Au cours des dernières décennies, la chirurgie mini invasive a progressivement gagné en popularité face à la chirurgie ouverte, grâce à de meilleurs bénéfices cliniques. Cependant, ce type d'intervention introduit une perte de vision directe sur la scène pour le chirurgien. L'introduction de la réalité augmentée en chirurgie mini invasive semble être une solution viable afin de remédier à ce problème et a donc été activement considérée par la recherche. Néanmoins, augmenter correctement une scène laparoscopique reste difficile à cause de la non-rigidité des tissus et organes abdominaux. En conséquence, la littérature ne fournit pas d'approche satisfaisante à la réalité augmentée en laparoscopie, car de telles méthodes manquent de précision ou requièrent un équipement supplémentaire, contraignant et onéreux. Dans ce contexte, nous présentons un nouveau paradigme à la réalité augmentée en chirurgie laparoscopique. Se reposant uniquement sur l'équipement standard d'une salle opératoire hybride, notre approche peut fournir la relation statique entre l'endoscope et un scan intraopératoire 3D. De nombreuses expériences sur un motif radio-opaque montrent quantitativement que nos augmentations sont exactes à moins d'un millimètre près. Des tests sur des données in vivo consolident la démonstration du potentiel clinique de notre approche dans plusieurs cas chirurgicaux réalistes. / Over the past decades, minimally invasive surgery has progressively become more popular than open surgery thanks to greater clinical benefits. However, this kind of intervention introduced a loss of direct vision upon the scene for the surgeon. Introducing augmented reality to minimally invasive surgery appears to be a viable solution to alleviate this drawback and has thus been an attractive topic for the research community. Yet, correctly augmenting a laparoscopic scene remains challenging, due to the non-rigidity of abdominal tissues and organs. Therefore, the literature does not report a satisfactory approach to laparoscopic augmented reality, as such methods lack accuracy or require expensive and impractical additional equipment. In light of this, we present a novel paradigm to augmented reality in abdominal minimally invasive surgery. Based only on standard hybrid operating room equipment, our approach can provide the static relationship between the endoscope and an intraoperative 3D scan. Extensive experiments on a radio-opaque pattern quantitatively show that the accuracy of our augmentations is less than one millimeter. Tests on in vivo data further demonstrates the clinical potential of our approach in several realistic surgical cases.

No description available.

Thesis (M.S.)--State University of New York at Binghamton, Department of Systems Science and Industrial Engineering, 2009. / Includes bibliographical references (leaves: 150-155).

