DE102018131501A1 - Method and system for operation-supporting visualization, computer program product - Google Patents

Abstract

The invention relates to a method and a system for visualization to assist surgery, in particular for visually supporting a percutaneous nephrolithotomy. A 3-dimensional pattern of at least three radiopaque markers (12) on the skin surface (20) of a patient to be prepared for the operation in the area of a planned access to an organ to be operated, 3-dimensional reference data created using one or more imaging scans of the area to be operated with the radiopaque markers (12) and from this a virtual 3-dimensional model (40) of the patient's tissue (22) in the operating area with the positions of the radiopaque markers (12) created, supplemented or compared and on the virtual

Description

The invention relates to a method and a system for operation-supporting visualization for an intervention on a patient, in particular for the visual support of a percutaneous nephrolithotomy, and a computer program product.

The invention relates to the field of operation-supporting visualization, especially in fields in which a direct view of the body to be operated is missing. This is the case in some minimally invasive procedures, such as the implantation of cochlear implants, percutaneous lung biopsy or percutaneous nephrolithotomy (PCNL). In percutaneous nephrolithotomy, kidney stones are localized and removed minimally invasively by puncturing the affected kidney. The patient lies supine or prone during the operation. The intervention is typically carried out with rigid endoscopes or hollow needles. The endoscope or hollow needle is inserted into the kidney along an insertion channel or “nephrostomy tract” through the skin and the tissue in between. This insertion channel is usually created with a thin hollow needle that pierces the renal parenchyma and penetrates into the renal pelvis, where the kidney stone is located.

These punctures are usually accompanied by fluoroscopy. The fluoroscopy is carried out by means of an X-ray device, which can be rotated and tilted on a C-arm and can take live X-rays in different projection planes. A contrast medium is used to image the kidney pelvis, as well as accompanying ultrasound measurements, if necessary. These images and measurements are used to assess whether the hollow needle is correctly placed. The preparation and execution of the puncture is the most time-consuming process step of the PCNL and takes up to 60 minutes. It includes preparation for fluoroscopy, positioning of the C-arm by a technical assistant, and taking multiple X-rays to take and identify the correct image of the anatomy involved. In addition, the C-arm must be rotated 45 to 90 degrees in a polar angle to detect the position of the kidney in the third dimension. This information is used to position and align the hollow needle for access to the kidney collection system, i.e. the kidney pelvis.

Since several x-rays are needed to obtain information regarding the positions of the kidneys during the operation, the time used for fluoroscopy (x-ray) is relatively long, on average around 240 seconds. This entails high radiation exposure. It is therefore desirable to reduce this radiation exposure for the patient and the personnel performing the operation.

A further complication can arise if the puncture is not sufficiently targeted. This can result in injury to neighboring organs and the pleural space, as well as bleeding.

In contrast, the object on which the invention is based is to reduce risks for the patient.

1. a) Erstellen eines 3-dimensionalen Musters von wenigstens drei radiopaken Markern durch Platzieren der radiopaken Marker auf der Hautoberfläche eines für die Operation vorzubereitenden Patienten an mehreren Stellen im Bereich eines geplanten Zugangs zu einem zu operierenden Organ,
2. b) Erstellen von 3-dimensionalen Referenzdaten mittels eines oder mehrerer bildgebender Scans des zu operierenden Bereichs mit den radiopaken Markern,
3. c) Erstellen, Ergänzen oder Abgleichen eines virtuellen 3-dimensionalen Modells des Gewebes, insbesondere eines zu operierenden Organs, des Patienten im zu operierenden Bereich, mit den Positionen der radiopaken Marker,
4. d) Bestimmen von räumlicher Positionierung und Orientierung eines Einführkanals für ein chirurgisches Instrument, insbesondere eine Hohlnadel oder ein Endoskop, am virtuellen 3-dimensionalen Modell,
5. e) Erfassen momentaner Positionen der radiopaken Marker am Patienten mittels einer AR-Brille und Abgleich der erfassten Positionen mit den Positionen der radiopaken Marker im virtuellen 3-dimensionalen Modell,
6. f) Berechnung einer momentanen Lage und Orientierung des Einführkanals relativ zur AR-Brille anhand des Abgleichs aus Verfahrensschritt e) mit den erfassten momentanen Positionen der radiopaken Marker und
7. g) Darstellen einer lagerichtigen Repräsentation des Einführkanals und/oder einer Verlängerung des Einführkanals außerhalb des Körpers des Patienten in einer Überlagerung visueller Informationen in der AR-Brille.

