Imaging-assisted endoscopic surgery: Cleveland clinic experience

Background and Purpose: Our initial experience in using computer-aided image assistance in minimally invasive urology was reported. Materials and Methods: The system consisted of a computer and a localizer allowing spatial localization of the position of the various surgical instruments, using a magnetic sensor as well as an optical sensor. Available imaging modality included real-time ultrasound as well as preoperative computed tomography (CT) or magnetic resonance imaging (MRI). Results: We first clinically applied the fusion system of real-time US with preoperative CT or MRI for percutanous radiofrequency/cryoablation for renal tumor. We also clinically applied an augmented reality visualization system that helps the laparoscopic surgeon to understand three-dimensional (3D) anatomies beyond the surgical view. Augmented reality was feasible and useful to facilitate the surgeon's direct interpretation of 3D anatomies of cancer or vital anatomies beyond the surgical view, using preoperative CT data during laparoscopic partial nephrectomy and intraoperative transrectal US during laparoscopic radical prostatectomy. To our knowledge, we report the first clinical use of augmented reality technology in urology. Conclusions: Imaging assistance beyond the endoscopic surgical view could increase the precision for and confidence of the surgeon, providing preoperative oncological data and understanding of the surrounding vital anatomies. Novel computer-based emerging techniques with 3D imaging technologies potentially indicate the ideal dissection plane to achieve better oncological outcomes as well as to maximize functional preservation.