Kyle Wu

Stereoscopic augmented reality for laparoscopic surgery

BackgroundConventional laparoscopes provide a flat representation of the three-dimensional (3D) operating field and are incapable of visualizing internal structures located beneath visible organ surfaces. Computed tomography (CT) and magnetic resonance (MR) images are difficult to fuse in real time with laparoscopic views due to the deformable nature of soft-tissue organs. Utilizing emerging camera technology, we have developed a real-time stereoscopic augmented-reality (AR) system for laparoscopic surgery by merging live laparoscopic ultrasound (LUS) with stereoscopic video. The system creates two new visual cues: (1) perception of true depth with improved understanding of 3D spatial relationships among anatomical structures, and (2) visualization of critical internal structures along with a more comprehensive visualization of the operating field.MethodsThe stereoscopic AR system has been designed for near-term clinical translation with seamless integration into the existing surgical workflow. It is composed of a stereoscopic vision system, a LUS system, and an optical tracker. Specialized software processes streams of imaging data from the tracked devices and registers those in real time. The resulting two ultrasound-augmented video streams (one for the left and one for the right eye) give a live stereoscopic AR view of the operating field. The team conducted a series of stereoscopic AR interrogations of the liver, gallbladder, biliary tree, and kidneys in two swine.ResultsThe preclinical studies demonstrated the feasibility of the stereoscopic AR system during in vivo procedures. Major internal structures could be easily identified. The system exhibited unobservable latency with acceptable image-to-video registration accuracy.ConclusionsWe presented the first in vivo use of a complete system with stereoscopic AR visualization capability. This new capability introduces new visual cues and enhances visualization of the surgical anatomy. The system shows promise to improve the precision and expand the capacity of minimally invasive laparoscopic surgeries.

Smart Tissue Anastomosis Robot (STAR): A Vision-Guided Robotics System for Laparoscopic Suturing

This paper introduces the smart tissue anastomosis robot (STAR). Currently, the STAR is a proof-of-concept for a vision-guided robotic system featuring an actuated laparoscopic suturing tool capable of executing running sutures from image-based commands. The STAR tool is designed around a commercially available laparoscopic suturing tool that is attached to a custom-made motor stage and the STAR supervisory control architecture that enables a surgeon to select and track incisions and the placement of stitches. The STAR supervisory-control interface provides two modes: A manual mode that enables a surgeon to specify the placement of each stitch and an automatic mode that automatically computes equally-spaced stitches based on an incision contour. Our experiments on planar phantoms demonstrate that the STAR in either mode is more accurate, up to four times more consistent and five times faster than surgeons using state-of-the-art robotic surgical system, four times faster than surgeons using manual Endo360®, and nine times faster than surgeons using manual laparoscopic tools.

Minimally Invasive Resynchronization Pacemaker: A Pediatric Animal Model

PURPOSE We developed a minimally invasive epicardial pacemaker implantation method for infants and congenital heart disease patients for whom a transvenous approach is contraindicated. The piglet is an ideal model for technical development. DESCRIPTION In 5 piglets we introduced a needle through subxiphoid approach under thoracoscopic guidance, inserting a wire into the pericardial space. Pacing leads were affixed to the left ventricular free wall and left atrial appendage. After verifying functionality with atrial and ventricular pacing and sensing, animals were euthanized. Pacemaker monitoring occurred daily for 4 days in the fifth animal. EVALUATION Through minimally invasive pericardial access, we directly visualized and fixated pacing leads to the left ventricle and left atrial appendage, successfully pacing atrium and ventricle. Epicardial structures were visualized. One piglet had contralateral pneumothorax, which resolved with needle decompression. No other adverse events occurred. CONCLUSIONS Minimally invasive epicardial pacemaker implantation in an infant model is feasible and effective. This innovation may be of value for pacing and resynchronization in infants and congenital heart disease patients. Survival studies with permanent generator implantation are under way.

Real-time epidural anesthesia guidance using optical coherence tomography needle probe

Epidural anesthesia is one of the most widely used anesthesia methods. We developed a small hand-held OCT forward-imaging needle device for real-time epidural anesthesia surgery guidance and demonstrated its feasibility through ex vivo experiments.

Imaging Spinal Structures With Polarization-Sensitive Optical Coherence Tomography

We investigate polarization-sensitive optical coherence tomography (PS-OCT) to obtain both intensity and polarization contrast images of in vivo and ex vivo spinal structures like subcutaneous fat, supraspinous ligament, interspinous ligament, ligamentum flavum, dura, and spinal cord in a piglet model. The PS-OCT can provide enhanced contrast characteristic structures compared to the intensity OCT; therefore it has the potential for guidance in spine interventional procedures.

Real-time Epidural Anesthesia Guidance Using Optical Coherence Tomography Needle Probe

Epidural anesthesia is one of the most widely used anesthesia methods. We developed a small hand-held OCT forward-imaging needle device for real-time epidural anesthesia surgery guidance and demonstrated its feasibility through ex vivo experiments.

Surgical Navigation Probe Utilizing Optical Coherence Tomography and Laser Doppler

We developed a surgical needle-type probe incorporating OCT for short range imaging and LD for long range flow detection and audio feedback. The feasibility for guidance towards blood vessels was demonstrated through in vivo experiments