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Wu HL, Yao LW, Shi HY, Wu LL, Li X, Zhang CX, Chen BR, Zhang J, Tan W, Cui N, Zhou W, Zhang JX, Xiao B, Gong RR, Ding Z, Yu HG. Validation of a real-time biliopancreatic endoscopic ultrasonography analytical device in China: a prospective, single-centre, randomised, controlled trial. Lancet Digit Health 2023; 5:e812-e820. [PMID: 37775472 DOI: 10.1016/s2589-7500(23)00160-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/16/2023] [Accepted: 08/09/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) is a key procedure for the diagnosis of biliopancreatic diseases. However, the performance among EUS endoscopists varies greatly and leads to blind spots during the operation, which can impair the health outcomes of patients. We previously developed an artificial intelligence (AI) device that accurately identified EUS standard stations and significantly reduced the difficulty of ultrasonography image interpretation. In this study, we updated the device (named EUS-IREAD) and validated its performance in improving the quality of EUS procedures. METHODS In this single-centre, randomised, controlled trial, we updated EUS-IREAD so it consisted of five learning models to identify eight EUS stations and 24 anatomical structures. The trial was done at the Renmin Hospital of Wuhan University (Wuhan, China) and included patients aged 18 years or older with suspected biliopancreatic (pancreas and biliopancreatic duct) lesions due to clinical symptoms, radiological findings, or laboratory findings, and with a high risk of pancreatic cancer. Patients were randomly assigned (1:1) by a dedicated research assistant using a computer-generated random number series (with a block size of four) to undergo the EUS procedure with or without the assistance of EUS-IREAD. Endoscopists in the EUS-IREAD-assisted group were required to observe all standard stations and anatomical structures according to the prompts by the AI device. Data collectors, the independent data anaylsis team, and patients were masked to group allocation. The primary outcome was the missed scanning rate of standard stations between the two groups, which was assessed in patients who underwent EUS procedure in accordance with the assigned intervention (per protocol). This trial is registered with ClinicalTrials.gov, NCT05457101. FINDINGS Between July 9, 2022, and Feb 28, 2023, 290 patients (mean age 55·93 years [SD 14·06], 152 [52%] male, and 138 [48%] female) were randomly assigned and analysed, including 144 in the EUS-IREAD-assisted group and 146 in the control group. The EUS-IREAD-assisted group had a lower missed scanning rate of stations than the control group (4·5% [SD 0·8] vs 14·3% [1·0], -9·8% [95% CI -12·2 to -7·5]; odds ratio 3·6 [95% Cl 2·6 to 4·9]; p<0·0001). No significant adverse event was found during the study. INTERPRETATION Our study confirms the capability of EUS-IREAD to monitor the blind spots and reduce the missed rate of stations and structures during EUS procedures. The EUS-IREAD has the potential to play an essential part in EUS quality control. FUNDING Innovation Team Project of Health Commission of Hubei Province and College-enterprise Deepening Reform Project of Wuhan University.
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Affiliation(s)
- Hui Ling Wu
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li Wen Yao
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hui Ying Shi
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lian Lian Wu
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xun Li
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chen Xia Zhang
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bo Ru Chen
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Zhang
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Tan
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ning Cui
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Zhou
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ji Xiang Zhang
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bing Xiao
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rong Rong Gong
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhen Ding
- Endoscopy Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Hong Gang Yu
- Department of Gastroenterology, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, and Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.
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Tontini GE, Manfredi G, Orlando S, Neumann H, Vecchi M, Buscarini E, Elli L. Endoscopic ultrasonography and small-bowel endoscopy: Present and future. Dig Endosc 2019; 31:627-643. [PMID: 31090965 DOI: 10.1111/den.13429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022]
Abstract
Over the last decade, impressive technological advances have occurred in ultrasonography and small-bowel endoscopy. Nowadays, endoscopic ultrasonography is an essential diagnostic tool and a therapeutic weapon for pancreatobiliary disorders. Capsule endoscopy and device-assisted enteroscopy have quickly become the reference standard for the diagnosis of small-bowel luminal diseases, thereby leading to radical changes in diagnostic and therapeutic pathways. We herein provide an up-to-date overview of the latest advances in endoscopic ultrasonography and small-bowel endoscopy, focusing on the emerging paradigms and technological innovations that might improve clinical practice in the near future.
