Stereotactic Pelvic Navigation With Augmented Reality for Transanal Total Mesorectal Excision

Jung-Myun Kwak, Luis Romagnolo, Arthur Wijsmuller, Cristians Gonzalez, Vincent Agnus, Fabiano R. Lucchesi, Armando Melani, Jacques Marescaux, Bernard Dallemagne

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

INTRODUCTION: Technical difficulty and unfamiliar surgical anatomy are the main challenges in transanal total mesorectal excision. Precise 3-dimensional real-time image guidance may facilitate the safety, accuracy, and efficiency of transanal total mesorectal excision. TECHNIQUE: A preoperative CT was obtained with 10 skin fiducials and further processed to emphasize the border of the anatomical structure by 3-dimensional modeling and pelvic organ segmentation. A forced sacral tilt by placing a 10-degree wedge under the patient's sacrum was induced to minimize pelvic organ movement caused by lithotomy position. An optical navigation system with cranial software was used. Preoperative CT images were loaded into the navigation system, and patient tracker was mounted onto the iliac bone. Once the patient-to-image paired point registration using skin fiducials was completed, the laparoscopic instrument mounted with instrument tracker was calibrated for instrument tracking. After validating the experimental setup and process of registration by navigating laparoscopic anterior resection, stereotactic navigation for transanal total mesorectal excision was performed in the low rectal neuroendocrine tumor. RESULTS: The fiducial registration error was 1.7 mm. The accuracy of target positioning was sufficient at less than 3 mm (1.8 ± 0.9 mm). Qualitative assessment using a Likert scale was well matched between the 2 observers. Of the 20 scores, 19 were judged as 4 (very good) or 5 (excellent). There was no statistical difference between mean Likert scales of the abdominal or transanal landmarks (4.4 ± 0.5 vs 4.3 ± 1.0, p = 0.965). CONCLUSIONS: Application of an existing navigation system to transanal total mesorectal excision for a low rectal tumor is feasible. The acceptable accuracy of target positioning justifies its clinical use. Further research is needed to prove the clinical need for the procedure and its impact on clinical outcomes.

Original languageEnglish
Pages (from-to)123-129
Number of pages7
JournalDiseases of the Colon and Rectum
Volume62
Issue number1
DOIs
Publication statusPublished - 2019 Jan 1

Fingerprint

Rectal Neoplasms
Patient Navigation
Sacrum
Optical Devices
Skin
Neuroendocrine Tumors
Anatomy
Software
Safety
Bone and Bones
Research

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Kwak, J-M., Romagnolo, L., Wijsmuller, A., Gonzalez, C., Agnus, V., Lucchesi, F. R., ... Dallemagne, B. (2019). Stereotactic Pelvic Navigation With Augmented Reality for Transanal Total Mesorectal Excision. Diseases of the Colon and Rectum, 62(1), 123-129. https://doi.org/10.1097/DCR.0000000000001259

Stereotactic Pelvic Navigation With Augmented Reality for Transanal Total Mesorectal Excision. / Kwak, Jung-Myun; Romagnolo, Luis; Wijsmuller, Arthur; Gonzalez, Cristians; Agnus, Vincent; Lucchesi, Fabiano R.; Melani, Armando; Marescaux, Jacques; Dallemagne, Bernard.

In: Diseases of the Colon and Rectum, Vol. 62, No. 1, 01.01.2019, p. 123-129.

Research output: Contribution to journalArticle

Kwak, J-M, Romagnolo, L, Wijsmuller, A, Gonzalez, C, Agnus, V, Lucchesi, FR, Melani, A, Marescaux, J & Dallemagne, B 2019, 'Stereotactic Pelvic Navigation With Augmented Reality for Transanal Total Mesorectal Excision', Diseases of the Colon and Rectum, vol. 62, no. 1, pp. 123-129. https://doi.org/10.1097/DCR.0000000000001259
Kwak, Jung-Myun ; Romagnolo, Luis ; Wijsmuller, Arthur ; Gonzalez, Cristians ; Agnus, Vincent ; Lucchesi, Fabiano R. ; Melani, Armando ; Marescaux, Jacques ; Dallemagne, Bernard. / Stereotactic Pelvic Navigation With Augmented Reality for Transanal Total Mesorectal Excision. In: Diseases of the Colon and Rectum. 2019 ; Vol. 62, No. 1. pp. 123-129.
@article{8645cf1f351142d988cd7585e50c0913,
title = "Stereotactic Pelvic Navigation With Augmented Reality for Transanal Total Mesorectal Excision",
abstract = "INTRODUCTION: Technical difficulty and unfamiliar surgical anatomy are the main challenges in transanal total mesorectal excision. Precise 3-dimensional real-time image guidance may facilitate the safety, accuracy, and efficiency of transanal total mesorectal excision. TECHNIQUE: A preoperative CT was obtained with 10 skin fiducials and further processed to emphasize the border of the anatomical structure by 3-dimensional modeling and pelvic organ segmentation. A forced sacral tilt by placing a 10-degree wedge under the patient's sacrum was induced to minimize pelvic organ movement caused by lithotomy position. An optical navigation system with cranial software was used. Preoperative CT images were loaded into the navigation system, and patient tracker was mounted onto the iliac bone. Once the patient-to-image paired point registration using skin fiducials was completed, the laparoscopic instrument mounted with instrument tracker was calibrated for instrument tracking. After validating the experimental setup and process of registration by navigating laparoscopic anterior resection, stereotactic navigation for transanal total mesorectal excision was performed in the low rectal neuroendocrine tumor. RESULTS: The fiducial registration error was 1.7 mm. The accuracy of target positioning was sufficient at less than 3 mm (1.8 ± 0.9 mm). Qualitative assessment using a Likert scale was well matched between the 2 observers. Of the 20 scores, 19 were judged as 4 (very good) or 5 (excellent). There was no statistical difference between mean Likert scales of the abdominal or transanal landmarks (4.4 ± 0.5 vs 4.3 ± 1.0, p = 0.965). CONCLUSIONS: Application of an existing navigation system to transanal total mesorectal excision for a low rectal tumor is feasible. The acceptable accuracy of target positioning justifies its clinical use. Further research is needed to prove the clinical need for the procedure and its impact on clinical outcomes.",
author = "Jung-Myun Kwak and Luis Romagnolo and Arthur Wijsmuller and Cristians Gonzalez and Vincent Agnus and Lucchesi, {Fabiano R.} and Armando Melani and Jacques Marescaux and Bernard Dallemagne",
year = "2019",
month = "1",
day = "1",
doi = "10.1097/DCR.0000000000001259",
language = "English",
volume = "62",
pages = "123--129",
journal = "Diseases of the Colon and Rectum",
issn = "0012-3706",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Stereotactic Pelvic Navigation With Augmented Reality for Transanal Total Mesorectal Excision

