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. 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 b ...

. 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 Fluorescence guided surgery (FGS), also called fluorescence image-guided surgery, or in the specific case of tumor resection, fluorescence guided resection, is a medical imaging technique used to detect fluorescently labelled structures during sur ...

. 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, mu ...

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 t ...

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 function ...

, CT, X-Ray and tomography. Optical topographic imaging using

structured light A structured light pattern designed for surface inspection An Automatix Seamtracker arc welding robot equipped with a camera and structured laser light source, enabling the robot to follow a welding seam automatically Structured light is the p ...

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

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 pe ...

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 using

stereotactic surgery Stereotactic surgery is a minimally invasive form of surgical intervention that makes use of a three-dimensional coordinate system to locate small targets inside the body and to perform on them some action such as ablation, biopsy, lesion, inj ...

and

radiosurgery Radiosurgery is surgery using radiation, that is, the destruction of precisely selected areas of tissue using ionizing radiation rather than excision with a blade. Like other forms of radiation therapy (also called radiotherapy), it is usually u ...

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 metabolic processes, and in other physiological activities including blood flow, ...

(PET) via technologies such as the N-localizer 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.

Benefits

Applications

Neurosurgery

Orthopedics

Urology

See also

References

Further reading