A probe-based electromagnetic navigation system to integrate computed tomography during upper gastrointestinal endoscopy

Background and study aims: For preoperative work-up, an examination tool that visualizes separately compiled diagnostics in augmented reality would be desirable. We developed a probe-based electromagnetic navigation system, which can be passed through the working channel of an endoscope, to integrate computed tomography (CT) information during upper gastrointestinal endoscopy.

Patients and methods: The target registration error (TRE) of the system was evaluated experimentally and clinically. A total of 24 study patients with upper gastrointestinal cancer were included in the study. The cancerous lesion was endoscopically located (mean duration 8.4 minutes, range 7.1 – 23.2) and the TRE (coronal, transverse, sagittal layer) was measured by comparing the distance between the navigation probe (at the tip of the endoscope) and the target lesion shown on the corresponding CT cross section.

Results: Experimental evaluations showed an accuracy in line with the system’s inherent failure rate, with a median TRE of 2.8 mm (IQR 1.8 – 4.3), 2.2 mm (0.4 – 3.7), and 2.8 mm (1.1 – 5.9) in the coronal, transverse, and sagittal planes, respectively. Clinical evaluation revealed a median TRE of 4.8 mm (1.9 – 10.1), 3.9 mm (0.7 – 7.1), and 4.2 mm (0.9 – 8.9), respectively. No complications occurred during navigated endoscopy.

Conclusions: The probe-based electromagnetic navigation system revealed high accuracy (TRE < 5 mm), facilitating improved interpretation of endoluminal imaging.

^* These author contributed equally to this work

• References

• 1 Clements DM, Bowrey DJ, Havard TJ. The role of staging investigations for oesophago-gastric carcinoma. Eur J Surg Oncol 2004; 30: 309-312
• 2 Cordin J, Lehmann K, Schneider PM. Clinical staging of adenocarcinoma of the esophagogastric junction. Recent Results Cancer Res 2010; 182: 73-83
• 3 Stein HJ, Feith M, Siewert JR. Individualized surgical strategies for cancer of the esophagogastric junction. Ann Chir Gynaecol 2000; 89: 191-198
• 4 Leira HO, Amundsen T, Tangen GA et al. A novel research platform for electromagnetic navigated bronchoscopy using cone beam CT imaging and an animal model. Minim Invasive Ther Allied Technol 2011; 20: 30-41
• 5 Fernandez-Esparrach G, San Jose Estepar R, Guarner-Argente C et al. The role of a computed tomography-based image registered navigation system for natural orifice transluminal endoscopic surgery: a comparative study in a porcine model. Endoscopy 2010; 42: 1096-1103
• 6 Kenngott HG, Wegner I, Neuhaus J et al. Magnetic tracking in the operation room using the da Vinci((R)) telemanipulator is feasible. J Robot Surg 2013; 7: 59-64
• 7 Yaniv Z, Wilson E, Lindisch D et al. Electromagnetic tracking in the clinical environment. Medical physics 2009; 36: 876-892
• 8 Gillen S, Wilhelm D, Meining A et al. The “ELITE” model: construct validation of a new training system for natural orifice transluminal endoscopic surgery (NOTES). Endoscopy 2009; 41: 395-399
• 9 Zhang JG, Liu HF. Functional imaging and endoscopy. World J Gastroenterol 2011; 17: 4277-4282
• 10 Kranzfelder M, Staub C, Fiolka A et al. Toward increased autonomy in the surgical OR: needs, requests, and expectations. Surg Endosc 2013; 27: 1681-1688
• 11 Nickel F, Kenngott HG, Neuhaus J et al. Navigation system for minimally invasive esophagectomy: experimental study in a porcine model. Surg Endosc 2013; 27: 3663-3670
• 12 Moreto M. Diagnosis of esophagogastric tumors. Endoscopy 2005; 37: 26-32
• 13 Fox MP, van Berkel V. Management of gastroesophageal junction tumors. Surg Clin North Am 2012; 92: 1199-1212
• 14 Haidegger T, Fenyvesi G, Sirokai B et al. Towards unified electromagnetic tracking system assessment-static errors. Annual International Conference of the IEEE Engineering in Medicine and Biology Society. Conf Proc IEEE Eng Med Biol Soc 2011; 2011: 1905-1908