The impact of Computer Integrated Surgery (CIS) on medicine in the next 20 years will be as great as that of Computer-Integrated Manufacturing on industrial production over the past 20 years. Development of advanced CIS systems isbest pursued within the context of systems-oriented multidisciplinary research providing close collaboration between engineering faculty, students, surgeons, and industry. This paper introduces basic themes of CIS systems and describes theoverall research strategy pursued within our NSF Engineering Research Center for Computer-Integrated Surgery. Weillustrate key concepts with examples drawn from our research.

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Camera work of the laparoscopic surgery was performed in 10 cases of laparoscopic cholecystectomy.The camerawork was classified into 4 kinds of motion, “zoom” (in and out), “tilt” (up and down), “pan” (right and left) and “search”. Also the size of the camera view was classified into “long-shot”, “median-shot” and “close-up”. Frequency of the camerawork were “zoom” 64.4 times.C “tilt” 11.9 times, “pan” 11.5 times and “search” 4 times during the laparoscopic proce-dure.The time ratio of the size of camera view were “long-shot” 9.5%, “median-shot” 67.3% and “close-up” 19.4%.This study revealed that laparoscopic cholecystectomy requires mainly “zoom” function of the laparoscope and “median” size of view.

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Virtual endoscopy is a new method of diagnosis using computer processing of 3-D image data sets. However clinicalapplication of virtual pancreatoscopy for pancreatic cancer has not been reported. In this study, the usefulness of virtualpancreatoscopy for pancreatic cancer was investigated. Twenty cases of pancreatic cancer were studied. Seven patientsunderwent pancreatectomy at National Cancer Center Hospital East from June to November in 1999. The MRI data wereacquired with a 1.5-T clinical imager. A multislab single shot fast spin echo sequence was used. Section thickness wasbetween 2 and 3 mm in the coronal plane. Virtual endoscopic images were generated with Advantage Windows system (G. E. U. S. A.). Clear virtual endoscopic images were obtained in 15 of 20 patients with panceratic cancer. It was possibleto visualize partial or complete obstruction of the panceatic duct. And we could get endoscopic views from the side ofpancreatic tail. Virtual pancreatoscopy is noninvasive and easy to generate. Viutual pancreatoscopy can provide theinformation that we cannot obtain by the real pancreatoscopy. It will be very useful to diagnose pancreatic cancer.

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Endoscope is one of the important tools in minimal invasive surgery. The field-of-view (FOV) of the endoscope is, however, quite limited. Improvident operations of the endoscope can result in missing important anatomical landmarks orlesions. Using image processing and computer graphics techniques, we have developed a virtual expansion system of theendoscopic view. A peripheral area of the endoscopic image is continuously digitized and memorized. This series of memorized images is then seamlessly displayed outside the live image. We used two visualization methods, 'static real-FOV'and'dynamic real-FOV'for real endoscopic images. Our system is applicable to any kind of optical instruments forsurgical use to assist the surgeon's visual cognition.

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