scholarly journals A Novel Intraoperative Ultrasound Probe for Transsphenoidal Surgery: First-in-human study

2021 ◽  
pp. 155335062110310
Author(s):  
Ivan Cabrilo ◽  
Rémi Delaunay ◽  
Clare L. Heaysman ◽  
Sebastien Ourselin ◽  
Valentina Vitiello ◽  
...  
Keyword(s):  
Surgical Navigation ◽  
Intraoperative Imaging ◽  
Human Study ◽  
Intraoperative Ultrasound ◽  
Pituitary Surgery ◽  
Ultrasound Probe ◽  
Surgical Equipment ◽  
Pituitary Fossa ◽  
Long Term Study ◽  
Stage 1

Background. Ultrasound has been explored as an alternative, less bulky, less time-consuming and less expensive means of intraoperative imaging in pituitary surgery. However, its use has been limited by the size of its probes relative to the transsphenoidal corridor. We developed a novel prototype that is more slender than previously reported forward-viewing probes and, in this report, we assess its feasibility and safety in an initial patient cohort. Method. The probe was integrated into the transsphenoidal approach in patients with pituitary adenoma, following a single-centre prospective proof of concept study design, as defined by the Innovation, Development, Exploration, Assessment and Long-Term Study (IDEAL) guidelines for assessing innovation in surgery (IDEAL stage 1 – Idea phase). Results. The probe was employed in 5 cases, and its ability to be used alongside the standard surgical equipment was demonstrated in each case. No adverse events were encountered. The average surgical time was 20 minutes longer than that of 30 contemporaneous cases operated without intraoperative ultrasound. Conclusion. We demonstrate the safety and feasibility of our novel ultrasound probe during transsphenoidal procedures to the pituitary fossa, and, as a next step, plan to integrate the device into a surgical navigation system (IDEAL Stage 2a – Development phase).

Transsellar Ultrasound in Pituitary Surgery With a Designated Probe

2015 ◽  
Vol 12 (2) ◽  
pp. 128-134 ◽  
Author(s):  
Ole Solheim ◽  
Tonni Franke Johansen ◽  
Johan Cappelen ◽  
Geirmund Unsgård ◽  
Tormod Selbekk
Keyword(s):  
Transsphenoidal Surgery ◽  
Intraoperative Imaging ◽  
Intraoperative Ultrasound ◽  
Pituitary Surgery ◽  
Extent Of Resection ◽  
Center Frequency ◽  
Ultrasound Probe ◽  
Flexible Form ◽  
Intraoperative Ultrasound Imaging ◽  
Surgical Field

Abstract BACKGROUND Anatomic orientation in transsphenoidal surgery can be difficult, and residual tumors are common. A major limitation of both direct microscopy and endoscopic visualization is the inability to see below the surface of the surgical field to confirm the location of vessels, nerves, tumor remnants, and normal pituitary tissue. OBJECTIVE To present our initial experience with a new forward-looking, custom-designed ultrasound probe for transsellar imaging. METHODS The center frequency of the prototype tightly curved linear array, bayonet-shaped probe is 12 MHz. Twenty-four patients with pituitary adenomas were included after informed consent. RESULTS With the use of transsellar ultrasound, we could confirm the location of important neurovascular structures and improve the extent of resection in 4 of 24 cases, as rated subjectively by the operating surgeons. Image quality was good. In 17 patients (71%), biochemical cures and/or complete resections were confirmed at 3 months. CONCLUSION We found the images from our custom-designed ultrasound probe to be clinically helpful for anatomic orientation during surgery, and the technology is potentially helpful for improving the extent of resection during transsphenoidal surgery. This quick and flexible form of intraoperative imaging in transsphenoidal surgery could be of great support for surgeons in both routine use and difficult cases. The concept of transsellar intraoperative ultrasound imaging can be further refined and developed.

