Augmented Reality in Minimally Invasive Surgery Lucio Tommaso De Paolis Department of Innovation Engineering University of Salento Lecce, Italy lucio.depaolis@unisalento.it Giovanni Aloisio Department of Innovation Engineering University of Salento Lecce, Italy giovanni.aloisio@unisalento.it Abstract—The advantages of the Minimally Invasive Surgery are evident for the patients, but these techniques have some limitations for the surgeons. In medicine, the Augmented Reality (AR) technology allows surgeons to have a sort of “X- ray” vision of the patient’s body and can help them during the surgical procedures. In this paper we present two applications of Augmented Reality that could be used as support for a more accurate preoperative surgical planning and also for an image- guided surgery. The first AR application can support the surgeon during the needle insertion for the Radiofrequency Ablation of the liver tumours in order to guide the needle and to have a precise placement of the instrument within the lesion. The augmented visualization can avoid as much as possible to destroy healthy cells of the liver. The second AR application can support the surgeon in the preoperative surgical planning by means of the visualization of the 3D models of the organs built from patient’s medical images and in the choice of the best insertion points of the trocars in the patient’s body. Keywords - Augmented Reality, medical images, minimally invasive surgery, laparoscopic pediatric surgery, RF ablation I. INTRODUCTION One trend in surgery is the transition from open procedures to minimally invasive interventions, where visual feedback to the surgeon is only possible through the laparoscope camera and direct palpation of organs is not possible. Minimally Invasive Surgery (MIS), such as laparoscopy or endoscopy, has changed the way to practice the surgery and, as a promising technique, the use of this surgical approah is nowadays widely accepted and adopted as an alternative to classical procedures. These techniques offer the possibility to surgeons of reaching the patient’s internal anatomy in a less invasive way and causing only a minimal trauma. The diseased area is reached by means of small incisions in the body and specific instruments and a camera are inserted through these ports; during the operation a monitor shows what is going on inside the body. Shorter hospitalizations, faster bowel function return, fewer wound-related complications and a more rapid return to normal activities have contributed to accept these surgical procedures and, if the advantages of this surgical method are evident on the patients, these techniques involve some limitations for the surgeons. In particular, the imagery is in 2D and the surgeon needs to develop new skills and dexterity in order to estimate the distance from the anatomical structures and work in a very limited workspace. The acquisition of medical images (CT or MRI) associated to the latest medical image processing provides an accurate knowledge of the patient’s anatomy and pathologies and could lead to an improvement in patient care by guiding of the surgeons during the surgical procedure. The emerging Augmented Reality (AR) technology has the potential to bring the direct visualization advantages of open surgery back to minimally invasive surgery and can increase the physician’s view with information gathered from the patient’s medical images. AR technology refers to a perception of a physical real environment whose elements are merged with virtual computer-generated objects in order to create a mixed reality. In addition to a mixture of real and virtual information, an AR application has to run in real time and its virtual objects have to be aligned (registered) with real world structures. Both of these requirements guarantee that the dynamics of real world environments remain after virtual data has been added [1]. In medicine the AR technology makes it possible to overlay virtual medical images of the organs on the real patient and it allows the surgeon to have a sort of “X-ray vision” of the patient’s internal anatomy. In order to register the data and fuse virtual and real imagery in real time, special devices are used in the AR platform. An advantage of using AR in surgery could be found in a better spatial perception and in the duration of the surgical procedure that could be shorter than in conventional way. The aim of this paper is to present two AR applications that could be used as support for a more accurate surgical preoperative planning and also for an image-guided surgery. The first application can support the surgeon during the needle insertion in the radiofrequency ablation of the liver tumours; the second one allows the surgeon to choose the more appropriate points for the insertion of the trocars a pediatric laparoscopic procedure. II. PREVIOUS WORKS Motivated by the benefits that MIS can bring to patients, many research groups are now focusing on the 273 Copyright (c) IARIA, 2012. ISBN: 978-1-61208-177-9 ACHI 2012 : The Fifth International Conference on Advances in Computer-Human Interactions