka Y, Numao N, Saito K, Fujii Y. Head-Mounted Display for a Personal Integrated Image Monitoring System: Ureteral Stent Placement. Urol Int 2014; 94:117-20. [DOI: 10.1159/000356987] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/28/2013] [Indexed: 11/19/2022]
Abstract
The personal head-mounted display (HMD) has emerged as a novel image monitoring system. We present here the application of a high-definition organic electroluminescent binocular HMD in ureteral stent placement. Our HMD system displayed multiple forms of information such as integrated, sharp, high-contrast images using a four-split screen or a picture-in-picture technique both seamlessly and synchronously. When both the operator and the assistant wore an HMD, they could continuously and simultaneously monitor the cystoscopic and fluoroscopic images in an ergonomically natural position. Furthermore, each participant was able to modulate the displayed images depending on the procedure. In all five cases, both the operator and the assistant successfully used this system with no unfavorable event. No participants experienced any HMD wear-related adverse effects. We therefore believe this HMD system might be potentially beneficial during ureteral stent placement procedures. Furthermore, it is compact, easily introduced and affordable.
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35
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A three-dimensional head-mounted display system (RoboSurgeon system) for gasless laparoendoscopic single-port partial cystectomy. Wideochir Inne Tech Maloinwazyjne 2014; 9:638-43. [PMID: 25562007 PMCID: PMC4280413 DOI: 10.5114/wiitm.2014.44407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 03/26/2014] [Accepted: 04/07/2014] [Indexed: 01/20/2023] Open
Abstract
We developed a new three-dimensional (3D) head-mounted display (HMD) system (RoboSurgeon system) that combines a high-definition 3D organic electroluminescent HMD with a high-definition 3D endoscope and applies it to minimally invasive surgery. This system presents the surgeon with a higher quality of magnified 3D imagery in front of the eyes, regardless of head position. We report 5 cases of RoboSurgeon gasless laparoendoscopic single-port partial cystectomy, which is carried out as part of our selective bladder-sparing protocol, with a technique utilizing both an intravesical and extravesical approach. While carrying out the surgery, the system provides the surgeon with both excellent 3D imagery of the operative field and clear imagery of the cystoscopy. All procedures were safely completed and there were no complications except for a case of postoperative lymphorrhea. Our experience shows that the 3D HMD system might facilitate maneuverability and safety in various minimally invasive procedures.
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36
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Takeshita H, Kihara K, Yoshida S, Higuchi S, Ito M, Nakanishi Y, Kijima T, Ishioka J, Matsuoka Y, Numao N, Saito K, Fujii Y. Clinical application of a modern high-definition head-mounted display in sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1499-1504. [PMID: 25063416 DOI: 10.7863/ultra.33.8.1499] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Because of the remarkably improved image quality and wearability of modern head-mounted displays, a monitoring system using a head-mounted display rather than a fixed-site monitor for sonographic scanning has the potential to improve the diagnostic performance and lessen the examiner's physical burden during a sonographic examination. In a preclinical setting, 2 head-mounted displays, the HMZ-T2 (Sony Corporation, Tokyo, Japan) and the Wrap1200 (Vuzix Corporation, Rochester, NY), were found to be applicable to sonography. In a clinical setting, the feasibility of the HMZ-T2 was shown by its good image quality and acceptable wearability. This modern device is appropriate for clinical use in sonography.
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Affiliation(s)
- Hideki Takeshita
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (H.T., K.K., S.Y., S.H., M.I., Y.N., T.K., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., N.N.)
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (H.T., K.K., S.Y., S.H., M.I., Y.N., T.K., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., N.N.)
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (H.T., K.K., S.Y., S.H., M.I., Y.N., T.K., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., N.N.)
| | - Saori Higuchi
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (H.T., K.K., S.Y., S.H., M.I., Y.N., T.K., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., N.N.)
| | - Masaya Ito
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (H.T., K.K., S.Y., S.H., M.I., Y.N., T.K., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., N.N.)
| | - Yasukazu Nakanishi
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (H.T., K.K., S.Y., S.H., M.I., Y.N., T.K., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., N.N.)
| | - Toshiki Kijima
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (H.T., K.K., S.Y., S.H., M.I., Y.N., T.K., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., N.N.)
