UNIPI aims to integrate and enhance the AOUP “Multidisciplinary robotic surgery center of the Azienda Ospedaliera Universitaria Pisana” with the acquisition of 3D intraoperative imaging devices and the implementation of ad-hoc developed workflows to take full advantage of the information content offered by our 4 Da Vinci robots. Intraoperative imaging will allow robotic and image-guided techniques to unleash their full potential. This applies to all surgical disciplines, but this holds particularly true for specialties targeting soft tissues, usually subjected to significant non-rigid and unpredictable deformations during surgery. The project objectives can be summarized as follow:
- selection and acquisition of the most suitable 3D imaging instrumentation (e.g. 3D Ultrasounds, 3D Rotational C-Arm, Portable CT / CBCT);
- definition of a structured workflow for the elaboration and the optimal fruition of the intraoperative data.
The activity is based on the acquisition of imaging systems that already reached the maximum technology readiness level and are commercially available. The imaging applications developed using the scanner will be at TRL7 (including clinical trials).
Upon thorough analysis with the surgeons involved in the project, we decided that that X-ray technology is the one that offers the greatest use scenarios (compared to ultrasound or magnetic resonance) in the surgical room. For this reason, we analysed the commercially available 3D X-Ray scanners that can be used in the OR. In particular, we took into account the need to move the scanner in different surgical rooms and potentiality in different buildings. We found only three movable scanners available on the market: the Samsung OmniTom, the Siemens SOMATOM and the Imaginalis SeeFactor. Among this, the Imaginalis SeeFactor is the only one capable of scanning all the anatomical districts and moreover it integrates on the same machine 3D cone bean CT, X-Ray and fluoroscopy. After an in-depth analysis of the scanner with the manufacturer (located in Tuscany), we decided to buy the device through the Instrument Sharing of the University of Pisa (CISUP). It will be installed in the Azienda Ospedaliero Universitaria Pisana (AOUP) Cisanello Hospital.
The work for implementing surgical interventions guided with this scanner has already begun. The selected surgcal procedure are: (1) robotic partial nephrectomy, (2) spine surgery, and (3) sacrocolpopexy.
For each one of the selected interventions we are working on:
- Definition of the surgical workflow.
- Dedicated hardware development and integration.
- Dedicated software development.
- Phantom test and feasibility.
- Surgical protocol.
- Documentation for the ethic committee and Ministry of Healthcare.
- Surgical trial.