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Affiliation(s)
- Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Stefania Orlando
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Digestive Endoscopy and Gastroenterology Unit, ASST of Cremona, Cremona, Italy
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Luca Elli
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Abstract
Background and Objective: Navigation of a flexible endoscopic ultrasound (EUS) probe inside the gastrointestinal (GI) tract is problematic due to the small window size and complex anatomy. The goal of the present study was to test the feasibility of a novel fusion imaging (FI) system which uses electromagnetic (EM) sensors to co-register the live EUS images with the pre-procedure computed tomography (CT) data with a novel navigation algorithm and catheter. Methods: An experienced gastroenterologist and a novice EUS operator tested the FI system on a GI tract bench top model. Also, the experienced gastroenterologist performed a case series of 20 patients during routine EUS examinations. Results: On the bench top model, the experienced and novice doctors reached the targets in 67 ± 18 s and 150 ± 24 s with a registration error of 6 ± 3 mm and 11 ± 4 mm, respectively. In the case series, the total procedure time was 24.6 ± 6.6 min, while the time to reach the clinical target was 8.7 ± 4.2 min. Conclusions: The FI system is feasible for clinical use, and can reduce the learning curve for EUS procedures and improve navigation and targeting in difficult anatomic locations.
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Affiliation(s)
| | | | - Gabriel Gruionu
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,
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Abstract
OBJECTIVE The aim of our article is to give an overview of the current and future possibilities of real-time image fusion involving ultrasound. We present a review of the existing English-language peer-reviewed literature assessing this technique, which covers technical solutions (for ultrasound and endoscopic ultrasound), image fusion in several anatomic regions, and electromagnetic needle tracking. CONCLUSION The recent progress of real-time ultrasound in image fusion may provide several new possibilities, including diagnosis, treatment, and follow-up of oncologic patients.
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Azagury DE, Ryou M, Shaikh SN, San José Estépar R, Lengyel BI, Jagadeesan J, Vosburgh KG, Thompson CC. Real-time computed tomography-based augmented reality for natural orifice transluminal endoscopic surgery navigation. Br J Surg 2012; 99:1246-53. [PMID: 22864885 DOI: 10.1002/bjs.8838] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) is technically challenging owing to endoscopic short-sighted visualization, excessive scope flexibility and lack of adequate instrumentation. Augmented reality may overcome these difficulties. This study tested whether an image registration system for NOTES procedures (IR-NOTES) can facilitate navigation. METHODS In three human cadavers 15 intra-abdominal organs were targeted endoscopically with and without IR-NOTES via both transgastric and transcolonic routes, by three endoscopists with different levels of expertise. Ease of navigation was evaluated objectively by kinematic analysis, and navigation complexity was determined by creating an organ access complexity score based on the same data. RESULTS Without IR-NOTES, 21 (11·7 per cent) of 180 targets were not reached (expert endoscopist 3, advanced 7, intermediate 11), compared with one (1 per cent) of 90 with IR-NOTES (intermediate endoscopist) (P = 0·002). Endoscope movements were significantly less complex in eight of the 15 listed organs when using IR-NOTES. The most complex areas to access were the pelvis and left upper quadrant, independently of the access route. The most difficult organs to access were the spleen (5 failed attempts; 3 of 7 kinematic variables significantly improved) and rectum (4 failed attempts; 5 of 7 kinematic variables significantly improved). The time needed to access the rectum through a transgastric approach was 206·3 s without and 54·9 s with IR-NOTES (P = 0·027). CONCLUSION The IR-NOTES system enhanced both navigation efficacy and ease of intra-abdominal NOTES exploration for operators of all levels. The system rendered some organs accessible to non-expert operators, thereby reducing one impediment to NOTES procedures.
