Integrated Stereo-3D Anatomical Navigation in Davinci Robotic-Assisted Surgery Using Osirix Image-Based Navigation System

Maki Sugimoto, MD PhD, Yoshiinori Morita, MD, Yuichiro Matsuoka, PhD, Mariko Man-i, MD, Shoko Fujiwara, MD, Tsuyoshi Sanuki, MD, Masaru Yoshida, MD, Takashi Toyonaga, MD, Takanobu Hayakumo, MD, Hiromu Kutsumi, MD, Etsuko Kumamoto, PhD, Kagayaki Kur. Kobe University

Introduction
We apply mixed reality (MR) consist of VR and augmented reality (AR) technology, in which electronically-generated dynamic 3D images are superimposed on the TilePRO of daVinci system or actual space in front of the surgeon, on the patient’s operative field or the surface of the abdomen, and evaluated such a system as a reference for surgical navigation and education. We also described the educational aspect of MR-assisted navigation in surgery for young surgeons.
Method
Post-processing MDCT data, we developed anatomical VR using DICOM viewer OsiriX application. 3-D reconstructions (volume rendering) were incorporated on the workstation-based display, TilePRO of daVinci, and previewed on the patient body surface and operative field from the projector as MR navigation during endoscopic procedure.
We also apply anaglyph images to provide a stereoscopic 3D effect, when viewed with 2 color glasses (each lens a chromatically opposite color as red and cyan) using OsiriX function. Images are made up of two color layers, superimposed, but offset with respect to each other to produce a depth effect. When viewed through the anaglyph glasses, surgeons reveal an integrated stereoscopic image fused into perception of a 3D scene or composition. The Polaris optical 3D measurement system was integrated into robotics for the tracking and synchronizing the movement of the robotic arms to 3D navigation. ?
Result
This 3D image-guided system provided better hand-eye coordination and accurate information for localizing the target lesions of benign and malignancies with its relationship to the surrounding vessels. MR procedure, when contained virtual endoscopy, could help understanding the surgical procedures and techniques in complex minimally invasive surgical procedure including single incision laparoscopic surgery and natural orifice translumenal endoscopic surgery (NOTES) using daVinci. The Polaris was able to identify the exact location and orientation of the robotic end-effector. With the exact location of the robotic end-effector known, the necessary positional accuracy can be better achieved in robotic image-guided navigation. ??
Conclusion
Our integrated stereo-3D navigation using OsiriX may provide accurate image guided navigation for robotic surgery.