University of Twente Student Theses


Augmented reality for laparoscopic liver navigation

Duren, K.M.L. van (2022) Augmented reality for laparoscopic liver navigation.

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Abstract:Surgery is considered the most desirable treatment for patients with colorectal liver metastases, as it provides the highest survival rates. Minimal invasive surgery, such as laparoscopic liver resections (LLR), has considerable benefits compared to open surgery due to the reduced surgical burden. However, LLR is more challenging due to the inability to palpate the liver, lack of depth perception, and limited field of view. Augmented reality (AR) offers a continuous and direct projection of essential anatomical structures during LLR, and could therefore improve treatment options and outcomes with LLR. AR fuses intraoperative imaging, preoperative imaging, and surgical instruments in a unified environment. This thesis presents AR technology to visualize anatomical liver structures during LLR, which involved several components. First, an adapter was developed and calibrated to track a laparoscope with a mean image-to-video error of 1.9 (0.9-3.8) mm, while ensuring sterilizability and accurate calibration. Second, software modules were developed in Unity to visualize tracked instruments and laparoscopic video feed in a three-dimensional (3D) space. Third, the combined preoperative data with the laparoscopic video feed were visualized in different overlays. The resulting software was suitable for real-time AR and customization of the AR visualizations according to surgeons’ preferences. The potential of AR for LLR was evaluated in a simulated clinical setting via phantom experiments. Four hepatobiliary surgeons localized lesions in a realistic liver phantom with conventional laparoscopic ultrasonography (LUS) and AR. The AR technology facilitated a successful registration of the 3D liver phantom model with essential anatomical structures visible. The phantom experiments showed promising results in terms of usability, and all surgeons agreed that AR technology would complement the current LLR procedure. AR with confirmation of LUS provided competitive location times compared to conventional LUS. This thesis demonstrated all elements of successful AR technology integration in a simulated clinical environment. Future implementation includes simplifying and refining the AR interface, implementing additional tracked laparoscopic instruments, and training surgeons.
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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