Image-guided surgery

Last updated September 12, 2023

Image-guided surgery (IGS) is any surgical procedure where the surgeon uses tracked surgical instruments in conjunction with preoperative or intraoperative images in order to directly or indirectly guide the procedure. Image guided surgery systems use cameras, ultrasonic, electromagnetic or a combination of fields to capture and relay the patient's anatomy and the surgeon's precise movements in relation to the patient, to computer monitors in the operating room or to augmented reality headsets (augmented reality surgical navigation technology).^[1]^[2]^[3] This is generally performed in real-time though there may be delays of seconds or minutes depending on the modality and application.

Benefits

The benefits of Image-guided surgery include greater control of the surgical procedure, real-time feedback on the effect of the intervention, reduced tissue trauma and disruption in gaining access to the anatomical structure. Image-guided surgery allows for: reduced post-operative neural deficits and adverse events associated with endovenous laser ablative procedures,^[5] and more effective removal of brain tumors that were once considered inoperable due to their size or location.^[6]

Applications

During image-guided surgery, the procedure is guided by preoperative or intraoperative imaging. Image-guided surgery has been applied to procedures involving on multiple organs such as the brain, spine, pelvis/hip, knee, lung, breast, liver, and prostate.^[7]

Part of the wider field of computer-assisted surgery, image-guided surgery can take place in hybrid operating rooms using intraoperative imaging. A hybrid operating room is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, CT scanners or MRI scanners. Most image-guided surgical procedures are minimally invasive. A field of medicine that pioneered and specializes in minimally invasive image-guided surgery is interventional radiology.

A hand-held surgical probe is an essential component of any image-guided surgery system as it provides the surgeon with a map of the designated area.^[8] During the surgical procedure, the IGS tracks the probe position and displays the anatomy beneath it as, for example, three orthogonal image slices on a workstation-based 3D imaging system. Existing IGS systems use different tracking techniques including mechanical, optical, ultrasonic, and electromagnetic.

When fluorescence modality is adopted to such devices, the technique is also called fluorescence image-guided surgery.

Image-guided surgery using medical ultrasound utilises sounds waves and as such does not require the protection and safety precautions necessary with ionising radiation modalities such as fluoroscopy, CT, X-Ray and tomography. Optical topographic imaging using structured light and machine vision stereoscopic cameras has been applied in neurosurgical navigation systems to reduce the use of intraoperative ionising radiation as well.^[9]

Modern image-guided surgery systems are often combined with robotics.^[7]

Neurosurgery

The various applications of navigation for neurosurgery have been widely used and reported for almost two decades.^[6] According to a study in 2000, researchers were already anticipating that a significant portion of neurosurgery would be performed using computer-based interventions.^[10] Recent advancements in ultrasound, including intravascular ultrasound (IVUS) allow for real-time cross sectional mapping of vessels and lateral tissues providing calibrated measurements of vessel diameters, contours and morphology.

Image-guided surgery was originally developed for treatment of brain tumors using stereotactic surgery and radiosurgery that are guided by computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) via technologies such as the N-localizer ^[11] and Sturm-Pastyr localizer.^[12]

Image-guided surgery systems are also used in spine surgery to guide the placement of implants and avoid damaging the nearby neurovascular structures.^[7]

Orthopedics

A mini-optical navigation system has been developed that makes real-time measurements to guide surgeons during total hip arthroplasty procedures.^[7] This image-guide surgery system involves a patient-mounted camera and a tracker for positional detection by the camera when mounted on surgical instruments or anatomical locations.^[7]

Urology

Image-guided surgery based on MRI is used to guide prostatic biopsy.^[7] Image guidance is used to assist surgeons with identifying anatomic landmarks and surgical planes between the prostate and neurovascular bundles during nerve-sparing procedures.^[7] This can help reduce negative effects of the procedure like sexual dysfunction and urinary incontinence.^[7]

Related Research Articles

Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peripheral nervous system.

Lars Leksell (1907–1986) was a Swedish physician and Professor of Neurosurgery at the Karolinska Institute in Stockholm, Sweden. He was the inventor of radiosurgery.

Radiosurgery is surgery using radiation, that is, the destruction of precisely selected areas of tissue using ionizing radiation rather than excision with a blade. Like other forms of radiation therapy, it is usually used to treat cancer. Radiosurgery was originally defined by the Swedish neurosurgeon Lars Leksell as "a single high dose fraction of radiation, stereotactically directed to an intracranial region of interest".

