title: Robust augmented reality guidance with fluorescent markers in laparoscopic surgery.
abstract: OBJECTIVE
  Laparoscopic interventions require the precise navigation of medical instruments through the patient's body, while taking critical structures into account. Although numerous concepts have been proposed for displaying subsurface anatomical detail using augmented reality, clinical translation of these methods has suffered from a lack of robustness as well as from cumbersome integration into the clinical workflow. The purpose of this study was to investigate the feasibility of a new approach to intra-operative registration based on fluorescent markers.
  
  
  METHODS
  The proposed approach to augmented reality visualization relies on metabolizable fluorescent markers that are attached to the target organ to guide a 2D/3D intra-operative registration algorithm. In an ex vivo porcine study, marker tracking performance is evaluated in the presence of smoke, blood, and tissue in the field of view of the endoscope.
  
  
  RESULTS
  In contrast to state-of-the-art needle-shaped fiducial markers, the fluorescent markers can be reliably tracked when occluded by smoke, blood or tissue. This makes the new 2D/3D intra-operative registration approach considerably more robust than state-of-the-art marker-based methods.
  
  
  CONCLUSIONS
  As the concept can be smoothly integrated into the clinical workflow, its potential for application in clinical laparoscopy is high.
authors.affiliation: Junior Group Computer-assisted Interventions, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. e.wild@dkfz-heidelberg.de.
authors.forename: Esther
authors.initials: E
authors.lastname: Wild
authors.affiliation: Department of Urology, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
authors.affiliation: Junior Group Computer-assisted Interventions, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.|Faculty of Mechanics and Electronics, Heilbronn University, Heilbronn, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schmid
authors.affiliation: Department of Urology, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Simpfendörfer
authors.affiliation: Junior Group Computer-assisted Interventions, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.|mbits imaging GmbH, Bergheimer Strasse 147, 69115, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Müller
authors.affiliation: Division of Radiopharmaceutical Chemistry, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Baranski
authors.affiliation: General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Kenngott
authors.affiliation: Division of Radiopharmaceutical Chemistry, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kopka
authors.affiliation: Junior Group Computer-assisted Interventions, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Maier-Hein
mesh_terms: D000465:Algorithms; D000818:Animals; D004396:Coloring Agents / Q000008:administration & dosage; D005240:Feasibility Studies; D057918:Fiducial Markers; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D010535:Laparoscopy / Q000379:methods*; D023421:Models, Animal; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013552:Swine
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Augmented reality; Fluorescence-guided surgery; Indocyanine green; Inside-out tracking; Intra-operative registration; Laparoscopy