Visual Enhacement of Fascia Facilitates Laparoscpic Preparation

Introduction: Laparoscopic surgery for both benign and malign diseases of the colon is well established. The correct dissection of layers may impose some difficulties in patients who underwent surgical interventions before, who suffer from inflammatory diseases and for surgeons who are still in their learning phase of laparoscopy. The presented system encompassing both hardware and software components serves to facilitate the identification of the fascia by visual transformation.
Methods and Procedures: The RealTimeFrame-System published in 2007 served to develop a software which in real-time mode alters the saturation of individual pixels enhancing the contrast between fatty tissue and fascia. The colours and saturations of other tissues are not impaired thus avoiding the creation of a picture which hides other important structures or possibly confuses the surgeon in his proceeding. Diverse algorithms were applied to video sequences of laparoscopic colon resections. Surgeons experienced in laparoscopy viewed these sequences to determine the optimal parameters of software-generated modification of the original picture. First clinical experiences were obtained using a second monitor next to the one routinely used in laparoscopy which displayed the augmented contrast. Optical transformation was achieved in real time mode and could be switched off according to the surgeon’s preference.
Results: The visual transformation allows a clear distinction of layers which implies a facilitation in preparation for the untrained surgeon and the experienced surgeon facing a difficult situs, respectively. This, in return, entails positive effects for both the patient with regard to the perioperative risk and the surgeon for whom the procedure becomes less stressful in certain situations. The stated factors will be evaluated in a prospective randomised trial to verify the estimated effects. Furthermore, the preparation of the rectum may be another procedure in which the application could be advantageous.
Conclusion: The results for the application of the transforming software obtained to this point appear to be very promising. Particularly, the mobilisation of the left sided hemicolon and the rectum may be faster and safer which constitutes a benefit for the patient.

Session: Poster

Program Number: P156

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