Augmented Reality for Laparoscopy in Gynaecological Oncological Surgery Computer assisted and interactive robotics in the operating room

Endometrial cancer is the most common gynaecological cancer in developed countries. Treatment is based on minimally invasive surgery including removal of the primary tumour and pelvic sentinel lymph node (SLN) biopsy, to obtain all the prognostic information needed to define an adapted and personalized management. The SLN technique as a tool to assess lymph node involvement fits perfectly in the context of therapeutic de-escalation in a population with a high disease-free survival and for which quality of life is a major element to be taken into account. The problem with this condition is, on the one hand, an imprecise radiological assessment preoperatively and, on the other hand, difficulties in detecting SLN intraoperatively due to the limitations of standard detection techniques.
To enable a more reliable and reproducible identification of SLN in these patients, we developed an augmented reality navigation system based on the use of a collaborative robotic arm allowing the spatial localization of the endoscope in real time and continuously. A first surgical guidance system based on extrinsic registration has been evaluated and has shown satisfactory results in animal experiments in terms of detection and accuracy. However, due to the need for intraoperative imaging, its application was considered incompatible with routine clinical practice.

For this reason, an intrinsic registration system has been designed. Results seem very promising on a human arterial phantom model, but need to be confirmed by a clinical study.