Laparoscopic Difference Between Optical See-Through and the See-Trough Video

 




Difference between Optical see-through and the see-trough video

Graphs showing the share of each display method used in AR according to the type of surgery. Compared to a conventional simple image transmission circuit with minimal processing - screen), our system requires the addition of a relatively conventional computer, the cost of which is around 1000 to 1500 euros. We use a 10mm Storz 0 ° optic either standard or Spies. The laparoscopic column is also a “standard” HD Storz column or a Storz Spies column.

During their internship in laparoscopic technique, many of them have not received practical training with simulators Laparoscopic Needle Driver.

The advantage of the Spies column is that the mode can used in particular, which by automatically improving the darker areas of the laparoscopic image facilitates the initial registration phase. At the exit of the column, the resolution of the video signal is 1920x1080 pixels with 25 images per second. The computer used is equipped with an Intel i7 processor and a powerful graphics card. 

Augmented Reality and Video Router

The specific software developed by our team for registration and tracking named "Uteraug" for "uterus" and "augmented reality". The Tracking phase implemented and carried out in optimized C ++ / CUDA language makes it possible to carry out an AR at 16 images per second, there is therefore a slight gap between the movement of the organ and the follow-up in RA. 

This shift was widely perceptible at the start of the experiments, it is now very small and allows a location surgical procedure to be performed using the AR screen. For the screen, we most often used a dual display, especially in clinical practice: the image circuit without RA not modified but added in parallel thanks to the use of a video router. The RA circuit installed. This makes it possible to always the conventional circuit in operation if the circuit RA is faulty. However, a single AR circuit can used with a display on the usual celioscopy screen. Our system therefore only requires a simple, inexpensive installation. On the left, the classic image circuit in conventional laparoscopy, on the right, the image circuit in our AR system.

Left: 

Dual display: usual screen and RA screen. AT

Right: 

Display of the AR on the screen of the laparoscopic column, one can notice at the top right of the screen the synchronous display in superimposition of the image.

Experimental Evaluation in a Uterine Model

To begin the development of our AR system, we chose a simple tumor model: uterine fibroids. Uterine fibroid is a benign tumor of smooth muscle cells in the uterus. It is the most common tumor in women of childbearing age, and estimate to occur at around 25% of women of childbearing age, but this frequency is probably underestimated since most uterine fibroids are asymptomatic and therefore go undiagnosed. 

Symptomatic cases are often symptomatic with pelvic pain, bleeding or an impact on fertility. After the clinical examination, the complementary first-line examination represent by the pelvic ultrasound. Pelvic ultrasound is very “operator dependent” and the use of posterior images is more difficult because it is a dynamic examination unlike CT or MRI are much more static. The realization of parallel serial sections is also very difficult and therefore makes reconstruction in ultrasound difficult. 

Magnetic Resonance Imaging 

In second intention, magnetic resonance imaging allows very precise mapping of myomas. It is often used in pre-therapy, or in cases of particularly numerous and / or large fibroids or associated pathologies. This examination is reproducible but must be complete with three section planes: sagittal, transverse, coronal, and three sequences T1, T2 and injection of gadolinium. 

However, there is no argument in the literature to recommend its systematic use.As far as surgical management is concerned; myomectomy remains the conservative treatment most often proposed, in particular in young patients, with a desire for pregnancy. In the case of small submucosal type 0, 1, or 2 myomas, hysteroscopic resection remains the standard treatment. 

For the rest of myomas, the laparoscopic approach is recommend as soon as the situation allows. Ulipristal acetate or LHRH analogues can use to reduce the size of the myoma preoperatively. The use of ulipristal in particular has become widespread with the corollary of a possible reduction in the indications for operation but also a reduction in the size of the myomas to operate on and a more flexible structure of these myomas making their localization even more difficult. 

Postoperative Adhesions 

The incision of the uterine serosa is the initial step in myomectomy. The number and size of incisions is an important factor in postoperative adhesions. The choice of the incision area is important in order to facilitate access to the momma, reduce the number and size of incisions and thus reduce the risk of postoperative adhesions. Indeed, in the event of myomectomy, the number and size of incisions made, the way of suturing the uterus and the number of knots made influence the de novo occurrence of postoperative adhesions. 

The objective of using AR in the management of fibroids would therefore be to optimize the surgery, by allowing the visualization of fibroids: because their precise location is sometimes difficult due to their number and size associated with the less force feedback associated with laparoscopy. Visualization of the uterine cavity, uterine vascularization, uterine muscle fibers and any other anatomical or structural element could also facilitate myoma surgery. 

Augmented reality had not yet developed, used or released on a highly mobile organ like the uterus. For the sake of the most scientific approach possible, we first tested our phantom uterus model. This initial work aimed to test the model and assess a potential benefit for myomectomy in terms of incision precision, with and without Augmented Reality. 

Conclusion

The results of this study show that the Augmented Reality system makes it possible to improve the precision of the localization of myomas and the ease of this localization evaluated by the surgeon.

For more information visit our website: www.gerati.com


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