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (H.T., K.K., S.Y., S.H., M.I., Y.N., T.K., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., N.N.)
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (H.T., K.K., S.Y., S.H., M.I., Y.N., T.K., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., N.N.)
| | - Noboru Numao
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (H.T., K.K., S.Y., S.H., M.I., Y.N., T.K., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., N.N.)
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (H.T., K.K., S.Y., S.H., M.I., Y.N., T.K., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., N.N.)
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (H.T., K.K., S.Y., S.H., M.I., Y.N., T.K., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., N.N.)
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Integrated image monitoring system using head-mounted display for gasless single-port clampless partial nephrectomy. Wideochir Inne Tech Maloinwazyjne 2014; 9:634-7. [PMID: 25562006 PMCID: PMC4280407 DOI: 10.5114/wiitm.2014.44155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 03/27/2014] [Accepted: 03/28/2014] [Indexed: 11/29/2022] Open
Abstract
A novel head-mounted display (HMD) offers a higher quality of endoscopic imagery in front of the eyes regardless of head position. We present an application of the HMD system as a personal integrated multi-image monitoring system in gasless single-port clampless partial nephrectomy (PN). Our HMD system displayed multiple forms of information as integrated, sharp, high-contrast images both seamlessly and synchronously using a four-split screen. The surgeon wearing an HMD display could continuously and simultaneously monitor the endoscopic, three-dimensional (3D) video and intraoperative ultrasound images. In addition, the operator can rotate the 3D video image using fingertip movements on the finger tracking system. All two clampless partial nephrectomies were safely completed within the operative time, blood loss was within usual limits and there were no complications. The integrated image HMD system might facilitate maneuverability and safety in minimally invasive clampless PN.
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Integrated image navigation system using head-mounted display in "RoboSurgeon" endoscopic radical prostatectomy. Wideochir Inne Tech Maloinwazyjne 2014; 9:613-8. [PMID: 25562001 PMCID: PMC4280404 DOI: 10.5114/wiitm.2014.44135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 02/28/2014] [Accepted: 03/23/2014] [Indexed: 11/25/2022] Open
Abstract
The safety and efficacy of minimally invasive surgery relies on visual information. We aimed to develop an integrated image navigation system (RoboSurgeon System) that combines head-mounted displays (HMDs) with multiple image modalities, and assessed its feasibility in 5 prostate cancer patients who underwent gasless single-port endoscopic radical prostatectomy. A robotically manipulated transrectal ultrasound (TRUS) system was used. In all cases, preoperative magnetic resonance (MR) images and intraoperative real-time images of an endoscope, TRUS, and HMD-mounted camera were integrated and displayed synchronously on each HMD in a four-split screen mode during the entire process. The TRUS helped identify the boundary with the adjacent structures endoscopically in reference to MR images. There were no negative incidents in intraoperative or postoperative courses. Integrated image navigation using HMDs as individualized monitors is feasible in the natural ergonomic position and may be beneficial to identify correct dissection planes. The efficacy of the RoboSurgeon System deserves further evaluation.
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A head-mounted display-based personal integrated-image monitoring system for transurethral resection of the prostate. Wideochir Inne Tech Maloinwazyjne 2014; 9:644-9. [PMID: 25562008 PMCID: PMC4280403 DOI: 10.5114/wiitm.2014.43040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/02/2013] [Accepted: 01/23/2014] [Indexed: 11/17/2022] Open
Abstract
The head-mounted display (HMD) is a new image monitoring system. We developed the Personal Integrated-image Monitoring System (PIM System) using the HMD (HMZ-T2, Sony Corporation, Tokyo, Japan) in combination with video splitters and multiplexers as a surgical guide system for transurethral resection of the prostate (TURP). The imaging information obtained from the cystoscope, the transurethral ultrasonography (TRUS), the video camera attached to the HMD, and the patient's vital signs monitor were split and integrated by the PIM System and a composite image was displayed by the HMD using a four-split screen technique. Wearing the HMD, the lead surgeon and the assistant could simultaneously and continuously monitor the same information displayed by the HMD in an ergonomically efficient posture. Each participant could independently rearrange the images comprising the composite image depending on the engaging step. Two benign prostatic hyperplasia (BPH) patients underwent TURP performed by surgeons guided with this system. In both cases, the TURP procedure was successfully performed, and their postoperative clinical courses had no remarkable unfavorable events. During the procedure, none of the participants experienced any HMD-wear related adverse effects or reported any discomfort.
