Development of continuous CT-guided minimally invasive surgery

Minimally invasive laparoscopic surgeries are known to lead to improved outcomes, less scarring, and significantly faster patient recovery as compared with conventional open invasive surgeries. Laparoscopes, used to visualize internal anatomy and guide laparoscopic surgeries, however, remain limited in visualization capability. Not only do they provide a relatively flat representation of the three-dimensional (3D) anatomy, they show only the exposed surfaces. A surgeon is thus unable to see inside a structure, which limits the precision of current-generation minimally invasive surgeries and is often a source of complications. To see inside a structure before dissecting it has been a long-standing need in minimally invasive laparoscopic surgeries, a need that laparoscopy is fundamentally limited in meeting. In this work we propose to use continuous computed tomography (CT) of the surgical field as a supplementary imaging tool to guide laparoscopic surgeries. The recent emergence of 64-slice CT and its continuing evolution make it an ideal candidate for four-dimensional (3D space + time) intraoperative imaging. We also propose a novel, elastic image registration-based technique to keep the net radiation dose within acceptable levels. We have successfully created 3D renderings from multislice CT corresponding to anatomy visible within the field of view of the laparoscope in a swine. These renderings show the underlying vasculature along with their latest intraoperative orientation. With additional developments, our research has the potential to help improve the precision of laparoscopic surgeries further, reduce complications, and expand the scope of minimally invasive surgeries.