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Affiliation(s)
- D E Azagury
- Minimally Invasive and Bariatric Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Beyond conventional endoscopic ultrasound: elastography, contrast enhancement and hybrid techniques. Curr Opin Gastroenterol 2011; 27:423-9. [PMID: 21844751 DOI: 10.1097/mog.0b013e328349cfab] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Endoscopic ultrasound (EUS) recently became a technique with a major clinical impact in digestive diseases. EUS determines a change in the diagnosis and management of more than half of examined patients. This review summarizes recent advances in the complementary EUS examination modalities such as elastography and microbubble contrast enhancement. RECENT FINDINGS EUS elastography is a well documented method that allows characterization and differentiation of pancreatic cancer and chronic pancreatitis. Quantitative elastography methods, especially based on computer analyses, retrieve numeric values and possibly eliminate the human bias. The use of contrast-enhanced EUS also allows a better visualization and differentiation of focal pancreatic lesions. A hypoenhanced mass as compared with the surrounding pancreatic parenchyma is highly suggestive for pancreatic adenocarcinoma, whereas a hyperenhanced lesion indicates an inflammatory mass. Furthermore, hybrid EUS imaging techniques (in combination with computed tomography or magnetic resonance) might be useful for an increased diagnostic confidence. SUMMARY Despite its advantages in assessing the organs situated near the gastrointestinal tract, EUS is still an operator-dependent technique. The new EUS examination modalities incorporated in modern ultrasound systems allow a highly accurate diagnosis.
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Berzin TM, Pleskow DK. Beyond simulation: can adjunctive technologies accelerate learning in gastrointestinal endoscopy? TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2011. [DOI: 10.1016/j.tgie.2011.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Obstein KL, Patil VD, Jayender J, San José Estépar R, Spofford IS, Lengyel BI, Vosburgh KG, Thompson CC. Evaluation of colonoscopy technical skill levels by use of an objective kinematic-based system. Gastrointest Endosc 2011; 73:315-21, 321.e1. [PMID: 21111413 PMCID: PMC3113705 DOI: 10.1016/j.gie.2010.09.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 09/02/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colonoscopy requires training and experience to ensure accuracy and safety. Currently, no objective, validated process exists to determine when an endoscopist has attained technical competence. Kinematics data describing movements of laparoscopic instruments have been used in surgical skill assessment to define expert surgical technique. We have developed a novel system to record kinematics data during colonoscopy and quantitatively assess colonoscopist performance. OBJECTIVE To use kinematic analysis of colonoscopy to quantitatively assess endoscopic technical performance. DESIGN Prospective cohort study. SETTING Tertiary-care academic medical center. POPULATION This study involved physicians who perform colonoscopy. INTERVENTION Application of a kinematics data collection system to colonoscopy evaluation. MAIN OUTCOME MEASUREMENTS Kinematics data, validated task load assessment instrument, and technical difficulty visual analog scale. RESULTS All 13 participants completed the colonoscopy to the terminal ileum on the standard colon model. Attending physicians reached the terminal ileum quicker than fellows (median time, 150.19 seconds vs 299.86 seconds; p<.01) with reduced path lengths for all 4 sensors, decreased flex (1.75 m vs 3.14 m; P=.03), smaller tip angulation, reduced absolute roll, and lower curvature of the endoscope. With performance of attending physicians serving as the expert reference standard, the mean kinematic score increased by 19.89 for each decrease in postgraduate year (P<.01). Overall, fellows experienced greater mental, physical, and temporal demand than did attending physicians. LIMITATION Small cohort size. CONCLUSION Kinematic data and score calculation appear useful in the evaluation of colonoscopy technical skill levels. The kinematic score appears to consistently vary by year of training. Because this assessment is nonsubjective, it may be an improvement over current methods for determination of competence. Ongoing studies are establishing benchmarks and characteristic profiles of skill groups based on kinematics data.
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Affiliation(s)
- Keith L Obstein
- Brigham & Women's Hospital, Center for Integration of Medicine and Innovative Technology Image Guidance Laboratory, Boston, Massachusetts 02115, USA
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9
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Shaikh SN, Thompson CC. Natural orifice translumenal surgery: Flexible platform review. World J Gastrointest Surg 2010; 2:210-6. [PMID: 21160877 PMCID: PMC2999243 DOI: 10.4240/wjgs.v2.i6.210] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Revised: 02/18/2010] [Accepted: 02/25/2010] [Indexed: 02/06/2023] Open
Abstract
Natural orifice translumenal surgery (NOTES) has garnished significant attention from surgeons and gastroenterologists, due to the fusion of flexible endoscopy and operative technique. Preliminary efforts suggest that NOTES holds potential for a less invasive approach with certain surgical conditions. Many of the hurdles encountered during the shift from open to laparoscopic surgery are now being revisited in the development of NOTES. Physician directed efforts, coupled with industry support, have brought about several NOTES specific devices and platforms to help address limitations with current instrumentation. This review addresses current flexible platforms and their attributes, advantages, disadvantages and limitations.
