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Patient-specific simulation of pneumoperitoneum for laparoscopic surgical planning

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Title: Patient-specific simulation of pneumoperitoneum for laparoscopic surgical planning
Authors: Dawda, S
Camara, M
Pratt, P
Vale, J
Darzi, A
Mayer, E
Item Type: Journal Article
Abstract: Gas insufflation in laparoscopy deforms the abdomen and stretches the overlying skin. This limits the use of surgical image-guidance technologies and challenges the appropriate placement of trocars, which influences the operative ease and potential quality of laparoscopic surgery. This work describes the development of a platform that simulates pneumoperitoneum in a patient-specific manner, using preoperative CT scans as input data. This aims to provide a more realistic representation of the intraoperative scenario and guide trocar positioning to optimize the ergonomics of laparoscopic instrumentation. The simulation was developed by generating 3D reconstructions of insufflated and deflated porcine CT scans and simulating an artificial pneumoperitoneum on the deflated model. Simulation parameters were optimized by minimizing the discrepancy between the simulated pneumoperitoneum and the ground truth model extracted from insufflated porcine scans. Insufflation modeling in humans was investigated by correlating the simulation’s output to real post-insufflation measurements obtained from patients in theatre. The simulation returned an average error of 7.26 mm and 10.5 mm in the most and least accurate datasets respectively. In context of the initial discrepancy without simulation (23.8 mm and 19.6 mm), the methods proposed here provide a significantly improved picture of the intraoperative scenario. The framework was also demonstrated capable of simulating pneumoperitoneum in humans. This study proposes a method for realistically simulating pneumoperitoneum to achieve optimal ergonomics during laparoscopy. Although further studies to validate the simulation in humans are needed, there is the opportunity to provide a more realistic, interactive simulation platform for future image-guided minimally invasive surgery.
Issue Date: 1-Oct-2019
Date of Acceptance: 28-Aug-2019
URI: http://hdl.handle.net/10044/1/73351
DOI: https://doi.org/10.1007/s10916-019-1441-z
ISSN: 0148-5598
Publisher: Springer
Journal / Book Title: Journal of Medical Systems
Volume: 43
Issue: 10
Copyright Statement: © 2019 The Authors. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
National Institute for Health Research
Funder's Grant Number: RDB04 79560
Keywords: 0806 Information Systems
1117 Public Health and Health Services
Medical Informatics
Publication Status: Published
Article Number: 317
Online Publication Date: 2019-09-10
Appears in Collections:Department of Surgery and Cancer