ORLANDO, FL (UroToday) - Dr. Gill discussed imaging advances for urologic oncology. His focus was how to use pre-operative imaging to facilitate surgeons' abilities to improve surgical outcomes. Augmented reality (AR) allows precise real-time identification of the 3-D location of various anatomical structures that are typically invisible at surgery. This concept has been applied to neurosurgery for some time. The first step is mapping of the structures with 3-D modeling. The preoperative imaging is superimposed on the CT or MRI scan to provide structural relationships. Real views of the patients are compared to virtual views to provide AR. For example the vena cava could be identified by AR during surgery so that it is not injured.

This has been tested at the Cleveland Clinic for renal and laparoscopic surgery. Body landmarks are merged to CT images in patients with renal lesions prior to cryosurgery. He showed examples of this. 3-D Doppler TRUS imaging and laparoscopic instruments are merged to the Polaris system for coordination of several optical trackers. This provides real time AR imaging used during surgery. He showed how the image is seen on the surgical image and can direct the surgery more accurately. For example, extra-capsular extension and the neurovascular bundle can be "painted" into the surgical field.

A color coded zonal navigation system can delineate distances from a tumor in order to get an appropriate surgical margin. This can be used for predictive navigation for more precise surgery with greater surgical confidence. On the monitor, the colors change as the scissors move from one zone to another thus advising the surgeon about the best surgical plane.

Body GPS is the ability to track a moving object in real time. Three transponders placed in a kidney tumor give dynamic surgical navigation to minimize the risk of a positive surgical margin.

Presented by Inderbir S. Gill, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday Contributing Editor Christopher P. Evans, MD, FACS

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