University of Twente Student Theses


A study into laparoscopic surgical navigation for colorectal cancer patients without a hybrid operating room

Noltes, L. (2019) A study into laparoscopic surgical navigation for colorectal cancer patients without a hybrid operating room.

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Abstract:Background: Surgery or a treatment in combination with surgery is the most common treatment for colorectal cancer. Surgical navigation could alleviate some limitations of laparoscopic surgery. At the Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AvL) a laparoscopic pointer is used for surgical navigation, which cannot be simultaneously inserted thought the trocar with a laparoscopic instrument. Therefore, surgical navigation might not be available all the time. Additionally, the current cone beam computed tomography (CBCT) registration exposes the patient and medical personal to radiation during the CBCT and makes surgical navigation limited available at the NKI-AvL and other hospitals. In this thesis, the clip-on, which integrates an electromagnetic (EM) sensor and the Ethicon Harmonic ACE (EH-ACE) into one device is evaluated, and the accuracy of 3D tracked ultrasound (US) registration for abdominal surgical navigation is compared to the current CBCT registration. Clip-on: The EM sensor is not exactly located at the tip of the disposable EH-ACE when using the clip-on. Four clip-on calibrations were evaluated on accuracy. The results show a clip-on calibration where only a single clip-on/EM sensor/EH-ACE combination is calibrated, which can be used with any clip-on and any EH-ACE with that specific EM sensor. Thereafter, the accuracy inside the entire table top field generator workfield is evaluated using 112 points of interest. The results show an root mean square error of 2 mm, with a significant difference (p = 0.004) of 0.2 mm when another EM sensor was used, which was not deemed clinical relevant. Surgical navigation can also be used during activation of the EH-ACE, because activation of the EH-ACE does not seem to influence the accuracy of tracking with the clip-on. Recommendation to further improve the design of the clip-on was made. Registration with 3D tracked ultrasound for abdominal surgical navigation: The target registration error (TRE) of 3D tracked US registration was compared to the CBCT registration for abdominal surgical navigation in a phantom study. The results show a comparable TRE for 3D tracked US registration and CBCT registration, when the segmented left and right iliac crest together with the os pubis were used for registration. Sweeping the US beam to fast over the anatomy must be prevented, because gaps in the segmentation negatively influence the registration results. Pre-processing of the data might be a solution when only left and/or right iliac crest segmentation are used for the registration with 3D tracked US. Before clinical implementation further research is necessary, especially focused on bone segmentation in US imaging.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine, 50 technical science in general
Programme:Technical Medicine MSc (60033)
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