Irreversible electroporation (IRE) is a soft tissue ablation technique suitable for treatment of inoperable tumours in the pancreas The process involves applying a high voltage electric field to the tissue containing the mass using needle electrodes, leaving cancerous cells irreversibly damaged and vulnerable to apoptosis Efficacy of the treatment depends heavily on the accuracy of needle placement and requires a high degree of skill from the operator In this paper, we describe an Augmented Reality (AR) system designed to overcome the challenges associated with planning and guiding the needle insertion process Our solution, based on the HoloLens (Microsoft, USA) platform, tracks the position of the headset, needle electrodes and ultrasound (US) probe in space The proof of concept implementation of the system uses this tracking data to render real-time holographic guides on the HoloLens, giving the user insight into the current progress of needle insertion and an indication of the target needle trajectory The operator's field of view is augmented using visual guides and real-time US feed rendered on a holographic plane, eliminating the need to consult external monitors Based on these early prototypes, we are aiming to develop a system that will lower the skill level required for IRE while increasing overall accuracy of needle insertion and, hence, the likelihood of successful treatment

/pdf/augmented-reality-needle-ablation-guidance-tool-for-4z6gvxe7jl.pdf

Augmented Reality needle ablation guidance tool for Irreversible Electroporation in the pancreas

Purpose of review The aim of the article is to evaluate the actual role of extracorporeal shock-wave lithotripsy (ESWL) in the management of urolithiasis based on the new developments of flexible ureterorenoscopy (FURS) and percutaneous nephrolithotomy (PCNL). Recent findings In Western Europe, there is a significant change of techniques used for treatment of renal stones with an increase of FURS and a decrease of ESWL. The reasons for this include the change of indications, technical improvement of the endourologic armamentarium, including robotic assistance. Mostly relevant is the introduction of digital reusable and single-use flexible ureterorenoscopes, whereas micro-PCNL has been abandoned. Some companies have stopped production of lithotripters and novel ideas to improve the efficacy of shock waves have not been implemented in the actual systems. Promising shock-wave technologies include the use of burst-shock-wave lithotripsy (SWL) or high-frequent ESWL. The main advantage would be the very fast pulverization of the stone as shown in in-vitro models. Summary The role of ESWL in the management of urolithiasis is decreasing, whereas FURS is constantly progressing. Quality and safety of intracorporeal shock-wave lithotripsy using holmium:YAG-laser under endoscopic control clearly outweighs the advantages of noninvasive ESWL. To regain ground, new technologies like burst-SWL or high-frequent ESWL have to be implemented in new systems.

Extracorporeal shock-wave lithotripsy: is it still valid in the era of robotic endourology? Can it be more efficient?

Surgical data science is a scientific discipline with the objective of improving the quality of interventional healthcare and its value through capturing, organization, analysis, and modeling of data. The goal of the 1st workshop on Surgical Data Science was to bring together researchers working on diverse topics in surgical data science in order to discuss existing challenges, potential standards and new research directions in the field. Inspired by current open space and think tank formats, it was organized in June 2016 in Heidelberg. While the first day of the workshop, which was dominated by interactive sessions, was open to the public, the second day was reserved for a board meeting on which the information gathered on the public day was processed by (1) discussing remaining open issues, (2) deriving a joint definition for surgical data science and (3) proposing potential strategies for advancing the field. This document summarizes the key findings.

pdf/surgical-data-science-a-consensus-perspective-40pr2oaji0.pdf

Surgical data science: A consensus perspective

Percutaneous radiofrequency ablation (RFA) of thyroid nodules is an alternative to surgical resection that offers the benefits of minimal scars for the patient, lower complication rates, and shorter treatment times. Ultrasound (US) is the preferred modality for guiding these procedures. The needle is usually kept within the US scanning plane to ensure needle visibility. However, this restricts flexibility in both transducer and needle movement and renders the procedure difficult, especially for inexperienced users. Existing navigation solutions often involve electromagnetic (EM) tracking, which requires placement of an external field generator (FG) in close proximity of the intervention site in order to avoid distortion of the EM field. This complicates the clinical workflow as placing the FG while ensuring that it neither restricts the physician’s workspace nor affects tracking accuracy is awkward and time-consuming. The EchoTrack concept overcomes these issues by combining the US probe and the EM FG in one modality, simultaneously providing both real-time US and tracking data without requiring the placement of an external FG for tracking. We propose a system and workflow to use EchoTrack for RFA of thyroid nodules. According to our results, the overall error of the EchoTrack system resulting from errors related to tracking and calibration is below 2 mm. Navigated thyroid RFA with the proposed concept is clinically feasible. Motion of internal critical structures relative to external markers can be up to several millimeters in extreme cases. The EchoTrack concept with its simple setup, flexibility, improved needle visualization, and additional guidance information has high potential to be clinically used for thyroid RFA.

