Accurate understanding of surgical tool-tip tracking error is important for decision making in image-guided surgery. In this Letter, the authors present a novel method to estimate/model surgical tool-tip tracking error in which they take pivot calibration uncertainty into consideration. First, a new type of error that is referred to as total target registration error (TTRE) is formally defined in a single-rigid registration. Target localisation error (TLE) in two spaces to be registered is considered in proposed TTRE formulation. With first-order approximation in fiducial localisation error (FLE) or TLE magnitude, TTRE statistics (mean, covariance matrix and root-mean-square (RMS)) are then derived. Second, surgical tool-tip tracking error in optical tracking system (OTS) frame is formulated using TTRE when pivot calibration uncertainty is considered. Finally, TTRE statistics of tool-tip in OTS frame are then propagated relative to a coordinate reference frame (CRF) rigid-body. Monte Carlo simulations are conducted to validate the proposed error model. The percentage passing statistical tests that there is no difference between simulated and theoretical mean and covariance matrix of tool-tip tracking error in CRF space is more than 90% in all test cases. The RMS percentage difference between simulated and theoretical tool-tip tracking error in CRF space is within 5% in all test cases.

In laparoscopic surgery, the surgeon must operate with a limited field of view and reduced depth perception. This makes spatial understanding of critical structures difficult, such as an endophytic tumour in a partial nephrectomy. Such tumours yield a high complication rate of 47%, and excising them increases the risk of cutting into the kidney's collecting system. To overcome these challenges, an augmented reality guidance system is proposed. Using intra-operative ultrasound, a single navigation aid, and surgical instrument tracking, four augmentations of guidance information are provided during tumour excision. Qualitative and quantitative system benefits are measured in simulated robot-assisted partial nephrectomies. Robot-to-camera calibration achieved a total registration error of 1.0 ± 0.4 mm while the total system error is 2.5 ± 0.5 mm. The system significantly reduced healthy tissue excised from an average (±standard deviation) of 30.6 ± 5.5 to 17.5 ± 2.4 cm³ (p < 0.05) and reduced the depth from the tumor underside to cut from an average (±standard deviation) of 10.2 ± 4.1 to 3.3 ± 2.3 mm (p < 0.05). Further evaluation is required in vivo, but the system has promising potential to reduce the amount of healthy parenchymal tissue excised.