Surgical Navigator Safeguarding Soft Tissue during Minimally Invasive Surgery: Feasibility Test on Electromagnetic Guidance

Giuseppe Lo Presti, Vito Cela, Mauro Ferrari, and Vincenzo Ferrari

Keywords

Surgical navigation system, electromagnetic tracking, hysterectomy, ureters

Abstract

We propose a solution to avoid unwanted piercing and cutting of tubular structures, in particular ureters, in robotic surgery. We propose a surgical navigator that allows surgeons to understand in real time the path of tubular structures in respect to surgical instruments during the intervention. In humans, the ureters are ducts made of smooth muscle fibers that propel urine from the kidneys to the urinary bladder. Since they are embedded in the surrounding structures, their identification during surgery is difficult. Particularly, for surgeries whose area of interest is very close to ureters, as for hysterectomy, the risk of piercing the ureter is high because the surgeon doesn’t have information about its exact path. We can embedded coils in urologic catheters, in order to insert them in ureters during surgery, and to determine ureters path (in 3D space) by means of a commercially available electromagnetic tracking system. The catheters contain a chain of sensors that will remain in the ureters as a beacon to address the effect of tissue motion and deformation. By tracking the surgical instruments tips, we can develop a system equipped with graphic interface and alarms, avoiding the cutting of ureters, safeguarding patients and preventing related disorders. In this feasibility study we evaluated the compatibility of electromagnetic tracking with a robotic device frequently employed for this kind of interventions.

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