The image enhanced operating environment in robot assisted laparoscopic partial nephrectomy

• Main Author: Hughes-Hallett, Archie
• Other Authors: Darzi, Ara ; Pratt, Philip ; Mayer, Erik ; Vale, Justin
• Published: Imperial College London 2016
• Subjects: 616.99
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.724143

In the last twenty-five years surgical practice has undergone radical change. Although this change has heralded improved patient outcomes it has also presented a new set of problems centred around the reduction in sensory inputs received by the modern surgeon. A potential solution to mitigate for this sensory loss is image guidance. The thesis has its heart four guiding aims: 1) To define the window of opportunity for the development of an image guidance platform for intra-abdominal MIS. 2) To establish whether there is a user need for image guidance in RAPN. 3) To better understand the fundamental safety and behavioural implications of the implementation of an IEOE. 4) To develop and validate a novel approach to image guidance in partial nephrectomy, utilising the preceding evidence base to inform this development. The first of these aims was met, through the development of a novel metric of innovation, with the growth potential of image guidance in abdominal surgical oncology subsequently examined. The second was addressed using a qualitative survey of robotic urologists. These two studies demonstrated that image guidance in intra-abdominal surgery lies in a period of rapid innovation growth, and that demand exists for image guidance in partial nephrectomy amongst the target population. In order to meet the third of the outlined aims, two potential drawbacks of augmenting the surgeon’s intraoperative view were examined, namely: inattention blindness, and the reliability and accuracy of the most commonly used method of image preparation: segmentation. Prior to the development of the platform the limitations of existing research platforms were examined and the problems needing to be addressed for efficacious image guidance were defined as part of a systematic review into image guidance in RAPN. These problems can be distilled down to issues pertaining to: image preparation, registration, deformation compensation, and display. Informed by this review and the findings of the previous thesis chapters a dual modality platform was developed capitalising on the respective strengths of pre- and intraoperative 4 imaging to deliver an image guidance solution offering significant benefit for both planning and execution phases. Overall, this thesis has systematically devised, and evidenced a first generation dual modality image guidance platform for partial nephrectomy, meeting the differing guidance needs for specific operative steps.