Minimally invasive surgery is enjoying rapid growth due to lower costs and reduced postoperative pain. Unfortunately, minimally invasive procedures are technically demanding and complicated by the fact that the surgeon has limited visibility into the surgical site and no tactile feedback. Creare is developing a system to enhance visualization of important anatomic features (major vessels and tumors) during the procedures. The Creare system incorporates a laser scanning capability into the surgical laparoscope. The laser scanner can provide highly detailed, three-dimensional measurements of organ shape and position in real time during surgery. The intraoperative measurements of organ position and shape can then be combined with information contained in preoperative magnetic resonance or computed tomographic imaging to allow the surgeon to determine the position of key anatomic features even though they may not be directly visible during the procedure.

We are currently working to apply this technology to minimally invasive kidney surgery – a common cancer of the urologic system. In the past, treatment of renal cancer required surgical removal of the entire affected kidney leaving the patient at life-long risk for developing renal insufficiency or complete loss of renal function if their remaining kidney was compromised for any reason. Fortunately, recent advances in imaging have dramatically increased detection of small tumors that are amenable to local resection. As a result, surgical resection of only that portion of the kidney containing the tumor (partial nephrectomy) has become the preferred approach in many patients. This transition to less aggressive surgery has been accompanied by increased reliance on minimally invasive, laparoscopic surgery. However, laparoscopic kidney surgery is extremely challenging, primarily due to difficulties in visualizing tumor margins and navigating around anatomic structures. As a result, the rate of significant complications (including vascular injuries and failure to obtain clear surgical margins) remains higher in laparoscopic partial nephrectomy than in comparable open procedures. Our work is intended to make these procedures safer and more effective by providing surgeons with the location of key anatomic features during the procedure.