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Yoshimoto K, Yamada K, Watabe K, Takeda M, Nishimura T, Kido M, Nagakura T, Takahashi H, Nishida T, Iijima H, Tsujii M, Takehara T, Ohno Y. Gastric Contraction Imaging System Using a 3-D Endoscope. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2014; 2:1800208. [PMID: 27170867 PMCID: PMC4861546 DOI: 10.1109/jtehm.2014.2298852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/08/2013] [Accepted: 12/09/2013] [Indexed: 11/06/2022]
Abstract
This paper presents a gastric contraction imaging system for assessment of gastric motility using a 3-D endoscope. Gastrointestinal diseases are mainly based on morphological abnormalities. However, gastrointestinal symptoms are sometimes apparent without visible abnormalities. One of the major factors for these diseases is abnormal gastrointestinal motility. For assessment of gastric motility, a gastric motility imaging system is needed. To assess the dynamic motility of the stomach, the proposed system measures 3-D gastric contractions derived from a 3-D profile of the stomach wall obtained with a developed 3-D endoscope. After obtaining contraction waves, their frequency, amplitude, and speed of propagation can be calculated using a Gaussian function. The proposed system was evaluated for 3-D measurements of several objects with known geometries. The results showed that the surface profiles could be obtained with an error of [Formula: see text] of the distance between two different points on images. Subsequently, we evaluated the validity of a prototype system using a wave simulated model. In the experiment, the amplitude and position of waves could be measured with 1-mm accuracy. The present results suggest that the proposed system can measure the speed and amplitude of contractions. This system has low invasiveness and can assess the motility of the stomach wall directly in a 3-D manner. Our method can be used for examination of gastric morphological and functional abnormalities.
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Affiliation(s)
- Kayo Yoshimoto
- Osaka University Division of Health Sciences Graduate School of Medicine Osaka Japan 565-0871
| | - Kenji Yamada
- Osaka University Division of Health Sciences Graduate School of Medicine Osaka Japan 565-0871
| | - Kenji Watabe
- Osaka University Department of Gastroenterology and Hepatology Graduate School of Medicine Osaka Japan 565-0871
| | - Maki Takeda
- Osaka University Division of Health Sciences Graduate School of Medicine Osaka Japan 565-0871
| | - Takahiro Nishimura
- Osaka University Division of Health Sciences Graduate School of Medicine Osaka Japan 565-0871
| | - Michiko Kido
- Osaka University Division of Health Sciences Graduate School of Medicine Osaka Japan 565-0871
| | - Toshiaki Nagakura
- Osaka Electro-Communication University Department of Biomedical Engineering Graduate School of Biomedical Engineering Osaka Japan 575-0063
| | - Hideya Takahashi
- Osaka University Division of Health Sciences Graduate School of Medicine Osaka Japan 565-0871
| | - Tsutomu Nishida
- Osaka University Department of Gastroenterology and Hepatology Graduate School of Medicine Osaka Japan 565-0871
| | - Hideki Iijima
- Osaka University Department of Gastroenterology and Hepatology Graduate School of Medicine Osaka Japan 565-0871
| | - Masahiko Tsujii
- Osaka University Department of Gastroenterology and Hepatology Graduate School of Medicine Osaka Japan 565-0871
| | - Tetsuo Takehara
- Osaka University Department of Gastroenterology and Hepatology Graduate School of Medicine Osaka Japan 565-0871
| | - Yuko Ohno
- Osaka University Division of Health Sciences Graduate School of Medicine Osaka Japan 565-0871
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Igarashi T. Editorial Comment to New three-dimensional head-mounted display system, TMDU-S-3D system, for minimally invasive surgery application: Procedures for gasless single-port radical nephrectomy. Int J Urol 2012; 19:890. [DOI: 10.1111/j.1442-2042.2012.03070.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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