La chirurgie laparoscopique reproduit fidèlement les principes de la chirurgie conventionnelle avec une agressioncorporelle minimale. Si cette chirurgie apparaît comme étant très avantageuse pour le patient, il s’agit d’une interventionchirurgicale difficile où la complexité du geste chirurgical est accrue, en comparaison avec la chirurgie conventionnelle.Cette complexité réside en partie dans la manipulation des instruments chirurgicaux et la visualisation dela scène chirurgicale (notamment le champ de visualisation restreint d’un endoscope classique). La prise de décisionsdu chirurgien pourrait être améliorée en identifiant des zones critiques ou d’intérêts non visibles dans la scènechirurgicale.Mes travaux de recherche visent à combiner la robotique, la vision par ordinateur et la fluorescence pour apporterune réponse à ces difficultés : l’imagerie de fluorescence fournira une information visuelle supplémentaire pour aiderle chirurgien dans la détermination des zones à opérer ou à éviter (par exemple, visualisation du canal cystique lorsd’une cholécystectomie). La robotique assurera la précision et l’efficience du geste du chirurgien ainsi qu’une visualisationet un suivi "plus intuitif" de la scène chirurgicale. L’association de ces deux technologies permettra de guideret sécuriser le geste chirurgical.Une première partie de ce travail a consisté en l’extraction d’informations visuelles dans les deux modalités d’imagerie(laparoscopie/fluorescence). Des méthodes de localisation 2D/3D en temps réel d’instruments chirurgicaux dansl’image laparoscopique et de cibles anatomiques dans l’image de fluorescence ont été conçues et développées.Une seconde partie a consisté en l’exploitation de l’information visuelle bimodale pour l’élaboration de lois de commandepour des robots porte-endoscope et porte-instrument. Des commandes par asservissement visuel d’un robotporte-endoscope pour suivre un ou plusieurs instruments dans l’image laparoscopique ou une cible d’intérêt dansl’image de fluorescence ont été mises en oeuvre.Dans l’objectif de pouvoir commander un robot porte-instrument, enfonction des informations visuelles fournies par le système d’imagerie, une méthode de calibrage basée sur l’exploitationde l’information 3D de la localisation d’instruments chirurgicaux a également été élaborée. Cet environnementmultimodal a été évalué quantitativement sur banc d’essai puis sur spécimens anatomiques.À terme ce travail pourra s’intégrer au sein d’architectures robotisées légères, non-rigidement liées, utilisant des robotsde comanipulation avec des commandes plus élaborées tel que le retour d’effort. Une telle "augmentation" descapacités de visualisation et d’action du chirurgien pourraient l’aider à optimiser la prise en charge de son patient. / Laparoscopic surgery faithfully reproduce the principles of conventional surgery with minimal physical aggression.If this surgery appears to be very beneficial for the patient, it is a difficult surgery where the complexity of surgicalact is increased, compared with conventional surgery. This complexity is partly due to the manipulation of surgicalinstruments and viewing the surgical scene (including the restricted field of view of a conventional endoscope). Thedecisions of the surgeon could be improved by identifying critical or not visible areas of interest in the surgical scene.My research aimed to combine robotics, computer vision and fluorescence to provide an answer to these problems :fluorescence imaging provides additional visual information to assist the surgeon in determining areas to operate or tobe avoided (for example, visualization of the cystic duct during cholecystectomy). Robotics will provide the accuracyand efficiency of the surgeon’s gesture as well as a visualization and a "more intuitive" tracking of the surgical scene.The combination of these two technologies will help guide and secure the surgical gesture.A first part of this work consisted in extracting visual information in both imagingmodalities (laparoscopy/fluorescence).Localization methods for 2D/3D real-time of laparoscopic surgical instruments in the laparoscopic image and anatomicaltargets in the fluorescence image have been designed and developed. A second part consisted in the exploitationof the bimodal visual information for developing control laws for robotics endoscope holder and the instrument holder.Visual servoing controls of a robotic endoscope holder to track one or more instruments in laparoscopic image ora target of interest in the fluorescence image were implemented. In order to control a robotic instrument holder withthe visual information provided by the imaging system, a calibration method based on the use of 3D information of thelocalization of surgical instruments was also developed. This multimodal environment was evaluated quantitativelyon the test bench and on anatomical specimens.Ultimately this work will be integrated within lightweight robotic architectures, not rigidly linked, using comanipulationrobots with more sophisticated controls such as force feedback. Such an "increase" viewing capabilities andsurgeon’s action could help to optimize the management of the patient.

The purpose of this study was to compare two transvaginal NOTES ovariectomy (OVE) techniques in bitches regarding technical issues, surgical time, complications, as well as plasma cortisol concentration and postoperative pain scores. A sample of 16 dogs was divided into two groups: GNH patients (n=8) underwent transvaginal hybrid-NOTES OVE; and GNT dogs (n=8) were submitted to transvaginal total-NOTES OVE. The surgical time was not different between groups. None of the dogs required rescue analgesic during or after surgery at any time point. Groups did not differ significantly from each other regarding pain scores, except for 72 hours after extubation on visual analogue scale (EVA) assessment. GNH group presented higher pain score than GNT at 72 hours. Plasma cortisol did not differ between groups in most time points. However, GNT group presented higher plasma cortisol at the baseline. Cortisol peaked at the immediate postoperative period in both groups, but was significantly raised only in the GNH group. Both NOTES OVE techniques were feasible and safe in dogs. However, proper patient selection is advised. Techniques showed similar results for all assessment. Both techniques presented low complications rates and reduced pain during and after surgery. / O presente estudo busca comparar duas novas técnicas de ovariectomia (OVE) por NOTES transvaginal em cadelas quanto a viabilidade técnica, tempo cirúrgico e incidência de complicações trans e pós-operatórias, bem como quanto à concentração de cortisol plasmático e escores de dor no período pós-operatório. Para tanto, uma amostra de 16 cadelas foi separada em dois grupos, sendo os pacientes do GNH (n=8) submetidos à OVE por NOTES transvaginal híbrida e os do grupo GNT (n=8) submetidas à OVE por NOTES transvaginal total. Os tempos cirúrgicos não diferiram entre os grupos experimentais. Nenhum dos cães requereu resgate analgésico nos períodos trans ou pós-operatório. Quanto ao escore de dor, os grupos não diferiram significativamente entre si na maioria dos tempos estudados, com exceção da avaliação nas 72 horas após extubação, na escala visual analógica (EVA), onde o GNH demonstrou índices mais elevados de dor que o grupo GNT. Os valores do cortisol plasmático não diferiram entre os grupos na maioria dos tempos, exceto no basal, onde os do grupo GNT foram superiores. Os valores mais elevados de cortisol para ambos os grupos experimentais foram encontrados no pós-operatório imediato, porém considerados significativos apenas para o grupo GNH. Ambas as técnicas de NOTES propostas se mostraram viáveis e seguras na realização de OV em cadelas, desde que executadas em pacientes selecionados quanto às condições anatômicas. As duas técnicas apresentaram resultados semelhantes para os parâmetros avaliados, com baixas taxas de complicações e reduzido estímulo álgico nos períodos trans e pós-operatório.