This task is solved by a method for the visualization of surgery for an intervention on a patient, in particular for the visual support of a percutaneous nephrolithotomy, comprising the following method steps:

1. a) creating a 3-dimensional pattern of at least three radiopaque markers by placing the radiopaque markers on the skin surface of a patient to be prepared for the operation at several locations in the area of a planned access to an organ to be operated on,
2. b) Creation of 3-dimensional reference data by means of one or more imaging scans of the area to be operated with the radiopaque markers,
3. c) creating, supplementing or comparing a virtual 3-dimensional model of the tissue, in particular an organ to be operated on, of the patient in the area to be operated on, with the positions of the radiopaque markers,
4. d) determining the spatial positioning and orientation of an insertion channel for a surgical instrument, in particular a hollow needle or an endoscope, on the virtual 3-dimensional model,
5. e) Acquisition of current positions of the radiopaque markers on the patient using AR glasses and comparison of the acquired positions with the positions of the radiopaque markers in the virtual 3-dimensional model,
6. f) calculation of a current position and orientation of the insertion channel relative to the AR glasses on the basis of the comparison from method step e) with the recorded current positions of the radio-opaque markers and
7. g) Representing a positionally correct representation of the insertion channel and / or an extension of the insertion channel outside the patient's body in a superimposition of visual information in the AR glasses.

The patient's safety is increased and the exposure of the patient and operating personnel to ionizing radiation is reduced by the intervention being supported by an imaging method in which a virtual 3D model of the region of the body to be operated on is created. This makes it possible to improve and secure the positioning of the hollow needle or the instrument and to reduce the general need for accompanying live fluoroscopy, which leads to high radiation exposure.

For this purpose, a virtual 3-dimensional model is first created, supplemented or compared on the basis of an imaging method, for example a CT scan or a plurality of X-ray scans from different directions and perspectives, which serves as the basis for determining a suitable puncture - or insertion channel is used. Using AR glasses (augmented reality), the surgeon is then shown an overlay of the model or at least a representation of the insertion channel, which is superimposed in the correct position on the image perceived by the surgeon or a camera of the AR glasses. The doctor therefore not only sees the patient in front of him, but also a superimposition of the insertion channel and, if applicable, the tissue to be pierced and / or the organ to be operated on and any other organs. For this purpose, AR glasses have position sensors and their own stereoscopic recording devices, which make it possible to determine the relative position of the AR glasses relative to the detected object, in this case the patient.

In order to define a common coordinate system as a reference for the different perspectives, radiopaque markers are placed on the skin surface in the area of the planned puncture site before the operation and before the start of the CT or X-ray scans Positions remain on the skin surface. The radiopaque markers are radio-opaque and are clearly contrasted in both CT scans and X-ray scans. The virtual 3D model thus contains, in addition to the spatial information about the patient's tissue in the area of the insertion channel, also the position information of the markers and, for the depth information, possibly the position of a kidney stone, which is also contrasting in the images.

In one aspect of the invention, before creating the 3-dimensional pattern of at least three radiopaque markers in step a), a virtual 3-dimensional model of the tissue, in particular of an organ to be operated on, of the patient in the area to be operated on, which is created in the step c) the positions of the radiopaque markers are supplemented or with which the positions of the radiopaque markers are compared and / or registered.