First clinical use of the EchoTrack guidance approach for radiofrequency ablation of thyroid gland nodules.

Thyroid nodules are a common finding in general population, with a prevalence of 20% to 70% at ultrasound (US) examination. Many of them are benign but treatment can be necessary to relief compressive symptoms. In the last years, percutaneous ablations have achieved amazing development in the treatment of thyroid nodules as they provide a minimally invasive but effective approach. We aimed to summarize the main aspects related to treatment of thyroid nodules with radiofrequency ablation (RFA), focusing on the use of different types of needles. A narrative review was performed and all papers analyzed reported good results in terms of nodule's size reduction and symptoms relief. No major complications have been reported, even though needles of bigger size seemed related with major risks of post-procedural local edema. Thus, thinner internally cooled multi tined needles [18-19 Gauge (G)] rather than larger needles (14 G) seem to have better results and less complications.

Which needle in the treatment of thyroid nodules

Pd42-08 introducing a combined ultrasound and electromagnetic tracking device for navigated sonographic kidney puncture.

A thyroid-like gelatin model was used to determine potential superiority of a new navigation system for ultrasound (US)-guided electrode insertion called EchoTrack, featuring a US probe with an integrated electromagnetic field generator, in comparison with conventional US when performing radiofrequency ablation. In order to compare 20 navigated ablations with 20 ablations under conventional US guidance, a thyroid-like gelatin model was used. In each group, 10 in-plane and 10 out-of-plane punctures were performed. Metal seeds measuring 8.5 
 $$\times $$
  1.8 mm served as ablation targets. The number of redirections until final electrode placement, targeting accuracy and electrode placement time were measured. The number of redirections could be significantly (
 $$p{<}0.0001$$
 ) reduced from 2.7 ± 1.3 in the conventional group to 0.2 ± 0.5 in the EchoTrack group. Accuracy increased from 3.9 ± 4.7 to 2.0 ± 1.9 mm. The total placement time increased from 39 ± 20.5 to 79.2 ± 26 s. EchoTrack is able to reduce the redirections needed to place the electrode in comparison with conventional US and provides high placement accuracy. Our new navigation system has high potential to reduce the risk of harming critical structures and to improve guidance during ablation of difficult nodules, as treatment planning as well as the safety of out-of-plane punctures are improved.

Ultrasound-navigated radiofrequency ablation of thyroid nodules with integrated electromagnetic tracking: comparison with conventional ultrasound guidance in gelatin models

Eine der Hauptursachen fur die fehlende Translation computerbasierter Assistenzsysteme in die klininische Routine ist die schlechte Integrierbarkeit in den klinischen Arbeitsablauf. Um dieses Problem zu losen, wurde kurzlich ein neuartiges Navigationskonzept vorgestellt, welches die Darstellung von medizinischen Instrumenten in Relation zu Ultraschalldaten auf Basis einer einzigen mobilen Modalitat (EchoTrack) ermoglicht. In diesem Beitrag wird die neue Methode erstmals fur die ultraschallgef uhrte Radiofrequenzablation (RFA) von Schilddrusenknoten adaptiert. Die wissenschaftlichen Beitrage beinhalten (1) ein Konzept zum Lokalisieren der benotigten RFA Sonde unter Beachtung von Sterilit atsbedingungen, (2) die Charakterisierung der Bewegung von Halsstrukturen, welche bei ultraschallgefuhrten Interventionen durch Schlucken, Sprache, Atem, Halsdrehung und mechanischen Druck der Ultraschallsonde verursacht wird, sowie (3) die Quantifizierung des Fehlers, welche bei der Schatzung der Lage von Zielstrukturen mit einem elektromagnetischen Hautmarker entstehen. Die Ergebnisse zeigen, dass die vorgenommenen Adaptionen den Einsatz des EchoTrack-Systems fur die Schilddrusen-RFA mit hinreichender Punktionsgenauigkeit ermoglichen. Bei den getesteten Storbewegungen kommt es jedoch zu Verschiebungen anatomischer Strukturen von uber 1 cm, weshalb beim Einsatz eines Hautmarkers ein ausreichender Sicherheitsabstand mit eingerechnet werden sollte.

EchoTrack für die navigierte ultraschall-geführte Radiofrequenzablation der Schilddrüse

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First clinical use of the EchoTrack guidance approach for radiofrequency ablation of thyroid gland nodules.

Pd42-08 introducing a combined ultrasound and electromagnetic tracking device for navigated sonographic kidney puncture.

Ultrasound-navigated radiofrequency ablation of thyroid nodules with integrated electromagnetic tracking: comparison with conventional ultrasound guidance in gelatin models

EchoTrack für die navigierte ultraschall-geführte Radiofrequenzablation der Schilddrüse