Minimally invasive procedures encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definition is invasive and many operations requiring incisions of some size are referred to as open surgery. Incisions made during open surgery can sometimes leave large wounds that may be painful and take a long time to heal. Advancements in medical technologies have enabled the development and regular use of minimally invasive procedures. For example, endovascular aneurysm repair, a minimally invasive surgery, has become the most common method of repairing abdominal aortic aneurysms in the US as of 2003. The procedure involves much smaller incisions than the corresponding open surgery procedure of open aortic surgery.

Stereotactic surgery is a minimally invasive form of surgical intervention that makes use of a three-dimensional coordinate system to locate small targets inside the body and to perform on them some action such as ablation, biopsy, lesion, injection, stimulation, implantation, radiosurgery (SRS), etc.

<span class="mw-page-title-main">Thalamotomy</span> Surgical procedure

Thalamotomy is a surgical procedure in which a functional lesion is made into the thalamus to improve the overall brain function in patients. First introduced in the 1950s, it is primarily effective for tremors such as those associated with Parkinson's disease, where a selected portion of the thalamus is surgically destroyed (ablated). Neurosurgeons use specialized equipment to precisely locate an area of the thalamus, usually choosing to work on only one side. Bilateral procedures are poorly tolerated because of increased complications and risk, including vision and speech problems. The positive effects on tremors are immediate. Other less destructive procedures are sometimes preferred, such as subthalamic deep brain stimulation, since this procedure can also improve tremors and other symptoms of PD.

<span class="mw-page-title-main">Neuroimaging</span> Set of techniques to measure and visualize aspects of the nervous system

Neuroimaging is the use of quantitative (computational) techniques to study the structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive manner. Increasingly it is also being used for quantitative research studies of brain disease and psychiatric illness. Neuroimaging is highly multidisciplinary involving neuroscience, computer science, psychology and statistics, and is not a medical specialty. Neuroimaging is sometimes confused with neuroradiology.

A fiducial marker or fiducial is an object placed in the field of view of an imaging system that appears in the image produced, for use as a point of reference or a measure. It may be either something placed into or on the imaging subject, or a mark or set of marks in the reticle of an optical instrument.

NeuroArm is an engineering research surgical robot specifically designed for neurosurgery. It is the first image-guided, MR-compatible surgical robot that has the capability to perform both microsurgery and stereotaxy.

Image-guided radiation therapy is the process of frequent imaging, during a course of radiation treatment, used to direct the treatment, position the patient, and compare to the pre-therapy imaging from the treatment plan. Immediately prior to, or during, a treatment fraction, the patient is localized in the treatment room in the same position as planned from the reference imaging dataset. An example of IGRT would include comparison of a cone beam computed tomography (CBCT) dataset, acquired on the treatment machine, with the computed tomography (CT) dataset from planning. IGRT would also include matching planar kilovoltage (kV) radiographs or megavoltage (MV) images with digital reconstructed radiographs (DRRs) from the planning CT.

Neuronavigation is the set of computer-assisted technologies used by neurosurgeons to guide or "navigate” within the confines of the skull or vertebral column during surgery, and used by psychiatrists to accurately target rTMS. The set of hardware for these purposes is referred to as a neuronavigator.

The Anne Arundel Medical Center (AAMC) is a regional health system headquartered in Annapolis, Maryland. In addition to the main campus in Annapolis, the group has outpatient pavilions in Bowie, Kent Island, Odenton, Easton and Waugh Chapel.

Patient registration is used to correlate the reference position of a virtual 3D dataset gathered by computer medical imaging with the reference position of the patient. This procedure is crucial in computer assisted surgery, in order to insure the reproducitibility of the preoperative registration and the clinical situation during surgery. The use of the term "patient registration" out of this context can lead to a confusion with the procedure of registering a patient into the files of a medical institution.

Computer-assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for surgical planning, and for guiding or performing surgical interventions. CAS is also known as computer-aided surgery, computer-assisted intervention, image-guided surgery, digital surgery and surgical navigation, but these are terms that are more or less synonymous with CAS. CAS has been a leading factor in the development of robotic surgery.

