The overall objective of the proposed research is to fully develop and conduct clinical translation of a novel technology that provides minimally invasive surgeons an ability to visualize exposed organ surfaces as well as structures hidden by them, together with a true appreciation of depth. A long-standing need in minimally invasive laparoscopic surgery has been to see inside and around a structure before dissecting, a need that currently used laparoscopes, even when high- definition and stereoscopic, cannot meet. We plan to achieve our objective by integrating 2 real- time surgical imaging modalities: (1) newly emerged 3-dimensional (3D) laparoscopic camera technology that allows visualizing the surgical anatomy with the highest image quality currently available and perception of true depth, and (2) laparoscopic ultrasound capable of visualizing hidden structures. We call the resulting visualization capability stereoscopic augmented reality (AR), in which 3D laparoscopic video (the reality) is augmented with ultrasound findings, especially the blood vessels. Children's National Medical Center and IGI Technologies will combine their complementary expertise to meet the goals of this project. Children's National, the site of the original research and development, brings unparalleled clinical image-guided surgery expertise and resources to facilitate clinical translation. IGI Technologies, a medical imaging small business, focuses on converting academic research into products. Overall, the specific aims of the proposed research are to: (1) create a compact, high-performance, operating room-ready 3D AR visualization system, and (2) test, demonstrate, and characterize the 3D AR visualization system.
These aims are designed to develop a clinically viable system and test 2 milestones relating to acceptable image overlay accuracy and system responsiveness. Meeting these milestones will signal successful completion of Phase I and our readiness to transition to Phase II, which will include animal and human testing of the developed system. The proposed system is novel in that no clinical system that combines 3D laparoscopic video and ultrasound exits. Successful execution of the proposed research will create a smart surgical visualization system that promises to provide surgeons greater confidence, minimize complications, shorten procedure times, reduce blood loss, and help expand the utilization of minimally invasive surgeries to beyond their 9%-12% current share of all surgeries. The anticipated benefits will apply equally to pediatric and adult surgery.

Public Health Relevance

Minimally invasive surgeons are limited to a relatively flat surface view of the surgical anatomy. This project will develop and conduct clinical translation of a new surgical visualization technique that will be 3-dimensional (i.e., will show depth) and expose hidden structures below the visible surfaces. This new visualization technique has the potential to give surgeons greater confidence, minimize complications, shorten procedure times, reduce blood loss, and expand the range of minimally invasive surgeries.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Small Business Technology Transfer (STTR) Grants - Phase I (R41)
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Special Emphasis Panel (ZRG1-SBIB-T (10))
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Narayanan, Deepa
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Igi Technologies, Inc.
United States
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Liu, Xinyang; Kang, Sukryool; Plishker, William et al. (2016) Laparoscopic stereoscopic augmented reality: toward a clinically viable electromagnetic tracking solution. J Med Imaging (Bellingham) 3:045001
Liu, Xinyang; Plishker, William; Zaki, George et al. (2016) On-demand calibration and evaluation for electromagnetically tracked laparoscope in augmented reality visualization. Int J Comput Assist Radiol Surg 11:1163-71
Liu, Xinyang; Su, He; Kang, Sukryool et al. (2015) Application of single-image camera calibration for ultrasound augmented laparoscopic visualization. Proc SPIE Int Soc Opt Eng 9415: