AUGMENTED REALITY NAVIGATION SYSTEM FOR LAPAROSCOPIC SURGERY FOR PEDIATRIC MALIGNANT TUMOR

The next paper is augmented Reality Navigation System for Laparoscopic surgery for pediatric malignant tumor on preparative CT image, Professor Sasaki, the Kyushu University. Thank you, Chairperson. Ladies and gentlemen, I'd like to present our paper, uh Augmented Reality Navigation System for Laparoscopic Surgery for Pediatric malignant tumor on preoperative CT images. In pediatric concluding surgery, it is sometimes difficult to detect and resect the tumor due to adhesion to the surrounding organs caused by previous surgery and the effect of the preparative chemotherapy and radiotherapy. Therefore, we believe that Pediatric oncretic surgery is a good indication for surgery using real-time navigation. We develop an air navigation system based on preoperative CT images for endoscopic surgery. This is the method. The multi multimodality markers are initially fixed on the patient body surface during preoperative CT, and the volume images are reconstructed using a 3D viewer software program. The tumor is extracted and the segmentation is performed. We use an optical tracking system for reconstruction between, uh, registration between reconstructed 3D images and body surface markers on the patient during operation. The multimodality markers are also attached to the scope and the and the direction of the laparoscopic views. We calculated. In this way, the air navigation system is uh air. Visualization was superimposed with the preoperative 3D images projected onto captured endoscopic live images. This is a typical overall image of air navigation during laparoscopic splenic surgery. As you can see, 3D reconstruction image from preoperative CT was was superimposed on real-time. Endoscopic images. Next, we present our patient using this navigation system. The patient is 4 years old girl. She was diagnosed with Williams tumor stage 2 at 2 years old of age, and she performed nephrectomy and treated with chemotherapy. When she was 3 years old. A local recurrence and lung metastasis were recognized and treated chemotherapy and radiotherapy. Lung metastasis is disappear and local recurrence was remained. This is a preoperative CT and MRI images. The size of the tumor was extremely decreased. Uh, treated by chemotherapy and radiotherapy. This is the air navigation. During operation. As you can see, we can detect the tumor before they insert the scope. The tumor is located behind the liver. Of course, this movie was already removed adhesion. We can reject the tumor using this system with minimal adiotomy without any difficulty because uh we can see the tumor from the beginning of the operation. Slide please. Next slide. Could you change to the next slide, please? Are there someone that could change to the next slide? Next patient, uh, this patient was diagnosed with alveolar abdominal sarcoma in the soft plate at 5 years of age. At 6 years of age, a metama was recognized in left chest wall and was rejected using thoracoscopy. After surgery, the patient was treated with both chemotherapy and radiotherapy. At 8 years of age, a thinning mass was detected in the left chest wall on a CT scan again. Identify and resecting the lung tumor, uh, resecting the chest wall tumor using la thoracoscopic surgery was considered difficult because uh the operation. This slide shows a preoperative CT image of the patient. Left slide figure shows the initial recurrence was recognized. Left, uh, right slide shows uh uh. Second recurrence at 80 years of age. This movie shows the air navigation system during operation. Movie, please. The movie, please. Green signal shows a recurrent tumor from 3D construction image from CT. As you can see, the tumor was not a bump, so that we cannot recognize the tumor without this navigation system. We are able to resect the tumor based on navigation system completely. So This light. Next slide, please. Could you change to this light? This navigation system for pediatric tumors were performed in 6 patients in our department. All 6 cases were detected and using this navigation system and successfully rejected without any complications. This is the conclusion. Thank you. Some question please. I went from Los Angeles, um. How much does this system cost and have you have an opportunity to compare this with perhaps intraoperative ultrasound? Uh, this is, uh, uh. $0.2 million US dollars. I, I assume that it's not too many hospitals afforded by that. Have you had an opportunity to compare that with an ultrasound? 3 Have, have you done any comparisons using the system, uh, to the intraoperative ultrasound? uh. Of course, uh, in, ah. Ultra sonography is a good method, but uh this case of the second case is uh Just all mass is not uh detected by US. So, uh, this is a, a good, uh, case for this navigation system. OK, the next question, please. Yeah, Joe Kubler Hanover, thank you very much. This is really exciting. I think it's, uh, it was a little glimpse in the future. Um, I have one question about the overlay. So I assume you, you saw the picture on the screen of the of the of the of the tower or of your laparoscopy screen, so you must have processed the, the image that comes from the, from the, from the camera. And you have put it through a computer. How you solve the problem that there's no delay in the image you see to what you do. You understand my question? Sorry, I, I can't follow you. It's difficult to process an image and operate on a processed image because you might have a delay of the image on your screen. You to the computer you put between the camera and the screen. So how you made sure that what you see is real time, that you don't get any delay in the transmission of the picture. You, you are meaning is, uh, this navigation system as a time lag or between rug image and the uh navigation image. Just one more question please thank you. Just one. Have you, do you use this, uh, system at all to elucidate or to show normal structures like the ureters or something, you know, in a, uh, colorectal case? microphone is Your micro Have you used this at all to show normal structures or normal anatomy such as the ureters, uh, to make sure that you don't injure them during a case? No muscle. 2 tumor and uh uh. We, uh, We we perform segmentation, the tumor from preoperative CT image so we can judge the tumor location from CT image so uh we can uh distinguish uh uh tumor. Thank you very much.