Image-guided surgery (IGS) is any
surgical
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
procedure where the
surgeon
In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...
uses tracked surgical instruments in conjunction with preoperative or intraoperative images in order to directly or indirectly guide the procedure. Image guided surgery systems use cameras, ultrasonic, electromagnetic or a combination or fields to capture and relay the patient's anatomy and the surgeon's precise movements in relation to the patient, to computer monitors in the operating room or to
augmented reality headsets (augmented reality surgical navigation technology). This is generally performed in real-time though there may be delays of seconds or minutes depending on the modality and application.
Image-guided surgery helps surgeons perform safer and less invasive procedures and has become a recognized standard of care in managing disorders including cranial, otorhinolaryngology, spine, orthopedic, and cardiovascular.
Benefits
The benefits of Image-guided surgery include greater control of the surgical procedure, real-time feedback on the effect of the intervention, reduced tissue trauma and disruption in gaining access to the anatomical structure. Image-guided surgery allows for: reduced post-operative neural deficits and adverse events associated with
endovenous laser ablative procedures, and more effective removal of brain tumors that were once considered inoperable due to their size or location.
Applications
During image-guided surgery, the procedure is guided by preoperative or intraoperative imaging. Image-guided surgery has been applied to procedures involving on multiple organs such as the brain, spine, pelvis/hip, knee, lung, breast, liver, and prostate.
Part of the wider field of
computer-assisted surgery
Computer-assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for surgical planning, and for guiding or performing surgical interventions. CAS is also known as computer-aided surgery, computer-assist ...
, image-guided surgery can take place in hybrid operating rooms using intraoperative imaging. A
hybrid operating room is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, CT scanners or MRI scanners. Most image-guided surgical procedures are
minimally invasive
Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definition ...
. A field of medicine that pioneered and specializes in minimally invasive image-guided surgery is
interventional radiology
Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs bo ...
.
A hand-held surgical probe is an essential component of any image-guided surgery system as it provides the surgeon with a map of the designated area. During the surgical procedure, the IGS tracks the probe position and displays the anatomy beneath it as, for example, three orthogonal image slices on a workstation-based 3D imaging system. Existing IGS systems use different tracking techniques including mechanical, optical, ultrasonic, and electromagnetic.
When
fluorescence
Fluorescence is the emission of light by a substance that has absorbed light or other electromagnetic radiation. It is a form of luminescence. In most cases, the emitted light has a longer wavelength, and therefore a lower photon energy, tha ...
modality is adopted to such devices, the technique is also called
fluorescence image-guided surgery.
Image-guided surgery using
medical ultrasound
Medical ultrasound includes diagnostic techniques (mainly imaging techniques) using ultrasound, as well as therapeutic applications of ultrasound. In diagnosis, it is used to create an image of internal body structures such as tendons, muscles ...
utilises sounds waves and as such does not require the protection and safety precautions necessary with
ionising radiation
Ionizing radiation (or ionising radiation), including nuclear radiation, consists of subatomic particles or electromagnetic waves that have sufficient energy to ionize atoms or molecules by detaching electrons from them. Some particles can travel ...
modalities such as
fluoroscopy
Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal structure and functio ...
, CT, X-Ray and tomography. Optical topographic imaging using
structured light and
machine vision
Machine vision (MV) is the technology and methods used to provide imaging-based automatic inspection and analysis for such applications as automatic inspection, process control, and robot guidance, usually in industry. Machine vision refers to ...
stereoscopic cameras has been applied in neurosurgical navigation systems to reduce the use of intraoperative
ionising radiation
Ionizing radiation (or ionising radiation), including nuclear radiation, consists of subatomic particles or electromagnetic waves that have sufficient energy to ionize atoms or molecules by detaching electrons from them. Some particles can travel ...
as well.
Modern image-guided surgery systems are often combined with
robotics
Robotics is an interdisciplinary branch of computer science and engineering. Robotics involves design, construction, operation, and use of robots. The goal of robotics is to design machines that can help and assist humans. Robotics integrat ...
.
Neurosurgery
The various applications of navigation for
neurosurgery
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peri ...
have been widely used and reported for almost two decades.
According to a study in 2000, researchers were already anticipating that a significant portion of neurosurgery would be performed using computer-based interventions. Recent advancements in ultrasound, including intravascular ultrasound (
IVUS
Intravascular ultrasound (IVUS) or intravascular echocardiography is a medical imaging methodology using a specially designed catheter with a miniaturized ultrasound probe attached to the distal end of the catheter. The proximal end of the cath ...
) allow for real-time cross sectional mapping of vessels and lateral tissues providing calibrated measurements of vessel diameters, contours and morphology.
Image-guided surgery was originally developed for treatment of brain
tumors
A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
using
stereotactic surgery and
radiosurgery that are guided by
computed tomography (CT),
magnetic resonance imaging
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...
(MRI) and
positron emission tomography
Positron emission tomography (PET) is a functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in Metabolism, metabolic processes, and in other physiological activities including bl ...
(PET) via technologies such as the
N-localizer
The N-localizer is a device that enables guidance of stereotactic surgery or radiosurgery using tomographic images that are obtained via computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET). The N-local ...
and Sturm-Pastyr localizer.
Image-guided surgery systems are also used in spine surgery to guide the placement of implants and avoid damaging the nearby neurovascular structures.
Orthopedics
A mini-optical navigation system has been developed that makes real-time measurements to guide surgeons during total hip arthroplasty procedures.
This image-guide surgery system involves a patient-mounted camera and a tracker for positional detection by the camera when mounted on surgical instruments or anatomical locations.
Urology
Image-guided surgery based on
MRI
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...
is used to guide prostatic biopsy.
Image guidance is used to assist surgeons with identifying anatomic landmarks and surgical planes between the prostate and neurovascular bundles during nerve-sparing procedures.
This can help reduce negative effects of the procedure like sexual dysfunction and urinary incontinence.
See also
*
Computer assisted surgery
Computer-assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for surgical planning, and for guiding or performing surgical interventions. CAS is also known as computer-aided surgery, computer-assist ...
*
Interventional radiology
Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs bo ...
*
Intraoperative MRI
Intraoperative magnetic resonance imaging (iMRI) refers to an operating room configuration that enables surgeons to image the patient via an MRI scanner while the patient is undergoing surgery, particularly brain surgery. iMRI reduces the risk of ...
*
Microsoft Hololens
Microsoft HoloLens is an augmented reality (AR)/ mixed reality (MR) headset developed and manufactured by Microsoft. HoloLens runs the Windows Mixed Reality platform under the Windows 10 operating system. Some of the positional tracking techn ...
*
Radiosurgery
*
Stereotactic surgery
References
Further reading
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{{DEFAULTSORT:Image-Guided Surgery
Computer-assisted surgery