Surgical cartographic navigation system for endoscopic bypass grafting

Objectives: Less orientation and missing haptic feedback are still the leading problems in Endoscopic Bypass Grafting with the da Vinci system. Support of the surgeon with improved vision and augmented reality is demanded. The augmentation of the coronary artery tree based on CT scan into the view of the endoscope is the direct approach. The results of a preclinical study show a suitable robust method with good results.

Methods: A 3D reconstructed virtual model of the coronaries based only on CT scan was registered to a patient phantom and overlaid into the video screen of the robot master consol.

Five heart phantoms were created with CT datasets and the Mimics 9.0. software. The segmented datasets were printed out with the 3D printer ZTM 510 and covered with an electrical conducting layer for the detection of the contact with the coronary artery or with the surrounding tissue.

Ten inexperienced medical students and ten daVinci experienced surgeons used this „Surgical Cartographic Navigation System“ (SCNS) in a surgery simulation with the goal of finding the LAD artery and contact the LAD with robot instruments.

Results: Set-up of SCNC took 8 minutes±3min. 68% experienced and 65% inexperienced hit the LAD correctly without statistically difference. 23% experienced and 24% inexperienced hit the target in a range of 2mm.

Conclusion: The overlaid information with the SCNS enables the surgeon to identify the coronary artery. The system is robust and easy to use with an open architecture design for technology transfer into other surgical applications.