Automated operative workflow analysis of endoscopic pituitary surgery using machine learning: development and preclinical evaluation (IDEAL stage 0)

2021 ◽  
pp. 1-8
Author(s):  
Danyal Z. Khan ◽  
Imanol Luengo ◽  
Santiago Barbarisi ◽  
Carole Addis ◽  
Lucy Culshaw ◽  
...  
Keyword(s):  
Machine Learning ◽  
Human Study ◽  
Time Integration ◽  
Surgical Techniques ◽  
Pituitary Surgery ◽  
Surgical Workflow ◽  
Surgical Workflow Analysis ◽  
Workflow Analysis ◽  
Long Term Study ◽  
Tumor Identification

OBJECTIVE Surgical workflow analysis involves systematically breaking down operations into key phases and steps. Automatic analysis of this workflow has potential uses for surgical training, preoperative planning, and outcome prediction. Recent advances in machine learning (ML) and computer vision have allowed accurate automated workflow analysis of operative videos. In this Idea, Development, Exploration, Assessment, Long-term study (IDEAL) stage 0 study, the authors sought to use Touch Surgery for the development and validation of an ML-powered analysis of phases and steps in the endoscopic transsphenoidal approach (eTSA) for pituitary adenoma resection, a first for neurosurgery. METHODS The surgical phases and steps of 50 anonymized eTSA operative videos were labeled by expert surgeons. Forty videos were used to train a combined convolutional and recurrent neural network model by Touch Surgery. Ten videos were used for model evaluation (accuracy, F1 score), comparing the phase and step recognition of surgeons to the automatic detection of the ML model. RESULTS The longest phase was the sellar phase (median 28 minutes), followed by the nasal phase (median 22 minutes) and the closure phase (median 14 minutes). The longest steps were step 5 (tumor identification and excision, median 17 minutes); step 3 (posterior septectomy and removal of sphenoid septations, median 14 minutes); and step 4 (anterior sellar wall removal, median 10 minutes). There were substantial variations within the recorded procedures in terms of video appearances, step duration, and step order, with only 50% of videos containing all 7 steps performed sequentially in numerical order. Despite this, the model was able to output accurate recognition of surgical phases (91% accuracy, 90% F1 score) and steps (76% accuracy, 75% F1 score). CONCLUSIONS In this IDEAL stage 0 study, ML techniques have been developed to automatically analyze operative videos of eTSA pituitary surgery. This technology has previously been shown to be acceptable to neurosurgical teams and patients. ML-based surgical workflow analysis has numerous potential uses—such as education (e.g., automatic indexing of contemporary operative videos for teaching), improved operative efficiency (e.g., orchestrating the entire surgical team to a common workflow), and improved patient outcomes (e.g., comparison of surgical techniques or early detection of adverse events). Future directions include the real-time integration of Touch Surgery into the live operative environment as an IDEAL stage 1 (first-in-human) study, and further development of underpinning ML models using larger data sets.

Image-Guided Spinal Surgery and Robotics in MIS: Where Are We Now?

2018 ◽  
Vol 1 (2) ◽  
pp. 2
Author(s):  
Chiung Chyi Shen
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Surgical Navigation ◽  
Improve Patient Safety ◽  
Intraoperative Imaging ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Image Guided