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Affiliation(s)
- Sohail N Shaikh
- Sohail N Shaikh, Christopher C Thompson, Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
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Coughlin G, Samavedi S, Palmer KJ, Patel VR. Role of image-guidance systems during NOTES. J Endourol 2009; 23:803-12. [PMID: 19438294 DOI: 10.1089/end.2008.0121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Natural orifice translumenal endoscopic surgery (NOTES) is a developing field with the potential to revolutionize our approach to abdominal surgery. Performing operations via a flexible endoscope introduced through a natural orifice presents several challenges to physicians. Orientation and interpretation of the endoscopic video image can be difficult. The surgeon must also learn to operate with the camera and instruments "in line." Advances in technology are currently addressing the challenges of NOTES. Image-guided navigation could potentially provide invaluable assistance during NOTES. Real-time information on spatial positioning and orientation as well as assistance with the identification of anatomy and localization of pathology are some of the possibilities. Image-guided surgery has become commonplace in disciplines such as neurosurgery where the anatomy is relatively rigid. To become widespread in intra-abdominal procedures and NOTES, advances that will allow systems to adapt to moving and deforming anatomy are needed. This article reviews the basics of image-guided surgery, the various image-guided systems, and their potential application to NOTES.
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Affiliation(s)
- Geoff Coughlin
- Global Robotics Institute, Florida Hospital Celebration Health, Orlando, 34747, USA.
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11
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San José Estépar R, Westin CF, Vosburgh KG. Towards real time 2D to 3D registration for ultrasound-guided endoscopic and laparoscopic procedures. Int J Comput Assist Radiol Surg 2009; 4:549-60. [PMID: 20033331 DOI: 10.1007/s11548-009-0369-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 05/18/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE A method to register endoscopic and laparoscopic ultrasound (US) images in real time with pre-operative computed tomography (CT) data sets has been developed with the goal of improving diagnosis, biopsy guidance, and surgical interventions in the abdomen. METHODS The technique, which has the potential to operate in real time, is based on a new phase correlation technique: LEPART, which specifies the location of a plane in the CT data which best corresponds to the US image. Validation of the method was carried out using an US phantom with cyst regions and with retrospective analysis of data sets from animal model experiments. RESULTS The phantom validation study shows that local translation displacements can be recovered for each US frame with a root mean squared error of 1.56 +/- 0.78 mm in less than 5 sec, using non-optimized algorithm implementations. CONCLUSION A new method for multimodality (preoperative CT and intraoperative US endoscopic images) registration to guide endoscopic interventions was developed and found to be efficient using clinically realistic datasets. The algorithm is inherently capable of being implemented in a parallel computing system so that full real time operation appears likely.
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Affiliation(s)
- Raúl San José Estépar
- Laboratory of Mathematics in Imaging, Brigham and Women's Hospital, Boston, MA, USA.
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12
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Abstract
Surgical errors occurring early in the learning curve of laparoscopic surgery providers delayed the uptake and progress of minimally invasive surgery (MIS) for years. This taught us a valuable lesson; innovations in surgical techniques should not be rapidly implemented until all aspects including applicability, feasibility and safety have been fully tested. In 2005, the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) published a white paper highlighting the barriers to NOTES development and identifying key elements for its progress. One of these elements is the training of future providers. Proficiency-based, virtual reality simulation will offer a feasible alternative to animal testing once the safety and efficacy parameters of NOTES are established. Recent advances in imaging including computed tomography (CT) scanning, magnetic resonance imaging (MRI) scanning, and ultrasound (US) scanning can offer improved image registration and real-time tracking. Combining these advanced imaging technologies with the newly designed virtual reality simulators will result in a fully comprehensive simulation curriculum which will offer a unique facility for future NOTES providers to train anytime, anywhere, and as much as they need to in order to achieve the pre-set proficiency levels for a variety of NOTES procedures. Furthermore they will incorporate patient-specific anatomical models obtained from patient imaging and uploaded onto the simulator to ensure face reliability and validity assurance. Training in a clean, safe environment with proximate feedback and performance analysis will help accelerate the learning curve and therefore improve patients' safety and outcomes in order to maximize the benefits of innovative access procedures such as NOTES.
