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Transorbital target localization with augmented ophthalmologic surgical endoscopy

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Access to the space behind the eyeball is limited by the position of the globe anteriorly, the neurovascular structures embedded in fat posteriorly, and the tight bony confine of the orbit. These anatomical relationships have impeded application of minimally invasive procedures to the region, such as foreign body removal, tumor biopsy, or the administration of medical therapy directly to the optic nerve. An image-guided system was developed using a magnetically tracked flexible endoscope to navigate behind the eye, with the aim of enabling accurate transorbital surgery to user-specified target locations.

Methods

Targets were defined by microspherical bulbs containing water or gadolinium contrast, with differing visible coloring agent. Six living pigs were anesthetized and two microspheres of differing color and contrast content were implanted in the fat tissue of each orbit. Preoperative T1-weighted MRI volumes were obtained and registered intraoperatively. The system capabilities were tested with a series of targeted surgical interventions. The surgeon was required to navigate the endoscope to each lucent microsphere and identify it by color. For three pigs, 3D/2D registration was performed such that the target’s image volume coordinates were used to display its location on real-time endoscope video.

Results

The ophthalmologic surgeon was able to correctly identify every target by color, with average intervention time of 24.2 min without enhancement and 3.2 min with enhancement. This difference is highly statistically significant \((p < 0.02)\) for reduction in localization time.

Conclusions

Accurate transorbital target localization is possible in-vivo using image-guided transorbital endoscopy, while endoscopic enhancement through the use of video augmentation significantly reduces procedure time.

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Acknowledgments

The authors would like to thank Amy Nunnally, Jamie Yates, and Phil Williams for their assistance with surgery, and Seth Smith with the Vanderbilt University Institute of Imaging Science for providing appropriate MR image sequences.

Conflict of interest

Michael DeLisi, Louise Mawn, and Robert Galloway declare that they have no conflict of interest. All institutional and national guidelines for the care and use of laboratory animals were followed.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Ctr, Nashville, TN, 37232, USA

    Michael P. DeLisi & Robert L. Galloway Jr.

  2. Department of Ophthalmology and Visual Sciences, Vanderbilt University, 2202 Vanderbilt Eye Institute, Nashville, TN, 37232, USA

    Louise A. Mawn

Authors
  1. Michael P. DeLisi
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  2. Louise A. Mawn
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  3. Robert L. Galloway Jr.
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Corresponding author

Correspondence to Michael P. DeLisi.

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DeLisi, M.P., Mawn, L.A. & Galloway, R.L. Transorbital target localization with augmented ophthalmologic surgical endoscopy. Int J CARS 10, 1141–1148 (2015). https://doi.org/10.1007/s11548-014-1112-y

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  • DOI: https://doi.org/10.1007/s11548-014-1112-y

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