La réalité augmentée permet d'aider les chirurgiens à localiser pendant l'opération la position des structures d'intérêt, comme les vaisseaux sanguins. Dans le cadre de la chirurgie laparoscopique, les modèles 3D affichés durant l'intervention ne correspondent pas à la réalité à cause des déformations dues au pneumopéritoine. Cette thèse a pour objectif de corriger ces déformations afin de fournir un modèle du foie réaliste. Nous proposons de déformer le modèle préopératoire du foie à partir d'une acquisition intraopératoire de la surface antérieure du foie. Un champ de déformations entre les modèles préopératoire et intraopératoire est calculé à partir de la distance géodésique à des repères anatomiques. De plus, une simulation biomécanique du pneumopéritoine est réalisée pour prédire la position de la cavité abdomino-thoracique qui est utilisée comme condition limite. L'évaluation de cette méthode montre que l'erreur de position du foie et de ses structures internes est réduite à 1cm. / Augmented reality can provide to surgeons during intervention the positions of critical structures like vessels. The 3D models displayed during a laparoscopic surgery intervention do not fit to reality due to pneumperitoneum deformations. This thesis aim is to correct these deformations to provide a realistic liver model during intervention. We propose to deform the preoperative liver model according to an intraoperative acquisition of the liver anterior surface. A deformation field between the preoperative and intraoperative models is computed according to the geodesic distance to anatomical landmarks. Moreover, a biomechanical simulation is realised to predict the position of the abdomino-thoracic cavity which is used as boundary conditions. This method evaluation shows that the position error of the liver and its vessels is reduced to 1cm.

Background: Due to the deficit of knowledge on fine motor skill far transfer from one domain of expertise to another, piano performance and surgical training serve as a relevant, interdisciplinary context in which to study the transfer of motor skills given both have relatively well-established levels of performance and require complex fine motor skills. Musicians tend to demonstrate greater ease in all aspects of procedural knowledge which are known to contribute to the early stages of motor learning. Previous research in the Piano Pedagogy Research Laboratory (PPRL) found that extensive piano training was correlated with faster learning of surgical knot-tying skills. However, the short-term two-day timeline was a limitation of the study. Objective: Our project has built on previous work in the PPRL to address the short-term nature of previous studies by measuring a long-term performance curve as well as retention of surgical training and also expanded on the previous project by focussing this time on laparoscopic tasks. This study compared performance curves of two participant groups (pianists and controls) over five consecutive days and retention one week later, as measured by speed and accuracy of task completion. Laparoscopic training consisted of six tasks repeated at every session. Since laparoscopy involves a variety of abilities concurrently, we also administered a battery of ten psychometric tests to isolate and measure specific aspects of non-motor and fine motor skills. Results: There was no statistical difference between participant groups on the majority of laparoscopic training and psychomotor assessments based on two-way mixed ANOVA and Mann-Whitney U test analysis, respectively. There were also little to no significant correlations between abilities and laparoscopic performance. The only significant confounding variable was that the control group was significantly more interested in surgery than the musician group (p = .037). Conclusion: Overall, these results demonstrate that piano performance training did not far transfer to laparoscopic surgery. This is relevant to the debate on far transfer of motor skills given this study’s robust design which addressed previous shortcomings by including a longer timeline and more specifications of musicians’ characteristics. Our findings indicate that fine motor skills are domain specific to music and surgery, respectively.

