Integrating FireFly fluorescence into image guidance for the da Vinci robot

Over the past several years, researchers have made significant progress toward providing image guidance for the da Vinci system, utilizing data sources such as robot kinematic data, endoscope image data, and preoperative medical images. One data source that could provide additional subsurface information for use in image guidance is the da Vinci's FireFly camera system. FireFly is a fluorescence imaging feature for the da Vinci system that uses injected indocyanine green dye and special endoscope filters to illuminate subsurface anatomical features as the surgeon operates. FireFly is now standard for many surgical procedures with the da Vinci robot; however, it is currently challenging to understand spatial relationships between pre-operative CT images and intraoperative fluorescence images. Here, we extend our image guidance system to incorporate FireFly information as well, so that the surgeon can view FireFly data in the image guidance display while operating with the da Vinci robot. We present a method for reconstructing 3D models of the FireFly fluorescence data from endoscope images and mapping the models into an image guidance display that also includes segmented, registered preoperative CT images. We analyze the accuracy of our reconstruction and mapping method and present a proof-of-concept application where we reconstruct a fluorescent subsurface blood vessel and map it into our image guidance display. Our method could be used to provide surgeons with additional context for the FireFly fluorescence imaging data or to provide additional data for computing or verifying the registration between the robot and preoperative images.