Self-contained image mapping of placental vasculature in 3D ultrasound-guided fetoscopy

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Surgical navigation technology directed at fetoscopic procedures is relatively underdeveloped compared with other forms of endoscopy. The narrow fetoscopic field of views and the vast vascular network on the placenta make examination and photocoagulation treatment of twin-to-twin transfusion syndrome challenging. Though ultrasonography is used for intraoperative guidance, its navigational ability is not fully exploited. This work aims to integrate 3D ultrasound imaging and endoscopic vision seamlessly for placental vasculature mapping through a self-contained framework without external navigational devices.


This is achieved through development, integration, and experimentation of novel navigational modules. Firstly, a framework design that addresses the current limitations based on identified gaps is conceptualized. Secondly, integration of navigational modules including (1) ultrasound-based localization, (2) image alignment, and (3) vision-based tracking to update the scene texture map is implemented. This updated texture map is projected to an ultrasound-constructed 3D model for photorealistic texturing of the 3D scene creating a panoramic view of the moving fetoscope. In addition, a collaborative scheme for the integration of the modular workflow system is proposed to schedule updates in a systematic fashion. Finally, experiments are carried out to evaluate each modular variation and an integrated collaborative scheme of the framework.


The modules and the collaborative scheme are evaluated through a series of phantom experiments with controlled trajectories for repeatability. The collaborative framework demonstrated the best accuracy (5.2 % RMS error) compared with all the three single-module variations during the experiment. Validation on an ex vivo monkey placenta shows visual continuity of the freehand fetoscopic panorama.


The proposed developed collaborative framework and the evaluation study of the framework variations provide analytical insights for effective integration of ultrasonography and endoscopy. This contributes to the development of navigation techniques in fetoscopic procedures and can potentially be extended to other applications in intraoperative imaging.

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This work was supported by JSPS KAKENHI Grant Number 26108008, JSPS KAKENHI Grant number 20345268, and Grant for Translational Systems Biology and Medicine Initiative (TSBMI) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

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Correspondence to Liangjing Yang.

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Dr. Ichiro Sakuma receives grants from the Japan Science and Technology Agency. Dr. Toshio Chiba and Dr. Etsuko Kobayashi receive grants from the Japan Society for the Promotion of Science. Dr. Liangjing Yang, Dr. Junchen Wang, Dr. Takehiro Ando, Dr. Hiromasa Yamashita, and Mr. Akihiro Kubota have no conflicts of interest or financial ties to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video 1: 3D Placental Vasculature Image Mapping

Video 2: Ultrasound-Based Image Mapping

Video 3: Vision-Based Image Mapping

Video 4: 3D Placental Vasculature Image Mapping on Monkey Placenta

Video 1: 3D Placental Vasculature Image Mapping

Video 2: Ultrasound-Based Image Mapping

Video 3: Vision-Based Image Mapping

Video 4: 3D Placental Vasculature Image Mapping on Monkey Placenta

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Yang, L., Wang, J., Ando, T. et al. Self-contained image mapping of placental vasculature in 3D ultrasound-guided fetoscopy. Surg Endosc 30, 4136–4149 (2016).

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  • Surgical navigation
  • Intraoperative registration
  • Vasculature mapping
  • Minimally invasive fetal surgery