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Proceedings Paper

Visual enhancement of fascial tissue in endoscopy
Author(s): Thomas Stehle; Alexander Behrens; Matthias Bolz; Til Aach
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Paper Abstract

A colon resection, necessary in case of colon cancer, can be performed minimally invasively by laparoscopy. Before the affected part of the colon can be removed, however, the colon must be mobilized. A good technique for mobilizing the colon is to use Gerota's fascia as a guiding structure, i. e. to dissect along this fascia, without harming it. The challenge of this technique is that Gerota's fascia is usually difficult to distinguish from other tissue. In this paper, we present an approach to enhance the visual contrast between fatty tissue covered by Gerota's fascia and uncovered fatty tissue, and the contrast of both structures to the remaining soft tissue in real time (50 fields per second). As fasciae are whitish transparent tissues, they cannot be identified by means of their color itself. Instead, we found that their most prominent feature to distinguish is the color saturation. To enhance their visible contrast, we applied a non-linear transformation to the saturation. An off-line evaluation was carried out consulting two specialists in laparoscopic colon resection. We presented them four scenes from two different interventions in which our enhancement was applied together with the original scenes. These scenes did not only contain situations where Gerota's fascia had to be found, but also situations where aerosol from ultrasonically activated scissors inhibited the clear vision, or situations where critical structures such as the ureter or nerves had to be identified under fascial tissue. The surgeons stated that our algorithm clearly offered an information gain in all of the presented scenes, and that it did not impair the clear vision in case of aerosol or the visibility of critical structures. So the colon mobilization could be carried out easier, faster, and safer. In the subsequent clinical on-line evaluation, the specialists confirmed the positive effect of the proposed algorithm on the visibility of Gerota's fascia.

Paper Details

Date Published: 17 March 2008
PDF: 9 pages
Proc. SPIE 6918, Medical Imaging 2008: Visualization, Image-Guided Procedures, and Modeling, 69180Z (17 March 2008); doi: 10.1117/12.769862
Show Author Affiliations
Thomas Stehle, RWTH Aachen Univ. (Germany)
Alexander Behrens, RWTH Aachen Univ. (Germany)
Matthias Bolz, Olympus Winter & Ibe GmbH (Germany)
Til Aach, RWTH Aachen Univ. (Germany)

Published in SPIE Proceedings Vol. 6918:
Medical Imaging 2008: Visualization, Image-Guided Procedures, and Modeling
Michael I. Miga; Kevin Robert Cleary, Editor(s)

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