Optimization of computer-assisted intraoperative guidance for complex oncological procedures

García Sevilla, Mónica

Publication:
Optimization of computer-assisted intraoperative guidance for complex oncological procedures

dc.contributor.advisor	Pascau González-Garzón, Javier
dc.contributor.author	García Sevilla, Mónica
dc.contributor.departamento	UC3M. Departamento de Bioingeniería e Ingeniería Aeroespacial	es
dc.date.accessioned	2022-05-31T10:19:06Z
dc.date.available	2022-05-31T10:19:06Z
dc.date.issued	2022-01
dc.date.submitted	2022-03-25
dc.description	Mención Internacional en el título de doctor
dc.description.abstract	The role of technology inside the operating room is constantly increasing, allowing surgical procedures previously considered impossible or too risky due to their complexity or limited access. These reliable tools have improved surgical efficiency and safety. Cancer treatment is one of the surgical specialties that has benefited most from these techniques due to its high incidence and the accuracy required for tumor resections with conservative approaches and clear margins. However, in many cases, introducing these technologies into surgical scenarios is expensive and entails complex setups that are obtrusive, invasive, and increase the operative time. In this thesis, we proposed convenient, accessible, reliable, and non-invasive solutions for two highly complex regions for tumor resection surgeries: pelvis and head and neck. We explored how the introduction of 3D printing, surgical navigation, and augmented reality in these scenarios provided high intraoperative precision. First, we presented a less invasive setup for osteotomy guidance in pelvic tumor resections based on small patient-specific instruments (PSIs) fabricated with a desktop 3D printer at a low cost. We evaluated their accuracy in a cadaveric study, following a realistic workflow, and obtained similar results to previous studies with more invasive setups. We also identified the ilium as the region more prone to errors. Then, we proposed surgical navigation using these small PSIs for image-to-patient registration. Artificial landmarks included in the PSIs substitute the anatomical landmarks and the bone surface commonly used for this step, which require additional bone exposure and is, therefore, more invasive. We also presented an alternative and more convenient installation of the dynamic reference frame used to track the patient movements in surgical navigation. The reference frame is inserted in a socket included in the PSIs and can be attached and detached without losing precision and simplifying the installation. We validated the setup in a cadaveric study, evaluating the accuracy and finding the optimal PSI configuration in the three most common scenarios for pelvic tumor resection. The results demonstrated high accuracy, where the main source of error was again incorrect placements of PSIs in regular and homogeneous regions such as the ilium. The main limitation of PSIs is the guidance error resulting from incorrect placements. To overcome this issue, we proposed augmented reality as a tool to guide PSI installation in the patient’s bone. We developed an application for smartphones and HoloLens 2 that displays the correct position intraoperatively. We measured the placement errors in a conventional and a realistic phantom, including a silicone layer to simulate tissue. The results demonstrated a significant reduction of errors with augmented reality compared to freehand placement, ensuring an installation of the PSI close to the target area. Finally, we proposed three setups for surgical navigation in palate tumor resections, using optical trackers and augmented reality. The tracking tools for the patient and surgical instruments were fabricated with low-cost desktop 3D printers and designed to provide less invasive setups compared to previous solutions. All setups presented similar results with high accuracy when tested in a 3D-printed patient-specific phantom. They were then validated in the real surgical case, and one of the solutions was applied for intraoperative guidance. Postoperative results demonstrated high navigation accuracy, obtaining optimal surgical outcomes. The proposed solution enabled a conservative surgical approach with a less invasive navigation setup. To conclude, in this thesis we have proposed new setups for intraoperative navigation in two complex surgical scenarios for tumor resection. We analyzed their navigation precision, defining the optimal configurations to ensure accuracy. With this, we have demonstrated that computer-assisted surgery techniques can be integrated into the surgical workflow with accessible and non-invasive setups. These results are a step further towards optimizing the procedures and continue improving surgical outcomes in complex surgical scenarios.	en
dc.description.degree	Programa de Doctorado en Ciencia y Tecnología Biomédica por la Universidad Carlos III de Madrid	es
dc.description.responsability	Presidente: Raúl San José Estépar.- Secretario: Alba González Álvarez.- Vocal: Simon Drouin	es
dc.identifier.uri	https://hdl.handle.net/10016/34941
dc.language.iso	eng	es
dc.relation.haspart	https://doi.org/10.1007/s11548-021-02322-3
dc.relation.haspart	https://doi.org/10.1109/ACCESS.2021.3115984
dc.relation.haspart	https://doi.org/10.3390/s21237824
dc.relation.haspart	https://doi.org/10.3389/fonc.2021.741191
dc.relation.ispartof	https://doi.org/10.1016/j.recot.2021.07.001
dc.relation.ispartof	https://doi.org/10.1007/s11548-019-01969-3
dc.relation.ispartof	https://doi.org/10.1007/s11548-020-02171-6
dc.relation.ispartof	https://doi.org/10.1007/s11548-021-02375-4
dc.rights	Atribución-NoComercial-SinDerivadas 3.0 España	*
dc.rights.accessRights	open access	en
dc.rights.uri	http://creativecommons.org/licenses/by-nc-nd/3.0/es/	*
dc.subject.eciencia	Biología y Biomedicina	es
dc.subject.other	Technology	en
dc.subject.other	Surgical procedures	en
dc.subject.other	Cancer	en
dc.title	Optimization of computer-assisted intraoperative guidance for complex oncological procedures	en
dc.type	doctoral thesis	*
dspace.entity.type	Publication