Hybrid optical-vision tracking in laparoscopy: accuracy of navigation and ultrasound reconstruction.

INTRODUCTION: The use of laparoscopic and robotic liver surgery is increasing. However, it presents challenges such as limited field of view and organ deformations. Surgeons rely on laparoscopic ultrasound (LUS) for guidance, but mentally correlating ultrasound images with pre-operative volumes can be difficult. In this direction, surgical navigation systems are being developed to assist with intra-operative understanding. One approach is performing intra-operative ultrasound 3D reconstructions. The accuracy of these reconstructions depends on tracking the LUS probe. MATERIAL AND METHODS: This study evaluates the accuracy of LUS probe tracking and ultrasound 3D reconstruction using a hybrid tracking approach. The LUS probe is tracked from laparoscope images, while an optical tracker tracks the laparoscope. The accuracy of hybrid tracking is compared to full optical tracking using a dual-modality tool. Ultrasound 3D reconstruction accuracy is assessed on an abdominal phantom with CT transformed into the optical tracker's coordinate system. RESULTS: Hybrid tracking achieves a tracking error < 2 mm within 10 cm between the laparoscope and the LUS probe. The ultrasound reconstruction accuracy is approximately 2 mm. CONCLUSION: Hybrid tracking shows promising results that can meet the required navigation accuracy for laparoscopic liver surgery.

Parity-time synthetic photonic lattices.

The development of new artificial structures and materials is today one of the major research challenges in optics. In most studies so far, the design of such structures has been based on the judicious manipulation of their refractive index properties. Recently, the prospect of simultaneously using gain and loss was suggested as a new way of achieving optical behaviour that is at present unattainable with standard arrangements. What facilitated these quests is the recently developed notion of 'parity-time symmetry' in optical systems, which allows a controlled interplay between gain and loss. Here we report the experimental observation of light transport in large-scale temporal lattices that are parity-time symmetric. In addition, we demonstrate that periodic structures respecting this symmetry can act as unidirectional invisible media when operated near their exceptional points. Our experimental results represent a step in the application of concepts from parity-time symmetry to a new generation of multifunctional optical devices and networks.

Observation of defect states in PT-symmetric optical lattices.

We provide the first experimental demonstration of defect states in parity-time (PT) symmetric mesh-periodic potentials. Our results indicate that these localized modes can undergo an abrupt phase transition in spite of the fact that they remain localized in a PT-symmetric periodic environment. Even more intriguing is the possibility of observing a linearly growing radiation emission from such defects provided their eigenvalue is associated with an exceptional point that resides within the continuum part of the spectrum. Localized complex modes existing outside the band-gap regions are also reported along with their evolution dynamics.

Photon propagation in a discrete fiber network: an interplay of coherence and losses.

We study light propagation in a photonic system that shows stepwise evolution in a discretized environment. It resembles a discrete-time version of photonic waveguide arrays or quantum walks. By introducing controlled photon losses to our experimental setup, we observe unexpected effects like subexponential energy decay and formation of complex fractal patterns. This demonstrates that the interplay of linear losses, discreteness and energy gradients leads to genuinely new coherent phenomena in classical and quantum optical experiments. Moreover, the influence of decoherence is investigated.

Radiopaque Fiducials Guiding Laparoscopic Resection of Liver Tumors.

