Clinical application of medical engineering-our experiences at research center for frontier medical enginnering

Endourology and laparoscopic surgery are growing in accordance with developments in instrumentation and progress in surgical technique. Recent advances in personal computer (PC) and image-processing technology have enabled novel images to be created from conventional endoscopic and laparoscopic video images. Such technology harbors the potential to advance endourology and laparoscopic surgery by adding new function and value to the endoscope. The panoramic images created by computer processing is an outstanding feature that can address the shortcomings of conventional endoscopy and laparoscopy, such as narrow field of view and discontinuous information. The wide panoramic images show an anatomical 'map' of the abdominal cavity and hollow organs with high brightness and resolution, as the images are collected from video images taken in a close-up manner. In tubular organs such as the prostatic urethra, reconstruction of three-dimensional structure can be achieved, implying the possibility of a liquid dynamic model for assessing local urethral resistance in urination. To navigate during surgery, three-dimensional (3D) volume-rendered images of the renal vessels, kidneys, and tumor were created intraoperatively by the surgeon using an imaging processing application. The surgeon adjusted the angle of view and the size of the images during the operation using a wireless mouse enclosed in a sterilized bag. These images were simultaneously incorporated into live endoscopic video using image-capture software. Computer-based processing of endoscopic images will establish new tools for endourology and laparoscopic surgery in the near future.