Patienter som genomgår laparoskopiska ingrepp sövs med anestesiläkemedel och behöver administration av intravenösa vätskor och inblåsning av koldioxidgas i bukhålan under operationen. Ju längre anestesitid och ju längre tid det laparoskopiska ingreppet tar desto större är risken att patienter drabbas av perioperativ hypotermi. Icke-invasiva och invasiva uppvärmningsmetoder visar kunna förebygga perioperativ hypotermin och de postoperativa komplikationer som associeras med hypotermiuppkomst vid laparoskopiska ingrepp.Syfte: Syftet är att beskriva omvårdnadsåtgärder som kan förebygga uppkomsten av perioperativ hypotermi och dess postoperativa komplikationer hos patienter som genomgår laparoskopisk kirurgi. Metod: En integrativ litteraturöversikt. Resultat: Studien visar att icke-invasiva och invasiva uppvärmningsåtgärder kan förebygga perioperativ hypotermi och minska de postoperativa komplikationerna associerade med hypotermi vid laparoskopisk kirurgi. Forcerad varmluftsbehandling visar sig vara den mest effektiva metoden för att förebygga perioperativ hypotermi. Andra icke-invasiva och invasiva värmebehandlingar är effektiva när de kombineras med varandra men inte när de administreras enskilt.Uppvärmningsmetoder visar sig förebygga uppkomst av hypotermi, bibehålla intraoperativ normotermi, öka komfort, minska postoperativa komplikationer vilket även leder till bättre återhämtning hos patienter som genomgår laparoskopisk kirurgi. Slutsats: Denna studie belyser att uppvärmnings åtgärder med invasiva och icke-invasiva uppvärmningsmetoder kan behandla och förebygga hypotermiuppkomst under den perioperativa perioden hos patienter som genomgår laparoskopisk kirurgi. Studien även visar att dessa uppvärmningsmetoder förebygger även de postoperativa komplikationer som associeras med perioperativ hypotermin vid laparoskopisk kirurgiuppkomst. / Patients undergoing laparoscopic procedures need anesthetics, intravenous fluids and insufflation of carbon dioxide gas during laparoscopic surgery. The larger the time of the anesthesia and the laparoscopic procedure is, the greater is the risk of the patients being affected by perioperative hypothermia. Non-invasive and invasive warming methods can prevent the onset of perioperative hypothermia during laparoscopic surgery. Purpose: The aim of the study is to describe the nursing interventions that can prevent the onset of perioperative hypothermia and its postoperative complications during laparoscopic surgery. Method: An integrative review. Result: The study indicates that non-invasive and invasive warming methods can prevent the onset of perioperative hypothermia and complications during laparoscopic surgery. Forced air warming turns out to be the most effective treatment to prevent perioperative hypothermia. Invasive and non-invasive warming treatments seem to be more effective in combination with each other to prevent perioperative hypothermia than when administered alone. These treatments prevent intraoperative hypothermia, maintain intraoperative normothermia, increase comfort, decrease postoperative complications and improve patient recovery after laparoscopic surgery. Conclusions: This study illustrates that non-invasive and invasive warming methods can treat and prevent the onset of perioperative hypothermia during laparoscopic surgery. The study even illustrates that these warming methods prevent the postoperative complications associated with perioperative hypothermia during laparoscopic surgery.

