title: Preoperative workflow for lymph nodes staging.
abstract: OBJECTIVE
  Accurate staging of lymph nodes relies mainly on surgical exploration and manual palpation. We present a new non-invasive diagnostic approach: simulated palpation through virtual laparoscopic instruments.
  
  
  METHODS
  We set up a diagnostic process to extract lymph nodes shape and position from CTs and to analyze the trend of pixels intensities to determine tissue properties in order to feedback the force information.
  
  
  RESULTS
  We have integrated the model, obtained from both the morphological information and stiffness values, in our laparoscopy simulator and surgeons can virtually palpate, with a haptic device, the lymph nodes. We evaluated the workflow extracting lymph nodes from a case study: the feedback provided through the simulator greatly helps the surgeon in the correct staging.
  
  
  CONCLUSIONS
  Results show the feasibility of the approach and in the future we will clinically evaluate this new diagnostic methodology. We are studying the possibility to integrate CTs with other imaging systems to increase the accuracy.
authors.affiliation: Department of Computer Science, University of Verona, 37134 Verona, Italy. debora@metropolis.sci.univr.it
authors.forename: Debora
authors.initials: D
authors.lastname: Botturi
authors.forename: Francesca
authors.initials: F
authors.lastname: Pizzorni Ferrarese
authors.forename: Giulia Angela
authors.initials: GA
authors.lastname: Zamboni
authors.forename: Davide
authors.initials: D
authors.lastname: Zerbato
mesh_terms: D000005:Abdomen; D006801:Humans; D010535:Laparoscopy; D008198:Lymph Nodes / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods*; D010173:Palpation; D011300:Preoperative Care; D014057:Tomography, X-Ray Computed; D057188:Workflow