title: Toward image guided robotic surgery: system validation.
abstract: OBJECTIVE
  Navigation for current robotic assisted surgical techniques is primarily accomplished through a stereo pair of laparoscopic camera images. These images provide standard optical visualization of the surface but provide no subsurface information. Image guidance methods allow the visualization of subsurface information to determine the current position in relationship to that of tracked tools.
  
  
  METHODS
  A robotic image guided surgical system was designed and implemented based on our previous laboratory studies. A series of experiments using tissue mimicking phantoms with injected target lesions was performed. The surgeon was asked to resect "tumor" tissue with and without the augmentation of image guidance using the da Vinci robotic surgical system. Resections were performed and compared to an ideal resection based on the radius of the tumor measured from preoperative computerized tomography. A quantity called the resection ratio, that is the ratio of resected tissue compared to the ideal resection, was calculated for each of 13 trials and compared.
  
  
  RESULTS
  The mean +/- SD resection ratio of procedures augmented with image guidance was smaller than that of procedures without image guidance (3.26 +/- 1.38 vs 9.01 +/- 1.81, p <0.01). Additionally, procedures using image guidance were shorter (average 8 vs 13 minutes).
  
  
  CONCLUSIONS
  It was demonstrated that there is a benefit from the augmentation of laparoscopic video with updated preoperative images. Incorporating our image guided system into the da Vinci robotic system improved overall tissue resection, as measured by our metric. Adding image guidance to the da Vinci robotic surgery system may result in the potential for improvements such as the decreased removal of benign tissue while maintaining an appropriate surgical margin.
authors.affiliation: Department of Urology Surgery, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Stanley D
authors.initials: SD
authors.lastname: Herrell
authors.forename: David Morgan
authors.initials: DM
authors.lastname: Kwartowitz
authors.forename: Paul M
authors.initials: PM
authors.lastname: Milhoua
authors.forename: Robert L
authors.initials: RL
authors.lastname: Galloway
mesh_terms: D004867:Equipment Design; D004869:Equipment Safety; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D017145:Models, Educational; D019047:Phantoms, Imaging; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D020535:Video-Assisted Surgery / Q000295:instrumentation* / Q000379:methods