Using multiple images and contours for deformable 3D–2D registration of a preoperative CT in laparoscopic liver surgery

Purpose Laparoscopic liver resection is a challenging procedure because of the difficulty to localise inner structures such as tumours and vessels. Augmented reality overcomes this problem by overlaying preoperative 3D models on the laparoscopic views. It requires deformable registration of the preoperative 3D models to the laparoscopic views, which is a challenging task due to the liver flexibility and partial visibility. Methods We propose several multi-view registration methods exploiting information from multiple views simultaneously in order to improve registration accuracy. They are designed to work on two scenarios: on rigidly related views and on non-rigidly related views. These methods exploit the liver’s anatomical landmarks and texture information available in all the views to constrain registration. Results We evaluated the registration accuracy of our methods quantitatively on synthetic and phantom data, and qualitatively on patient data. We measured 3D target registration errors in mm for the whole liver for the quantitative case, and 2D reprojection errors in pixels for the qualitative case. Conclusion The proposed rigidly related multi-view methods improve registration accuracy compared to the baseline single-view method. They comply with the 1 cm oncologic resection margin advised for hepatocellular carcinoma interventions, depending on the available registration constraints. The non-rigidly related multi-view method does not provide a noticeable improvement. This means that using multiple views with the rigidity assumption achieves the best overall registration error.