AU - Kwak, Jung-Myun

AU - Romagnolo, Luis

AU - Wijsmuller, Arthur

AU - Gonzalez, Cristians

AU - Agnus, Vincent

AU - Lucchesi, Fabiano R.

AU - Melani, Armando

AU - Marescaux, Jacques

AU - Dallemagne, Bernard

PY - 2019/1/1

Y1 - 2019/1/1

N2 - INTRODUCTION: Technical difficulty and unfamiliar surgical anatomy are the main challenges in transanal total mesorectal excision. Precise 3-dimensional real-time image guidance may facilitate the safety, accuracy, and efficiency of transanal total mesorectal excision. TECHNIQUE: A preoperative CT was obtained with 10 skin fiducials and further processed to emphasize the border of the anatomical structure by 3-dimensional modeling and pelvic organ segmentation. A forced sacral tilt by placing a 10-degree wedge under the patient's sacrum was induced to minimize pelvic organ movement caused by lithotomy position. An optical navigation system with cranial software was used. Preoperative CT images were loaded into the navigation system, and patient tracker was mounted onto the iliac bone. Once the patient-to-image paired point registration using skin fiducials was completed, the laparoscopic instrument mounted with instrument tracker was calibrated for instrument tracking. After validating the experimental setup and process of registration by navigating laparoscopic anterior resection, stereotactic navigation for transanal total mesorectal excision was performed in the low rectal neuroendocrine tumor. RESULTS: The fiducial registration error was 1.7 mm. The accuracy of target positioning was sufficient at less than 3 mm (1.8 ± 0.9 mm). Qualitative assessment using a Likert scale was well matched between the 2 observers. Of the 20 scores, 19 were judged as 4 (very good) or 5 (excellent). There was no statistical difference between mean Likert scales of the abdominal or transanal landmarks (4.4 ± 0.5 vs 4.3 ± 1.0, p = 0.965). CONCLUSIONS: Application of an existing navigation system to transanal total mesorectal excision for a low rectal tumor is feasible. The acceptable accuracy of target positioning justifies its clinical use. Further research is needed to prove the clinical need for the procedure and its impact on clinical outcomes.

AB - INTRODUCTION: Technical difficulty and unfamiliar surgical anatomy are the main challenges in transanal total mesorectal excision. Precise 3-dimensional real-time image guidance may facilitate the safety, accuracy, and efficiency of transanal total mesorectal excision. TECHNIQUE: A preoperative CT was obtained with 10 skin fiducials and further processed to emphasize the border of the anatomical structure by 3-dimensional modeling and pelvic organ segmentation. A forced sacral tilt by placing a 10-degree wedge under the patient's sacrum was induced to minimize pelvic organ movement caused by lithotomy position. An optical navigation system with cranial software was used. Preoperative CT images were loaded into the navigation system, and patient tracker was mounted onto the iliac bone. Once the patient-to-image paired point registration using skin fiducials was completed, the laparoscopic instrument mounted with instrument tracker was calibrated for instrument tracking. After validating the experimental setup and process of registration by navigating laparoscopic anterior resection, stereotactic navigation for transanal total mesorectal excision was performed in the low rectal neuroendocrine tumor. RESULTS: The fiducial registration error was 1.7 mm. The accuracy of target positioning was sufficient at less than 3 mm (1.8 ± 0.9 mm). Qualitative assessment using a Likert scale was well matched between the 2 observers. Of the 20 scores, 19 were judged as 4 (very good) or 5 (excellent). There was no statistical difference between mean Likert scales of the abdominal or transanal landmarks (4.4 ± 0.5 vs 4.3 ± 1.0, p = 0.965). CONCLUSIONS: Application of an existing navigation system to transanal total mesorectal excision for a low rectal tumor is feasible. The acceptable accuracy of target positioning justifies its clinical use. Further research is needed to prove the clinical need for the procedure and its impact on clinical outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85058611439&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058611439&partnerID=8YFLogxK

U2 - 10.1097/DCR.0000000000001259

DO - 10.1097/DCR.0000000000001259

M3 - Article

C2 - 30531268

AN - SCOPUS:85058611439

VL - 62

SP - 123

EP - 129

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

SN - 0012-3706

IS - 1

ER -