研究目的
To develop and assess the feasibility of an integrated image navigation system (RoboSurgeon System) that combines head-mounted displays with multiple image modalities for use in gasless single-port endoscopic radical prostatectomy.
研究成果
The integrated image navigation system using head-mounted displays is feasible and safe for use in gasless single-port endoscopic radical prostatectomy. It allows simultaneous and synchronous monitoring of multiple image modalities in a natural ergonomic position, potentially improving surgical safety and outcomes. The system is compact and affordable compared to alternatives like the da Vinci Surgical System, but its efficacy requires further evaluation in larger studies and other types of minimally invasive surgery.
研究不足
The study has a small sample size (5 patients) and lacks a control arm for comparison. The RoboSurgeon System requires coordination with a robotic-TRUS operator, and remote-control devices for independent manipulation are not yet implemented. Further refinement and evaluation are needed to prove actual benefits.
1：Experimental Design and Method Selection:
The study involved developing and testing the RoboSurgeon System, which integrates head-mounted displays (HMDs) with various image modalities (endoscope, transrectal ultrasound (TRUS), MRI, and HMD-mounted camera) for use in minimally invasive surgery. The system was evaluated in a clinical setting with prostate cancer patients undergoing radical prostatectomy.
2：Sample Selection and Data Sources:
Five men with clinically localized prostate cancer were selected for the study, with informed consent and institutional review board approval. Preoperative MRI and intraoperative TRUS images were used.
3：List of Experimental Equipment and Materials:
Equipment included HMD units (HMS-3000MT or prototype from Sony), endoscope system (Visera Elite and Endoeye Flex 3D from Olympus), ultrasound console (Prosound from Hitachi Aloka Medical), HMD-mounted camera, electronic health record system (Fujitsu FIP), multiplexers (VPM-H1 from MEDIAEDGE), robotic TRUS system with biplanar probe and floor-mounted stepping unit (SURE-POINT from Bard Medical), brachytherapy planning system (Oncentra Prostate from Nucletron), wound retractor (Alexis from Applied Medical), PLES retractors (from Inomedics), and a robotic endoscope holder (Aerovision from Skynet) in one case.
4：Experimental Procedures and Operational Workflow:
Patients underwent gasless single-port endoscopic radical prostatectomy. The RoboSurgeon System was set up within 10 minutes. Images from MRI, endoscope, TRUS, and HMD-mounted camera were integrated using a four-split screen on HMDs via multiplexers. The robotic TRUS system was operated by an assistant, and images were displayed synchronously. Surgeons and assistants could independently arrange images using foot pedal controllers. The surgical procedure involved standard steps for radical prostatectomy, with TRUS used to identify anatomical structures.
5：Data Analysis Methods:
Feasibility was assessed based on successful setup, image quality, intraoperative and postoperative outcomes, and absence of adverse effects. No specific statistical analysis was mentioned; the study was descriptive.
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endoscope system
Visera Elite and Endoeye Flex 3D
Olympus
Provides real-time endoscopic video feed for surgical navigation.
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head-mounted display
HMS-3000MT
Sony
Used as an individualized monitor to display integrated images from multiple modalities in a four-split screen during surgery.
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ultrasound console
Prosound
Hitachi Aloka Medical
Used for intraoperative transrectal ultrasound imaging.
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electronic health record system
Fujitsu FIP
Fujitsu
Stores and displays preoperative MRI images for reference during surgery.
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multiplexer
VPM-H1
MEDIAEDGE
Integrates and splits images from different sources for display on HMDs.
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stepping and stabilizing unit
SURE-POINT
Bard Medical
Holds and stabilizes the transrectal ultrasound probe during robotic manipulation.
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brachytherapy planning system
Oncentra Prostate
Nucletron
Operates the robotic TRUS system for automatic probe movement and adjustment.
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wound retractor
Alexis
Applied Medical
Used to create and maintain the single port access in the abdomen during surgery.
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retractor
PLES
Inomedics
Maintains the intrapelvic working space during the surgical procedure.
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robotic endoscope holder
Aerovision
Skynet
Holds and moves the endoscope automatically, synchronized with the surgeon's head movements via HMD sensor.
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MRI imager
Achieva
Philips
Used for preoperative magnetic resonance imaging of patients.
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