Instrument Tracking for Safety and Surgical View Optimization in Laparoscopic Surgery

Supervision: Dr. Christoph Hennersperger, Prof. Dr. Nassir Navab , and Dr. Kushal Chummun

Student:

Laparoscopic (minimally invasive, key hole) surgery involves usage of a laparoscope (camera), and laparoscopic instruments (graspers, scissors, monopolar and bipolar devices). First the abdomen is insufflated with carbon dioxide to create a space between the abdominal wall and organs. The laparoscope and laparoscopic instruments are then inserted through small 5 or 10 mm incisions in the abdomen. The laparoscope projects the image within the abdomen onto a screen. The surgeon can therefore visualise the inside of the abdomen and the operating instruments to carry the surgical procedure.

At present, there is increasing interest in surgical procedures using a robot-assisted device. The advantages of using such a device include a steady, tremor-free image, the elimination of small inaccurate movements and decreased energy expenditure by the assistant [1]. A number of studies have evaluated the advantages of robotic camera devices compared with manually controlled cameras or different types of devices [1, 3-5]

The possibility of developing a laparoscope with a tracking system that will automatically identify and follow the operating surgeon’s instruments does provide significant benefit without requiring bulky robotic systems. Firstly by withdrawing the need to always have an assistant will reduce cost. With an instrument tracking system, there is no need for additional pedals and headband to move the camera, which can be confusing, uncomfortable, unsafe and may actually increase the length of surgery. Besides that, an increased safety of the procedure will be achieved by providing a steadier image and with incorporated safety mechanisms.

The current project aims at developing a laparoscopic camera system mounted on the operating bed. The proposed system will track the primary surgeon’s instruments without the need for any constant input. The aim is thereby to recognise key tools with priority (sharp tool 1st), and track their movement in situ to move a camera accordingly. With safety features being one priority, the camera will by default be focused on the instrument with higher priority (i.e scissors, monopolar and bipolar devices) in view. Whenever e.g. the monopolar or bipolar device is out of view, this will allow in future to disable the energy source of those instruments, which will greatly reduce one of the commonest cause of injuries during laparoscopic surgery.

References:

• 1. Comparison of surgical performance during laparoscopic radical prostatectomy of two robotic camera holders, EndoAssist^? and AESOP: a pilot study.Wagner AA, Varkarakis IM, Link RE, Sullivan W, Su LM Urology. 2006 Jul; 68(1):70-4.
• 2. Camera and instrument holders and their clinical value in minimally invasive surgery. Jaspers JE, Breedveld P, Herder JL, Grimbergen CA Surg Laparosc Endosc Percutan Tech. 2004 Jun; 14(3):145-52.
• 3. Stolzenburg JU, Franz T, Kallidonis P, et al. Comparison of the FreeHand^?® robotic camera holder with human assistants during endoscopic extra peritoneal radical prostatectomy. BJU Int. 2010;107:970–974.
• 4. Yamada K, Kato S. Robot-assisted thoracoscopic lung resection aimed at solo surgery for primary lung cancer. Gen Thorac and Cardiovasc Surg. 2008;56:292–294.
• 5. Uchal M, Haughn C, Raftopoulos Y, et al. Robotic camera holder as good as expert camera holder: a randomized crossover trial. Surg Laparosc Endosc Percutan Tech. 2009;19:272–275