title: Development of a navigation system for minimally invasive esophagectomy.
abstract: BACKGROUND
  A major challenge of minimally invasive esophagectomy is the uncertainty about the exact location of the tumor and associated lymph nodes. This study aimed to develop a navigation system for visualizing surgical instruments in relation to the tumor and anatomic structures in the chest.
  
  
  METHODS
  An immobilization device consisting of a vacuum mattress fixed to a stretcher was built to decrease patient movement and organ deformation. Computer tomography (CT) markers were embedded in the stretcher at a defined distance to a detachable plate with optical markers on the side of the stretcher. A second plate of optical markers was fixed to the operating instrument. These two optical marker plates were tracked with an optical tracking system. Their positions were then registered in a preoperative CT data set using the authors' navigation software. This allowed a real-time visualization of the instrument and target structures. To assess the accuracy of the system, the authors designed a phantom consisting of a box containing small spheres in a specific three-dimensional layout. The positions of the spheres were first measured with the navigation system and then compared with the known real positions to determine the accuracy of the system.
  
  
  RESULTS
  In the accuracy assessment, the navigation system showed a precision of 0.95 +/- 0.78 mm. In a test data set, the instrument could be successfully navigated to the tumor and target structures.
  
  
  CONCLUSIONS
  The described navigation system provided real-time information about the position and orientation of the working instrument in relation to the tumor in an experimental setup. Consequently, it might improve minimally invasive esophagectomy and allow for surgical dissection in an adequate distance to the tumor margin and ease the location of affected lymph nodes.
authors.affiliation: Department of General, Abdominal, and Transplant Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. hannes.kenngott@med.uni-heidelberg.de
authors.forename: H G
authors.initials: HG
authors.lastname: Kenngott
authors.forename: J
authors.initials: J
authors.lastname: Neuhaus
authors.forename: B P
authors.initials: BP
authors.lastname: Müller-Stich
authors.forename: I
authors.initials: I
authors.lastname: Wolf
authors.forename: M
authors.initials: M
authors.lastname: Vetter
authors.forename: H-P
authors.initials: HP
authors.lastname: Meinzer
authors.forename: J
authors.initials: J
authors.lastname: Köninger
authors.forename: M W
authors.initials: MW
authors.lastname: Büchler
authors.forename: C N
authors.initials: CN
authors.lastname: Gutt
mesh_terms: D003199:Computer Systems; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016629:Esophagectomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D019060:Minimally Invasive Surgical Procedures; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed