Teber, DoguGuven, SelcukSimpfendoerfer, TobiasBaumhauer, MathiasGueven, Esref OguzYencilek, FarukGoezen, Ali Serdar2020-03-262020-03-2620090302-28381873-7560https://dx.doi.org/10.1016/j.eururo.2009.05.017https://hdl.handle.net/20.500.12395/23313Background: Use of an augmented reality (AR)-based soft tissue navigation system in urologic laparoscopic surgery is an evolving technique. Objective: To evaluate a novel soft tissue navigation system developed to enhance the surgeon's perception and to provide decision-making guidance directly before initiation of kidney resection for laparoscopic partial nephrectomy (LPN). Design, setting, and participants: Custom-designed navigation aids, a mobile C-arm capable of cone-beam imaging, and a standard personal computer were used. The feasibility and reproducibility of inside-out tracking principles were evaluated in a porcine model with an artificially created intraparenchymal tumor in vitro. The same algorithm was then incorporated into clinical practice during LPN. Interventions: Evaluation of a fully automated inside-out tracking system was repeated in exactly the same way for 10 different porcine renal units. Additionally, 10 patients underwent retroperitoneal LPNs under manual AR guidance by one surgeon. Measurements: The navigation errors and image-acquisition times were determined in vitro. The mean operative time, time to locate the tumor, and positive surgical margin were assessed in vivo. Results and limitations: The system was able to navigate and superpose the virtually created images and real-time images with an error margin of only 0.5 mm, and fully automated initial image acquisition took 40 ms. The mean operative time was 165 min (range: 135-195 min), and mean time to locate the tumor was 20 min (range: 1327 min). None of the cases required conversion to open surgery. Definitive histology revealed tumor-free margins in all 10 cases. Conclusions: This novel AR tracking system proved to be functional with a reasonable margin of error and image-to-image registration time. Mounting the pre- or intraoperative imaging properties on real-time videoendoscopic images in a real-time manner will simplify and increase the precision of laparoscopic procedures. (C) 2009 European Association of Urology Published by Elsevier B.V. All rights reserved.en10.1016/j.eururo.2009.05.017info:eu-repo/semantics/closedAccessComputer-Assisted SurgeryAugmented RealitySoft Tissue NavigationLaparoscopic PartialNephrectomyArticle56233233819477580Q1WOS:000268527600022Q1