C. Federico Davrieux, MD1, Mariano Eduardo Giménez, PhD2, Cristians A. Gonzalez, MD1, Alexandre Ancel, PhD1, Maxime Guinin, PhD1, Bénédicte Fahrer, MCs2, Jung-Myun Kwak, MD1, Edgardo Serra, MD3, Jacques Marescaux, MD, FACS, Hon, FRCS, Hon, FJSES, Hon, FASA2, Alexandre Hostettler, PhD2. 1IHU-Strasbourg, 2IRCAD, 3CIEN Center, Integral Center of Endocrinology and Nutrition
Aims: Image-guided surgery (IGS) is growing in importance with each year. Various imaging technologies are used. A major one is ultrasound (US). This is inexpensive and safe, however it can be difficult to use and is operator dependent. The objective of this study was to test whether a new Mixed Reality Navigation System (MRNS) improved percutaneous punctures. This system allowed to clearly visualize the needle tip, needle orientation, US probe and target simultaneously with an interactive 3D computer User Interface (UI).
Methods: Prospective pre-clinical comparative study. An opaque ballistic gel phantom containing grapes of different sizes (between 7 and 25 mm) was used to simulate targets. The evaluation consisted of US-guided needle punctures divided into two groups, standard group consisted of punctures using the standard approach (US-guided), and assisted navigation group consisted of punctures using MRNS.
The navigation system comprised an electromagnetic (EM) generator field (Aurora System – NDI Medical), an EM tracking device with two EM sensors (attached to the needle and probe), a US digital image grabber, and a software program for 3D visualization and interactive navigation (ARES/IRCAD). An additional software captured the US image output, and the position of both the needle and probe in the EM field. The software shows this information with a 3D interactive UI in real time.
For the punctures of the assisted navigation group, the target was centralized with the ultrasound probe. The target centre was marked in the software and used as a guide. The software showed the orientation and trajectory of the needle with respect to the ultrasound plane, the distance to the objective and a virtual view centered on the tip of the needle. For the standard group, US-guided was performed using the lateral plane approach.
Once a puncture was completed, a Computed Tomography scan was made of the phantom and needle. The distance between the needle tip and the center of the target was measured using the three spatial dimensions (caudal-cephalic, medial-lateral and anterior-posterior). The time required to complete the puncture and the number of puncture attempts was also calculated.
Results: Total participants was n=23, between surgeons, medical technicians and radiologist. They presented different experiences in percutaneous procedures. It was divided into novices (without experience, 69.5%) and experienced (with experience >25 procedures, 30.5%). Each participant performed the puncture of 6 targets. For puncture completion time, the difference was not statistically significative (assisted navigation group 28, 3 ± 24.7 vs. standard group 39.3 ± 46.3 – p 0.775). The total punctures attempts were lower in the assisted navigation group compared to the standard group (1.0 ± 0.2 vs. 1.8 ± 1.1 – p 0.000). The assisted navigation group was more accurate than the standard group (4.2 ± 2.9 vs 6.5 ± 4.7 – p 0.003), observed in both novices and experienced. Using MRNS, the experts improved, and the novices had similar results than the experts with the standard procedure.
Conclusion: The use of MRNS improved, the ultrasound-guided percutaneous punctures parameters compared to the standard approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 90986
Program Number: ET002
Presentation Session: Emerging Technology Session (Non CME)
Presentation Type: Podium