Surgical navigation still saddled with technical limits

Despite the entry of more navigation systems for various surgical applications in recent years, the widespread use of these systems are hampered by numerous technical limits and high costs which discourage many surgeons to fully rely on these instruments.

“Navigation systems are not commonplace and only for a comparatively small number of applications,” said Dr. Jan Stallkamp, of the Fraunhofer Project Group for Automation in Medicine & Biotechnology (PAMB) in Mannheim, Germany.

Stallkamp, who lectured in a thematic session on new technologies at the 29th Annual EAU Congress currently held in Stockholm and wrote a supplemental article on new technologies for the EUT Congress Newsletter, said there is a gap between the overall interest among surgeons and the everyday practicality of using navigation systems.

“Current navigation systems are costly while only providing some additional information for orientation,” said Stallkamp, as he noted that these extra information can prove to be very useful in specific clinical applications.

“The main problem is that they require a specialist operator. The information provided by the systems has to be interpreted carefully and introduces new sources of error,” he pointed out.

He added the imbalance between benefit and potential harms or side-effects argues against the widespread use of state-of-the-art navigation systems. For navigation systems to be considered as indispensible tools, there should be improvement in information quality and easy handling, such as a shorter set-up time of around five minutes.

Moreover, there is a demand for such systems to perform more tasks in the intervention room to justify development efforts.

In other words, Stallkamp said “…the full potential or benefits of navigation systems have not been exhausted yet.”

One of the limits that he cited was the inability of current navigation methods to cope with the geometrical changes of soft tissues during an intervention.

“A multimodal sensor solution could deliver sufficient data for precise real-time navigation with a holistic image of the surgical situation,” he said, adding that many enabling technologies are not yet available and neither do the mechanical, electronic or organisational interfaces exist.

Looking ahead, Stallkamp said future navigation systems would have automated features or functions that could lead to automated diagnostic systems. But the evolution to these sophisticated features are still in their nascent stage and the process remains complex due to the sequential nature of the required technical developments.

Source: Thematic Session 2: J. Stallkamp, “Surgical navigation for diagnosis and treatment”; 13 April 2014; 29th Annual EAU Congress, Stockholm, Sweden