リアルタイムナビゲーションシステムの開発と腹腔鏡下手術への応用

Development and clinical application of augmented reality navigation system for laparoscopic surgery

◆要旨：腹腔鏡下手術におけるナビゲーションは他の領域に比べると技術的課題が多く，普及が遅れている．筆者らは，腹腔鏡の視野に合わせてナビゲーション画像を重畳表示させる，拡張現実感（augmented reality）表示ナビゲーションシステムを開発している．腹腔鏡下手術で術中情報をリアルタイムに得られるモダリティとして，エコーに着目し，先端の屈曲するエコープローブと磁気式トラッキングシステムを用いて腹腔内の3 Dエコー画像を取得し，ナビゲーションとして用い，エコー以外にも術前に撮影したCT，MRI画像に基づく3 D画像も腹腔鏡視野に重畳させることができる．腹腔鏡下手術におけるナビゲーションの問題点を概説し，ナビゲーションシステムの開発と臨床応用について筆者らの試みを紹介する．

　Recently, navigation system has found a wide acceptance in various surgical fields. However, in the field of laparoscopic surgery, because of large deformations between preoperative images and organs confirmed during the operation, clinical application of navigation system is difficult. Moreover, the restricted views and the lack of tactile sensation in laparoscopic surgery restricts the surgeon's ability and thus makes the surgeon stressful. More informations that could be used by the surgeons during the operation are necessary. We have newly developed an augmented reality（AR）navigation system which integrates the images by using an accurate three dimensional sensory system that can be utilized in laparoscopic surgery. Augmented reality visualization, which superimposes the visualized pre/intra-operative 3 D images onto captured laparoscopic live images was achieved and displayed on the monitor. The overlayed 3 D images were quickly updated and reconstructed, followed by the real laparoscopic images. We have preliminary established a'combined'AR navigation system and applied it to various clinical cases.