Use of pedicle screws is widespread in spinal surgery for degenerative, traumatic, and oncological diseases. The conventional technique is based on the recognition of anatomic landmarks, preparation and palpation of cortices of the pedicle under control of an intraoperative C-arm (iC-arm) fluoroscopy. With these conventional methods, the median pedicle screw accuracy ranges from 86.7% to 93.8%, even if perforation rates range from 21.1% to 39.8%.The development of novel intraoperative navigational techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous and multiplanar views of spinal anatomy. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. These systems, such as fluoroscopy-based image guidance ("virtual fluoroscopy") and computed tomography (CT)-based computer-guidance systems, have sensibly minimized risk of pedicle screw misplacement, with overall perforation rates ranging from between 14.3% and 9.3%, respectively."Virtual fluoroscopy" allows simultaneous two-dimensional (2D) guidance in multiple planes, but does not provide any axial images; quality of images is directly dependent on the resolution of the acquired fluoroscopic projections. Furthermore, computer-assisted surgical navigation systems decrease the reliance on intraoperative imaging, thus reducing the use of intraprocedure ionizing radiation. The major limitation of this technique is related to the variation of the position of the patient from the preoperative CT scan, usually obtained before surgery in a supine position, and the operative position (prone). The next technological evolution is the use of an intraoperative CT (iCT) scan, which would allow us to solve the position-dependent changes, granting a higher accuracy in the navigation system. 

Abstract 2055: A Fingertip-Mounted Ultrasound Probe for Open-Chest Echocardiographic Imaging During Heart Surgery: Pilot Studies with a New Scanning Method

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ling Hui ◽  
Ronald W Schutz ◽  
Scott Corbett ◽  
Evan Dudik ◽  
Shelly Kinnune ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Left Atrium ◽  
Heart Surgery ◽  
Intraoperative Imaging ◽  
Imaging Study ◽  
Ultrasound Probe ◽  
Pilot Studies ◽  
Scanning Method ◽  
Open Chest ◽  
Array Ultrasound

Background: We report a newly developed fingertip-mounted ultrasound probe (SonicEye®), which has been applied to an open-chest intraoperative imaging study. This probe is small, flexible, and quickly detachable. Its intuitive positioning makes it easy to acquire images in standard as well as unique views including views from the diaphragmatic surface of the left ventricle and behind the left atrium with a “heads up” that can be easily viewed by the surgeon while looking at the heart and the probe. Methods: In an open-chest study of two 12–14 kg piglets, the finger-mounted (11 mm radius, 4 – 6 MHz) and a conventional phased array ultrasound probe (Siemens 7V3C, 4 – 6 MHz) were used for scanning on a Siemens Cypress system. Images were recorded and analyzed for quality of image offline. Results: The fingertip-mounted ultrasound probe had the same performance as the conventional ultrasound probe as regards to image quality and Doppler performance. Furthermore, the probe could provide unique views from behind the left atrium and/or under the diaphragmatic surface of the left ventricle that even TEE does not match. Conclusions: The fingertip-mounted probe was able to capture high quality images during our study. This probe is easy to wear and provides high resolution unique images which should be useful for intraoperative evaluation of cardiac repairs.

Enhanced Anatomic Visualization with Ultrasound-Assisted Intracranial Image-Guidance in Neurosurgery

2002 ◽  
Vol 1 (3) ◽  
pp. 181-185 ◽  
Author(s):  
Alexandre M. N. Marinho ◽  
Manali Barua ◽  
John Haller ◽  
Timothy C. Ryken
Keyword(s):  
Image Guidance ◽  
Surgical Navigation ◽  
Intraoperative Ultrasound ◽  
Ultrasound Images ◽  
Brain Shift ◽  
Resonance Imaging ◽  
Surgical Navigation System ◽  
Ultrasound Assisted ◽  
Magnetic Resonance Imaging Mri ◽  
Ultrasound Scanner

Anatomical comparisons between ultrasound images and magnetic resonance imaging (MRI)/computed tomography (CT) preoperative images were performed in four ultrasound-assisted image-guided intracranial surgeries. An ultrasound scanner connected to a surgical navigation system allowed the neurosurgeon to acquire useful views from that integration, offering an improved method for visualization. This surgical navigation device and associated ultrasound provides real-time brain shift correction. The accuracy of navigation depends on the identification of the anatomic structures. Despite some limitations of the ultrasound images, the ability to compare preoperative MRI and intraoperative ultrasound proved useful to the surgeon.

scholarly journals The role of intraoperative ultrasound in small renal mass robotic enucleation