<p>Training and ergonomics evaluation for laparoscopic surgery is an important tool for the assessment of trainees. Timely and objective assessment helps surgeons improve hand dexterity and movement precision, and perform surgery in an ergonomic manner. Traditionally, skill is evaluated by expert surgeons observing trainees, but this approach is both expensive and subjective. The approach proposed by this research employs an Ascension 3DGuidance trakSTAR system that captures the positions and orientations of hand and laparoscopic tool trajectories. Recorded trajectories are automatically analysed to extract meaningful feedback for training evaluation using statistical and machine learning methods.</p> <p>The data are acquired while a subject performs a standardized task such as peg transfer or suturing. The system records laproscopic instrument positions, hand, forearms, elbows trajectories, as well as wrist angles. We propose several metrics that attempt to objectively quantify the skill level or ergonomics of the procedure. The metrics for surgical skills are based on surgical instrument tip trajectories, whereas the ergonomics metric uses wrist angles. These metrics have been developed using statistical and machine learning methods.</p> <p>The metrics have been experimentally evaluated by using a population of seven first year postgraduate urology residents, one general surgery resident, and eight fourth year postgraduate urology residents and fellows. The machine learning approach discriminated correctly in 73% of cases between experts and novices. The machine learning approach applied to ergonomics data correctly discriminates between experts and novices in 88% of the cases for the peg transfer task and 75% for the suturing task. We also propose a method to derive a competency-based score using either statistical or machine learning derived metrics.</p> <p>Initial experimental data show that the proposed methods discriminate between the skills and ergonomics of expert and novice surgeons. The proposed system can be a valuable tool for research and training evaluation in laparoscopic surgery.</p> / Master of Applied Science (MASc)

A cirurgia geral tem experimentado após a década de noventa, com o desenvolvimento da laparoscopia, espetacular melhoria em todos os resultados. Uma menor morbimortalidade se deve ao menor trauma cirúrgico causado pelas cirurgias feitas por pequenos orifícios. O desenvolvimento tecnológico de endoscópios rígidos e flexíveis, propiciou aos médicos um acesso direto às patologias abdominais sem a necessidade de grandes aberturas da cavidade celômica. Assim, houve grande melhoria não somente dos resultados estéticos, mas principalmente na redução de morbidade. Nas cirurgias das vias biliares isso não foi diferente. Com o aprimoramento da técnica cirúrgica laparoscópica, a via de acesso cirúrgico endoscópica passou a ser preferida. Entretanto, a realidade da laparoscopia em muitos locais não se faz presente no tratamento da coledocolitíase, principalmente quando tal patologia é tratada em centros com menor aporte de recursos financeiros. A retirada de cálculos da via biliar principal exige o uso de fibroscópios de alto custo, bem como dispositivos descartáveis de alto valor, forçando o cirurgião desprovido de tais recursos muitas vezes a realizar a cirurgia de maneira convencional ou, no mínimo, aumentado a dificuldade do procedimento por via laparoscópica. Com o intuito de equacionar tal dificuldade, propõe-se com este dispositivo, mais um conceito de abordagem para este problema, inédito, testado em macroambiente, com utilização de cateter contendo balão com polímero autoexpansivo capaz de apreender os cálculos da via biliar principal por meio de inclusão. Utilizando os preceitos da colangiografia per operatória, o novo método propõe a retirada dos cálculos da via biliar principal de maneira indireta com auxílio de métodos de imagem comuns à maioria dos hospitais de média complexidade. / General surgery has experienced after the nineties, with the development of laparoscopy, spectacular improvement in outcomes. Lower morbidity and mortality is due to less surgical trauma caused by surgeries performed by small orifices. The technological development of rigid and flexible endoscopes gave doctors direct access to abdominal pathologies without the need for large openings in the coelomic cavity. Thus, there was a great improvement not only in the aesthetic results, but mainly in the reduction of morbidity. In biliary surgeries this was not different. With the improvement of the laparoscopic surgical technique, the endoscopic cirurgical approach was favored. However, the reality of laparoscopy in many places is not present in the treatment of choledocholithiasis, especially when such pathology is treated in centers with lower financial resources. Removal of stones from the main biliary tract requires the use of high-cost fibroscopes as well as high-value disposable devices, forcing the surgeon devoid of such resources, many times undergoing conventional surgery or at a minimum, increasing the difficulty of the procedure by laparoscopic approach. With the purpose of equating this difficulty, it is proposed with this device, another concept of approach to this problem, novel, tested in macro environment, with the use of balloon catheter containing self expanding polymer capable of grasping the calculi of the common bile duct by inclusion. Using the trans-operative cholangiography precepts, the new method proposes to extract the principal biliary tract calculi indirectly with the help of imaging methods common to the most hospitals.