Multimodal fusion of 2D thoracoscopic images with a pre-operative 3D anatomical model of the spine is useful for minimally invasive surgical procedures using an angled monocular endoscope with varying focal length. An offline calibration procedure has been developed to compute initial endoscope parameters, such as lens distortion, focal length and optical center before surgery. An optical tracking system is used to update extrinsic parameters describing the position and orientation of the endoscope in real-time during the procedure. This calibration allows the registration of the thoracoscopic image sequence with a pre-operative MRI 3D model of the spine. Two visualization methods merging the 3D model and thoracoscopic image sequence have been developed using both augmented reality and augmented virtuality paradigms primarily as an aid for discectomy. Augmented views are generated by adding annotations and projecting the MRI 3D model onto real thoracoscopic images. Virtual views are generated by projecting the real thoracoscopic images on a virtual view of the 3D model. Experimental results showed that the calibration procedure accuracy obtained by computing the relative 3D reconstruction error on a known object was 1.0 mm. Two orthopedic surgeons assessed the generated views, confirming the relevance and added value of the proposed visualization tool for minimally invasive discectomy assistance.
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