2016 ◽  
Vol 88 (4) ◽  
pp. 311 ◽  
Author(s):  
Roberta Gunelli ◽  
Massimo Fiori ◽  
Cristiano Salaris ◽  
Umberto Salomone ◽  
Marco Urbinati ◽  
...  
Keyword(s):  
Renal Mass ◽  
Intraoperative Ultrasound ◽  
Radical Resection ◽  
Tumor Location ◽  
Small Renal Mass ◽  
Ultrasound Probe ◽  
3D Vision ◽  
Ischemic Time ◽  
Minimal Invasiveness ◽  
Robotic Ultrasound

Introduction: As a result of the growing evidence on tumor radical resection in literature, simple enucleation has become one of the best techniques associated to robotic surgery in the treatment of renal neoplasia, as it guarantees minimal invasiveness and the maximum sparing of renal tissue, facilitating the use of reduced or zero ischemia techniques during resection. The use of a robotic ultrasound probe represents a useful tool to detect and define tumor location, especially in poorly exophytic small renal mass. Materials and methods: A total of 22 robotic enucleations were performed on < 3 cm renal neoplasias (PADUA score 18 Pz 6/7 e 4 Pz 8) using a 12-5 MHz robotic ultrasound probe (BK Drop-In 8826). Results: Once kidney had been isolated from the adipose capsule at the site of the neoplasia (2), the exact position of the lesion could be easily identified in all cases (22/22), even for mostly endophytic lesions, thanks to the insertion of the ultrasound probe through the assistant port. Images were produced and visualized by the surgeon using the TilePro feature of the DaVinci surgical system for producing a picture-in-picture image on the console screen. The margins of resection were then marked with cautery, thus allowing for speedy anatomical dissection. This reduced the time of ischemia to 8 min (6-13) and facilitated the enucleation technique when performed without clamping the renal peduncle (6/22). No complications due to the use of the ultrasound probe were observed. Conclusions: The use of an intraoperative robotic ultrasound probe has allowed for easier identification of small, mostly endophytic neoplasias, better anatomical approach, shorter ischemic time, reduced risk of pseudocapsule rupture during dissection, and easier enucleation in cases performed without clamping. It is noteworthy that the use of intraoperative ultrasound probe allows mental reconstruction of the tumor through an accurate 3D vision of the hidden field during surgical dissection.

Surgical Navigation with Intraoperative Imaging

2012 ◽  
pp. 12-20 ◽  
Author(s):  
Arya Nabavi ◽  
Andreas M. Stark ◽  
Lutz Dörner ◽  
H. Maximilian Mehdorn
Keyword(s):  
Surgical Navigation ◽  
Intraoperative Imaging

The historical evolution of transsphenoidal surgery: facilitation by technological advances

2009 ◽  
Vol 27 (3) ◽  
pp. E8 ◽  
Author(s):  
Chirag D. Gandhi ◽  
Lana D. Christiano ◽  
Jean Anderson Eloy ◽  
Charles J. Prestigiacomo ◽  
Kalmon D. Post
Keyword(s):  
Transsphenoidal Surgery ◽  
Intraoperative Imaging ◽  
Pituitary Surgery ◽  
Early History ◽  
Past Century ◽  
Historical Evolution ◽  
Surgical Microscope ◽  
The Past ◽  
Technological Advances ◽  
History Of

Over the past century, pituitary surgery has undergone multiple evolutions in surgical technique and technological advancements that have resulted in what practitioners now recognize as modern transsphenoidal surgery (TSS). Although the procedure is now well established in current neurosurgical literature, the historical maze that led to its development continues to be of interest because it allows a better appreciation of the unique contributions by the pioneers of the technique, and of the innovative spirit that continues to fuel neurosurgery. The early events in the history of TSS have already been well documented. This paper therefore summarizes the major early transitions along the timeline, and then further concentrates on some of the more recent advancements in TSS, such as the surgical microscope, fluoroscopy, endoscopy, intraoperative imaging, and frameless guidance. The account of each of these innovations is unique because they were each developed as a response to certain historical needs by the surgeon. An understanding of these more recent contributions, coupled with the early history, provides a more complete perspective on modern TSS.

A Flat-Panel Ultrasound Robot to Align an Abdominal Ultrasound Probe During Laparoscopic Partial Nephrectomy

2012 ◽  
Author(s):  
Jan D. J. Gumprecht ◽  
Florian B. Geiger ◽  
Tim C. Lueth ◽  
Jens-Uwe Stolzenburg
Keyword(s):  
Minimally Invasive ◽  
Degrees Of Freedom ◽  
Intraoperative Imaging ◽  
Abdominal Ultrasound ◽  
Kidney Tumor ◽  
Ultrasound Probe ◽  
Flat Panel ◽  
Operating Field ◽  
Operating Room Table ◽  
Laparoscopic Removal

There were over 28.000 kidney tumor incidences in Germany in 2010. Minimally invasive (laparoscopic) removal of these tumors has become more and more popular. Intraoperative imaging during these procedures is mainly performed with videolaparoscopes. However, they provide only superficial images of the operating field increasing the challenge to remove the tumor. Conventional sonographic approaches may overcome this problem but require an additional assistant to guide the probe. To eliminate the need for an additional assistant, we developed a new robot with four degrees of freedom to motorize a sonographic probe. The robot can be installed in the operating room table and is directly controlled by the surgeon with telemanipulation. In experiments we showed that the accuracy of the kinematic is above the resolution of the sonographic probe.

A Novel Platform for Image-guided Ultrasound

Neurosurgery ◽  
2006 ◽  
Vol 58 (4) ◽  
pp. 710-718 ◽  
Author(s):  
Wuttipong Tirakotai ◽  
Dorothea Miller ◽  
Stefan Heinze ◽  
Ludwig Benes ◽  
Helmut Bertalanffy ◽  
...  
Keyword(s):  
Navigation System ◽  
Imaging Modality ◽  
Intraoperative Imaging ◽  
Intraoperative Ultrasound ◽  
Image Data ◽  
Cost Effective ◽  
Present System ◽  
Data Sets ◽  
Brain Shift ◽  
Ultrasound Device

Abstract OBJECTIVE: The combination of classic neuronavigation and intraoperative ultrasound is a recent innovation in image guidance technology. However, this technique requires two hardware components (neuronavigation and an ultrasound system). It was the aim of the study to describe a new simplified technology of a so-called one-platform navigation system developed by our institution in collaboration with the industry and to demonstrate its range of various applications. METHODS: An ultrasound device (IGSonic; BrainLAB, Munich, Germany) is integrated into the VectorVision2 navigation system (BrainLAB, Munich, Germany). The IGSonic Probe 10V5 is connected to the VectorVision Navigation station via an IGSonic Device Box. Once the ultrasound probe is calibrated, the navigated ultrasound displays the sonographic image of the intracranial anatomy on the navigation screen in a composed overlay fashion. It might depict vascular structures within the ultrasound plane by a duplex mode. Ultrasound can also be operated independently from navigation. RESULTS: The VectorVision2 system combines intraoperative ultrasound data sets with preoperatively acquired neuronavigation data sets in plug and play fashion. The system provides a cost-effective intraoperative imaging modality that offers a good anatomic orientation by various composite images, including the display of the amount of brain shift. In our institution, the comprehensible interface led to a routine use of the technology by several neurosurgeons who had not been familiar with the ultrasound technology before. CONCLUSION: The integration of an ultrasound device into an existing navigation system has been successfully developed. The system offers a friendly user interface and cost-effective intraoperative imaging feedback. Although brain shift can be visualized by an image overlay technology as demonstrated by the present system, future developments should aim at fusion techniques of both intra- and preoperative image data sets.

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