Interaction of Navigation with Minimal Access Surgery

Minimal access surgery (MAS) includes conventional minimally invasive laparoscopic and thoracoscopic surgery, single incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES). An end of the evolution of MAS is not foreseeable, but there are still limitations. In the most common fields of intestinal surgery (cholecystectomy, appendectomy, colo-rectal resection) limitations of MAS shook dogma for surgical strategy and procedure. Automation units and telesurgical systems try to assist the surgical action. Remaining limitations are caused by lack of tactile sense and spatial awareness. With expanding application of minimal access technique in surgery the need for navigation assistance will increase. Future expansion is basically reliant on the feasibility of navigated surgery. Navigation must respect the problems of organ shift and realise continuous localisation of the surgical target as well as spatial orientation of surgical instruments and camera view.