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Affiliation(s)
- M Al-Akash
- National Surgical Training Centre, Royal College of Surgeons in Ireland, 121 St. Stephen's Green, Dublin 2, Ireland.
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Estépar RSJ, Stylopoulos N, Ellis R, Samset E, Westin CF, Thompson C, Vosburgh K. Towards scarless surgery: an endoscopic ultrasound navigation system for transgastric access procedures. ACTA ACUST UNITED AC 2008; 12:311-24. [PMID: 18066947 DOI: 10.3109/10929080701746892] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Scarless surgery is an innovative and promising technique that may herald a new era in surgical procedures. We have created a navigation system, named IRGUS, for endoscopic and transgastric access interventions and have validated it in in vivo pilot studies. Our hypothesis is that endoscopic ultrasound procedures will be performed more easily and efficiently if the operator is provided with approximately registered 3D and 2D processed CT images in real time that correspond to the probe position and ultrasound image. MATERIALS AND METHODS The system provides augmented visual feedback and additional contextual information to assist the operator. It establishes correspondence between the real-time endoscopic ultrasound image and a preoperative CT volume registered using electromagnetic tracking of the endoscopic ultrasound probe position. Based on this positional information, the CT volume is reformatted in approximately the same coordinate frame as the ultrasound image and displayed to the operator. RESULTS The system reduces the mental burden of probe navigation and enhances the operator's ability to interpret the ultrasound image. Using an initial rigid body registration, we measured the mis-registration error between the ultrasound image and the reformatted CT plane to be less than 5 mm, which is sufficient to enable the performance of novice users of endoscopic systems to approach that of expert users. CONCLUSIONS Our analysis shows that real-time display of data using rigid registration is sufficiently accurate to assist surgeons in performing endoscopic abdominal procedures. By using preoperative data to provide context and support for image interpretation and real-time imaging for targeting, it appears probable that both preoperative and intraoperative data may be used to improve operator performance.
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Hookey LC, Ellis R. Natural orifice translumenal endoscopic surgery (NOTES): what are we getting into? CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2007; 21:423-4. [PMID: 17637942 PMCID: PMC2657960 DOI: 10.1155/2007/109878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Lawrence C Hookey
- Division of Gastroenterology, Department of Surgery, Hotel Dieu Hospital, Queen's University, Kingston, Ontario, Canada.
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Dimaio S, Kapur T, Cleary K, Aylward S, Kazanzides P, Vosburgh K, Ellis R, Duncan J, Farahani K, Lemke H, Peters T, Lorensen WB, Gobbi D, Haller J, Clarke LL, Pizer S, Taylor R, Galloway R, Fichtinger G, Hata N, Lawson K, Tempany C, Kikinis R, Jolesz F. Challenges in image-guided therapy system design. Neuroimage 2007; 37 Suppl 1:S144-51. [PMID: 17644360 PMCID: PMC3780776 DOI: 10.1016/j.neuroimage.2007.04.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 04/13/2007] [Accepted: 04/16/2007] [Indexed: 10/23/2022] Open
Abstract
System development for image-guided therapy (IGT), or image-guided interventions (IGI), continues to be an area of active interest across academic and industry groups. This is an emerging field that is growing rapidly: major academic institutions and medical device manufacturers have produced IGT technologies that are in routine clinical use, dozens of high-impact publications are published in well regarded journals each year, and several small companies have successfully commercialized sophisticated IGT systems. In meetings between IGT investigators over the last two years, a consensus has emerged that several key areas must be addressed collaboratively by the community to reach the next level of impact and efficiency in IGT research and development to improve patient care. These meetings culminated in a two-day workshop that brought together several academic and industrial leaders in the field today. The goals of the workshop were to identify gaps in the engineering infrastructure available to IGT researchers, develop the role of research funding agencies and the recently established US-based National Center for Image Guided Therapy (NCIGT), and ultimately to facilitate the transfer of technology among research centers that are sponsored by the National Institutes of Health (NIH). Workshop discussions spanned many of the current challenges in the development and deployment of new IGT systems. Key challenges were identified in a number of areas, including: validation standards; workflows, use-cases, and application requirements; component reusability; and device interface standards. This report elaborates on these key points and proposes research challenges that are to be addressed by a joint effort between academic, industry, and NIH participants.
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Affiliation(s)
- Simon Dimaio
- Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.
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