Laparoscopic navigation pointer for three-dimensional image-guided surgery

Background: The main drawback with the laparoscopic approach is that the surgeon is unable to palpate vessels, tumors, and organs during surgery. Furthermore, the laparoscope provides only surface view of organs. There is a need for more advanced visualizations that can enhance the view to include information below the surface of the organs for planning of the procedure and for control and guidance during treatment. Methods: We propose three-dimensional (3D) navigation technology based on preoperatively acquired magnetic resonance or computed tomography data used in combination with a laparoscopic navigation pointer (LNP). The LNP has an attached position tracker that allows the surgeon to control the display of images interactively before and during surgery. This study evaluated the patient registration accuracy, the feasibility of image-based navigation and, qualitatively, the navigation precision in the retroperitoneum during laparoscopic surgery. Results: This technology was used during the treatment of six patients (involving adrenalectomies and a neuroma protruding into the pelvis). An average patient registration accuracy of 6.90 mm was achieved. The precision during navigation in the retroperitoneum was, in some cases, better than the patient registration accuracy suggested. The technology helped the surgeons to understand better the anatomy and to locate blood vessels. Conclusions: In the reported cases, the LNP was a useful tool for image guidance in laparoscopic surgery, both for planning the surgical approach in detail and for guidance. The authors believe that adominal 3D image guidance using an LNP has a large potential for improving laparoscopic surgery, especially when vessels and anatomic relations may be difficult to identify using only a laparoscope. Accordingly, they believe this new technology could increase safety and make it easier for the surgeon to perform successful laparoscopic surgery.