title: What technical barriers exist for real-time fluoroscopic and video image overlay in robotic surgery?
abstract: BACKGROUND
  A hypothetical advantage of the da Vinci console is its ability to integrate multiple visual data sources. Current platforms for augmented reality surgery fuse pre-operative radiographic studies but are limited with their ability to update with intra-operative imaging. The aim of our study was to evaluate the feasibility of real-time radiographic image overlay with current technology.
  
  
  METHODS
  S-video composite output from a fluoroscopic C-arm was superimposed onto the video output of the da Vinci device. Image superimposition disparity measurements were evaluated in a bench model. The feasibility of robotic dissection assisted by real-time cholangiogram and intravenous pyelogram was evaluated.
  
  
  RESULTS
  Image alignment resulted in a radiographic blind spot and image disparity with severely limited application in an in vivo model.
  
  
  CONCLUSIONS
  External collisions of the robotic device and visual disparity in multiple planes negate the current implementation of fluoroscopic overlay and will require more elegant methods of computer-assisted registration.
authors.affiliation: Department of Surgery, Columbia University College of Physicians and Surgeons, St. Luke's-Roosevelt Hospital Center, New York, NY 10019, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Afthinos
authors.forename: M J
authors.initials: MJ
authors.lastname: Latif
authors.forename: F Y
authors.initials: FY
authors.lastname: Bhora
authors.forename: C P
authors.initials: CP
authors.lastname: Connery
authors.forename: J J
authors.initials: JJ
authors.lastname: McGinty
authors.forename: A
authors.initials: A
authors.lastname: Burra
authors.forename: M
authors.initials: M
authors.lastname: Attiyeh
authors.forename: G J
authors.initials: GJ
authors.lastname: Todd
authors.forename: S J
authors.initials: SJ
authors.lastname: Belsley
mesh_terms: D000818:Animals; D016477:Artifacts; D002758:Cholangiography / Q000295:instrumentation / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects* / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D016343:Monitoring, Intraoperative / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012371:Robotics / Q000295:instrumentation / Q000379:methods; D013382:Subtraction Technique / Q000009:adverse effects; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013552:Swine; D014567:Urography / Q000295:instrumentation / Q000379:methods