What technical barriers exist for real-time fluoroscopic and video image overlay in robotic surgery?

Background A hypothetical advantage of the da Vinci (R) console is its ability to integrate multiple visual data sources. Current platforms for augmented reality surgery fuse pre-operative radiographic studies but are limited with their ability to update with intra-operative imaging. The aim of our study was to evaluate the feasibility of real-time radiographic image overlay with current technology. Methods S-video composite output from a fluoroscopic C-arm was superimposed onto the video output of the da Vinci device. Image superimposition disparity measurements were evaluated in a bench model. The feasibility of robotic dissection assisted by real-time cholangiogram and intravenous pyelogram was evaluated. Results Image alignment resulted in a radiographic blind spot and image disparity with severely limited application in an in vivo model. Conclusions External collisions of the robotic device and visual disparity in multiple planes negate the current implementation of fluoroscopic overlay and will require more elegant methods of computer-assisted registration. Copyright (C) 2008 John Wiley & Sons, Ltd.