PhD Defence Laura Aguilera Saiz | Robot-Assisted Image-Guided Surgical Navigation | Electromagnetic Tracking For Abdominopelvic Lymph Node Localization

Robot-Assisted Image-Guided Surgical Navigation | Electromagnetic Tracking For Abdominopelvic Lymph Node Localization

Laura Aguilera Saiz is a PhD student in the department Temporary. (Co)Promotors are prof.dr. T.J.M. Ruers, dr. ir. H.C. Groen PhD & dr. W.J. Heerink from the faculty Science & Technology (TNW), University of Twente.

Lymph node metastasis is important in cancer staging and treatment. Although lymph node dissection is effective for disease control, removing all lymph nodes within an anatomical region can result in complications and potential morbidity. Targeted removal of only malignant lymph nodes is therefore preferred but remains challenging because these nodes are often small, deeply located, and difficult to identify during surgery.

This dissertation explores the development and clinical implementation of image-guided surgical navigation for robot-assisted abdominopelvic surgery. This work addresses the challenges of implementing precise intraoperative guidance in complex surgical environments. By combining patient-specific three-dimensional anatomical models with real-time instrument tracking, navigation provides surgeons with intraoperative guidance to improve target localization. The work evaluates the current state of the art, develops a dedicated navigation solution for robot-assisted surgery, and validates its technical performance and clinical feasibility.

To support clinical implementation, an existing in-house navigation platform was adapted for robotic surgery. The system was optimized through electromagnetic compatibility testing, ultrasound-based registration, robotic instrument tracking, and integrated augmented and virtual reality visualization. The developed navigation system accurately localized small lymph nodes and demonstrated the feasibility of integration into robot-assisted prostate cancer surgery. 

Additionally, navigation was evaluated in open lymph node removal procedures involving soft-tissue anatomy of the groin. In challenging cases, navigation improved target localization compared with conventional techniques while achieving high surgeon acceptance.

This dissertation demonstrates that image-guided navigation can be successfully integrated into robotic surgical workflows and provides a foundation for safer, more precise, and less invasive oncological surgery.