<span class="mw-page-title-main">Surgical planning</span>

Surgical planning is the preoperative method of pre-visualising a surgical intervention, in order to predefine the surgical steps and furthermore the bone segment navigation in the context of computer-assisted surgery. The surgical planning is most important in neurosurgery and oral and maxillofacial surgery. The transfer of the surgical planning to the patient is generally made using a medical navigation system.

Russell A. Brown, an American physician and computer scientist, is the inventor of the N-localizer technology that enables guidance of stereotactic surgery or radiosurgery using medical images that are obtained via computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET).

A hybrid operating room is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, X-ray computed tomography (CT) scanners or magnetic resonance imaging (MRI) scanners. These imaging devices enable minimally-invasive surgery. Minimally-invasive surgery is intended to be less traumatic for the patient and minimize incisions on the patient and perform surgery procedure through one or several small cuts.

Ferenc Andras Jolesz was a Hungarian-American physician and scientist best known for his research on image guided therapy, the process by which information derived from diagnostic imaging is used to improve the localization and targeting of diseased tissue to monitor and control treatment during surgical and interventional procedures. He pioneered the field of Magnetic Resonance Imaging-guided interventions and introduced of a variety of new medical procedures based on novel combinations of imaging and therapy delivery.

Augmented reality-assisted surgery (ARAS) is a surgical tool utilizing technology that superimposes a computer-generated image on a surgeon's view of the operative field, thus providing a composite view for the surgeon of the patient with a computer generated overlay enhancing the operative experience. It can be used for training, preparation for an operation, or performance of an operation. ARAS can be performed using a wide array of technology, including an optical head-mounted display (OHMD)—such as the Google Glass XE 22.1 or Vuzix STAR 1200 XL—and a digital overlay from robotic and laparoscopic surgery feeds. The technique has been primarily been tested in the urological and cardiovascular domains.

Bone malrotation refers to the situation that results when a bone heals out of rotational alignment from another bone, or part of bone. It often occurs as the result of a surgical complication after a fracture where intramedullary nailing (IMN) occurs, especially in the femur and tibial bones, but can also occur genetically at birth. The severity of this complication is often neglected due to its complexity to detect and treat, yet if left untreated, bone malrotation can significantly impact regular bodily functioning, and even lead to severe arthritis. Detection throughout history has become more advanced and accurate, ranging from clinical assessment to ultrasounds to CT scans. Treatment can include an osteotomy, a major surgical procedure where bones are cut and realigned correctly, or compensatory methods, where individuals learn to externally or internally rotate their limb to compensate for the rotation. Further research is currently being examined in this area to reduce occurrences of malrotation, including detailed computer navigation to improve visual accuracy during surgery.

References

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↑ "10 Augmented Reality Surgery Companies". 24 October 2019.
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↑ Grace J, Wang Y, Robinson D, Tahuil C, Xu R (2018). Retrospective Analysis: Collateral nerve damage and local tissue trauma associated with endovenous laser ablation therapy. Ultrasound Guided Endovenous Laser Ablation Union International de Phlebology World Congress. Melbourne Australia.
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↑ Jakubovic R, Guha D, Gupta S, Lu M, Jivraj J, Standish BA, et al. (October 2018). "High Speed, High Density Intraoperative 3D Optical Topographical Imaging with Efficient Registration to MRI and CT for Craniospinal Surgical Navigation". Scientific Reports. 8 (1): 14894. Bibcode:2018NatSR...814894J. doi:10.1038/s41598-018-32424-z. PMC 6173775 . PMID 30291261.
↑ Kelly PJ (January 2000). "Stereotactic surgery: what is past is prologue". Neurosurgery. 46 (1): 16–27. doi: 10.1093/neurosurgery/46.1.16 . PMID 10626931.
↑ Galloway, RL Jr. (2015). "Introduction and Historical Perspectives on Image-Guided Surgery". In Golby, AJ (ed.). Image-Guided Neurosurgery. Amsterdam: Elsevier. pp. 2–4. doi:10.1016/B978-0-12-800870-6.00001-7. ISBN 978-0-12-800870-6.
↑ Sturm V, Pastyr O, Schlegel W, Scharfenberg H, Zabel HJ, Netzeband G, Schabbert S, Berberich W (1983). "Stereotactic computer tomography with a modified Riechert-Mundinger device as the basis for integrated stereotactic neuroradiological investigations". Acta Neurochirurgica. 68 (1–2): 11–17. doi:10.1007/BF01406197. PMID 6344559. S2CID 38864553.