The Centre has a long history of developing new techniques for medical imaging (particularly in magnetic resonance imaging), transforming them from a primarily diagnostic modality into an interventional and therapeutic platform. This is facilitated by the Centre's strong engineering background in practical imaging and image analysis platform development, as well as advances in minimal access and robotic assisted surgery. Hamlyn has a strong tradition in pursuing basic sciences and theoretical research, with a clear focus on clinical translation.

In response to the current paradigm shift and clinical demand in bringing cellular and molecular imaging modalities to an in vivo – in situ setting during surgical intervention, our recent research has also been focussed on novel biophotonics platforms that can be used for real-time tissue characterisation, functional assessment, and intraoperative guidance during minimally invasive surgery. This includes, for example, SMART confocal laser endomicroscopy, time-resolved fluorescence spectroscopy and flexible FLIM catheters.

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  • Journal article
    Skinner C, Thompson AJ, Thursz MR, Marchesi JR, Vergis Net al., 2020,

    Intestinal permeability and bacterial translocation in patients with liver disease, focusing on alcoholic aetiology: methods of assessment and therapeutic intervention

    , Therapeutic Advances in Gastroenterology, Vol: 13, Pages: 1-16, ISSN: 1756-2848

    Increased bacterial translocation (BT) across the gut barrier due to greater intestinal permeability (IP) is seen across a range of conditions, including alcohol-related liver disease (ArLD). The phenomenon of BT may contribute to both the pathogenesis and the development of complications in ArLD. There are a number of methods available to assess IP and in this review we look at their various advantages and limitations. The knowledge around BT and IP in ArLD is also reviewed, as well as the therapeutic strategies currently in use and in development.

  • Journal article
    Kim JA, Wales DJ, Yang G-Z, 2020,

    Optical spectroscopy for in vivo medical diagnosis-a review of the state of the art and future perspectives

  • Journal article
    Davids J, Manivannan S, Darzi A, Giannarou S, Ashrafian H, Marcus HJet al., 2020,

    Simulation for skills training in neurosurgery: a systematic review, meta-analysis, and analysis of progressive scholarly acceptance.

    , Neurosurgical Review, Vol: 44, Pages: 1853-1867, ISSN: 0344-5607

    At a time of significant global unrest and uncertainty surrounding how the delivery of clinical training will unfold over the coming years, we offer a systematic review, meta-analysis, and bibliometric analysis of global studies showing the crucial role simulation will play in training. Our aim was to determine the types of simulators in use, their effectiveness in improving clinical skills, and whether we have reached a point of global acceptance. A PRISMA-guided global systematic review of the neurosurgical simulators available, a meta-analysis of their effectiveness, and an extended analysis of their progressive scholarly acceptance on studies meeting our inclusion criteria of simulation in neurosurgical education were performed. Improvement in procedural knowledge and technical skills was evaluated. Of the identified 7405 studies, 56 studies met the inclusion criteria, collectively reporting 50 simulator types ranging from cadaveric, low-fidelity, and part-task to virtual reality (VR) simulators. In all, 32 studies were included in the meta-analysis, including 7 randomised controlled trials. A random effects, ratio of means effects measure quantified statistically significant improvement in procedural knowledge by 50.2% (ES 0.502; CI 0.355; 0.649, p < 0.001), technical skill including accuracy by 32.5% (ES 0.325; CI - 0.482; - 0.167, p < 0.001), and speed by 25% (ES - 0.25, CI - 0.399; - 0.107, p < 0.001). The initial number of VR studies (n = 91) was approximately double the number of refining studies (n = 45) indicating it is yet to reach progressive scholarly acceptance. There is strong evidence for a beneficial impact of adopting simulation in the improvement of procedural knowledge and technical skill. We show a growing trend towards the adoption of neurosurgical simulators, although we have not fully gained progressive scholarly acceptance for VR-based simulation technologies in neurosurgical education.

  • Conference paper
    Zhan J, Cartucho J, Giannarou S, 2020,

    Autonomous tissue scanning under free-form motion for intraoperative tissue characterisation

    , 2020 IEEE International Conference on Robotics and Automation (ICRA), Publisher: IEEE, Pages: 11147-11154

    In Minimally Invasive Surgery (MIS), tissue scanning with imaging probes is required for subsurface visualisation to characterise the state of the tissue. However, scanning of large tissue surfaces in the presence of motion is a challenging task for the surgeon. Recently, robot-assisted local tissue scanning has been investigated for motion stabilisation of imaging probes to facilitate the capturing of good quality images and reduce the surgeon's cognitive load. Nonetheless, these approaches require the tissue surface to be static or translating with periodic motion. To eliminate these assumptions, we propose a visual servoing framework for autonomous tissue scanning, able to deal with free-form tissue motion. The 3D structure of the surgical scene is recovered, and a feature-based method is proposed to estimate the motion of the tissue in real-time. The desired scanning trajectory is manually defined on a reference frame and continuously updated using projective geometry to follow the tissue motion and control the movement of the robotic arm. The advantage of the proposed method is that it does not require the learning of the tissue motion prior to scanning and can deal with free-form motion. We deployed this framework on the da Vinci ® surgical robot using the da Vinci Research Kit (dVRK) for Ultrasound tissue scanning. Our framework can be easily extended to other probe-based imaging modalities.

  • Journal article
    Huang B, Tsai Y-Y, Cartucho J, Vyas K, Tuch D, Giannarou S, Elson DSet al., 2020,

    Tracking and visualization of the sensing area for a tethered laparoscopic gamma probe

    , International Journal of Computer Assisted Radiology and Surgery, Vol: 15, Pages: 1389-1397, ISSN: 1861-6410

    PurposeIn surgical oncology, complete cancer resection and lymph node identification are challenging due to the lack of reliable intraoperative visualization. Recently, endoscopic radio-guided cancer resection has been introduced where a novel tethered laparoscopic gamma detector can be used to determine the location of tracer activity, which can complement preoperative nuclear imaging data and endoscopic imaging. However, these probes do not clearly indicate where on the tissue surface the activity originates, making localization of pathological sites difficult and increasing the mental workload of the surgeons. Therefore, a robust real-time gamma probe tracking system integrated with augmented reality is proposed.MethodsA dual-pattern marker has been attached to the gamma probe, which combines chessboard vertices and circular dots for higher detection accuracy. Both patterns are detected simultaneously based on blob detection and the pixel intensity-based vertices detector and used to estimate the pose of the probe. Temporal information is incorporated into the framework to reduce tracking failure. Furthermore, we utilized the 3D point cloud generated from structure from motion to find the intersection between the probe axis and the tissue surface. When presented as an augmented image, this can provide visual feedback to the surgeons.ResultsThe method has been validated with ground truth probe pose data generated using the OptiTrack system. When detecting the orientation of the pose using circular dots and chessboard dots alone, the mean error obtained is 0.05∘and 0.06∘, respectively. As for the translation, the mean error for each pattern is 1.78 mm and 1.81 mm. The detection limits for pitch, roll and yaw are 360∘,360∘ and 8∘–82∘∪188∘–352∘.ConclusionThe performance evaluation results show that this dual-pattern marker can provide high detection rates, as well as more accurate pose estimation and a larger workspace than the previously proposed hyb

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