BACKGROUND: Minimal invasive laparoscopic resection of liver tumors is less traumatic compared with open surgical resection and may be a better option for many patients. However, localization of intrahepatic tumors remains a challenge. Availability of hybrid operating rooms, equipped for high performance radiologic imaging, allows for new methods of surgical navigation. METHODS: Twelve patients planned for laparoscopic resection of liver tumors were included. Before resection started, tumors were marked with radiopaque fiducials. Four fiducials were positioned with ultrasound within 1 cm of the tumor. Tumor and fiducials were localized with contrast enhanced cone beam computed tomography. Fluoroscopy with an overlay of cone beam computed tomography markings was projected side-by-side on the same screen as the laparoscopic view to visualize tumor location. The fiducials were eventually removed. Laparoscopic ultrasound, the standard method of localizing a tumor, was also used. The benefits of the 2 visualization methods were estimated by the operator. Procedure times, radiation doses and resection margins were recorded. RESULTS: Fluoroscopy with radiopaque fiducials provided valuable information, complementing the laparoscopic ultrasound, particularly during the early phase of resection. In the later phase, mobilization of the tumor-containing liver segment caused significant displacement of the fluoroscopic overlay. The technique evolved during course of the study, with decreasing procedure times and radiation doses. Radical resection was achieved for all patients. CONCLUSIONS: Radiopaque fiducials and fluoroscopy can complement laparoscopic ultrasound for guiding resection of liver tumors. Combining radiologic and optical imaging in a hybrid operating suit may facilitate development of augmented reality techniques for surgical navigation.

Evaluation of a novel navigation platform for laparoscopic liver surgery with organ deformation compensation using injected fiducials.

In laparoscopic liver resection, surgeons conventionally rely on anatomical landmarks detected through a laparoscope, preoperative volumetric images and laparoscopic ultrasound to compensate for the challenges of minimally invasive access. Image guidance using optical tracking and registration procedures is a promising tool, although often undermined by its inaccuracy. This study evaluates a novel surgical navigation solution that can compensate for liver deformations using an accurate and effective registration method. The proposed solution relies on a robotic C-arm to perform registration to preoperative CT/MRI image data and allows for intraoperative updates during resection using fluoroscopic images. Navigation is offered both as a 3D liver model with real-time instrument visualization, as well as an augmented reality overlay on the laparoscope camera view. Testing was conducted through a pre-clinical trial which included four porcine models. Accuracy of the navigation system was measured through two evaluation methods: liver surface fiducials reprojection and a comparison between planned and navigated resection margins. Target Registration Error with the fiducials evaluation shows that the accuracy in the vicinity of the lesion was 3.78±1.89 mm. Resection margin evaluations resulted in an overall median accuracy of 4.44 mm with a maximum error of 9.75 mm over the four subjects. The presented solution is accurate enough to be potentially clinically beneficial for surgical guidance in laparoscopic liver surgery.

Observation of optical solitons in PT-symmetric lattices.

Controlling light transport in nonlinear active environments is a topic of considerable interest in the field of optics. In such complex arrangements, of particular importance is to devise strategies to subdue chaotic behaviour even in the presence of gain/loss and nonlinearity, which often assume adversarial roles. Quite recently, notions of parity-time (PT) symmetry have been suggested in photonic settings as a means to enforce stable energy flow in platforms that simultaneously employ both amplification and attenuation. Here we report the experimental observation of optical solitons in PT-symmetric lattices. Unlike other non-conservative nonlinear arrangements where self-trapped states appear as fixed points in the parameter space of the governing equations, discrete PT solitons form a continuous parametric family of solutions. The possibility of synthesizing PT-symmetric saturable absorbers, where a nonlinear wave finds a lossless path through an otherwise absorptive system is also demonstrated.

Hybrid colloidal plasmonic-photonic crystals.

We review the recently emerged class of hybrid metal-dielectric colloidal photonic crystals. The hybrid approach is understood as the combination of a dielectric photonic crystal with a continuous metal film. It allows to achieve a strong modification of the optical properties of photonic crystals by involving the light scattering at electronic excitations in the metal component into moulding of the light flow in series to the diffraction resonances occurring in the body of the photonic crystal. We consider different realizations of hybrid plasmonic-photonic crystals based on two- and three-dimensional colloidal photonic crystals in association with flat and corrugated metal films. In agreement with model calculations, different resonance phenomena determine the optical response of hybrid crystals leading to a broadly tuneable functionality of these crystals.