Within the scope of the invention, the creation of the virtual model on the basis of CT scans or X-ray scans can in principle take place with or without the radiopaque markers being placed beforehand. A previous placement, which is contained in the feature alternative of step c), that the virtual model is created with the positions of the radiopaque markers, allows the virtual model to be determined with the positions of the markers in one go, so that an immediate positional relationship the marker for the tissue or organs in the model exists and only a scan is necessary.

If the radiopaque markers are applied after the virtual model has been created, a further scan, for example a fluoroscopy or a CT or X-ray scan, is necessary, which allows the positions of the radiopaque markers to be related to the existing virtual model . The model is either supplemented with the positions of the radio-opaque markers, or a fixed relationship between the model and marker positions is registered, ie a comparison is made. This has the advantage that any shifts in the anatomy between the time of the scan and the operation can be kept very small, while the more time-consuming step of creating the virtual model has already taken place beforehand. This increases the security of the process.

Since the AR glasses also have a camera, they also record the optically striking radiopaque markers on the patient's skin surface. It can therefore be compared where the AR glasses are in relation to the virtual 3D model and how the 3D model and the insertion channel are to be represented. These are known 3-dimensional transformations, i.e. translations and rotations, for which there are many software and hardware solutions in information technology.

While the needle is being inserted and inserted, the insertion channel is displayed to the surgeon in the AR glasses worn by the surgeon. This is comparable to the display of an entry lane or an entry corridor for an aircraft pilot and supports the doctor in correctly inserting the hollow needle and thus avoiding further damage to the patient.

Advantageously, the insertion channel, and in particular a puncture site, is visually highlighted, in particular framed or marked in color. This highlighting makes it possible to check the attending doctor that his real hollow needle is correctly inserted. Since the AR glasses detect changes in position, the display of the insertion channel is accordingly carried along in the display. In this way, the doctor can check whether the hollow needle also corresponds correctly with the planned insertion channel in the different perspectives.

Process steps e), f) and g) are advantageously carried out continuously during an operative intervention. This means that during the operation it is continuously checked at which position the AR glasses are in relation to the patient, mainly in relation to the radiopaque markers, so that the display that the AR glasses offers to the doctor is closed shows the correct perspective view of the insertion channel as well as the surrounding tissue at any time.

A CT scan is preferably carried out as imaging scans in method step b) and / or one or more X-ray scans are carried out in several planes, from which a spatial distribution of the tissue is extracted.

Advantageously, in step f), a current position and orientation of tissue structures or the organ to be operated is additionally calculated from the virtual 3-dimensional model and the tissue structures or organ to be operated from the 3-dimensional model in step g) in a positionally correct representation the AR glasses. The term “tissue” or “tissue structure” also includes the patient's organs. This gives the doctor the opportunity, in addition to the pure position and orientation of the insertion channel, to also estimate where the surrounding tissue and where the organ to be treated is located, in order to be able to better estimate how closely neighboring tissue is in the various phases of insertion of the hollow needle into the tissue Organs are and therefore as little harmful as possible, for example being able to react to patient movements.

During the surgical intervention, live images of a live fluoroscopy, which also records the radiopaque markers, are advantageously converted into the spatial system of the virtual 3-dimensional model based on the positions of the radiopaque markers recorded in the live fluoroscopy and are correctly positioned in the AR glasses shown. This part of the procedure has already been carried out when the hollow needle was introduced and is associated with radiation exposure for the patient and the operating personnel. However, since the introduction of the hollow needle is visually supported according to the invention, live fluoroscopy is primarily used for control purposes and can therefore be carried out much faster and therefore with less radiation exposure than before. In this case, it is also sufficient if the live fluoroscopy is carried out in a plane which completely encompasses the insertion channel, in other words that the insertion channel lies in the plane shown and is not shown in a shortened perspective. The level can be selected in such a way that it is particularly easy to see at which critical points the hollow needle would cause particularly great damage if it deviates from the indicated insertion channel.

For this purpose, the scans of the live fluoroscopy are advantageously generated in one plane of the insertion channel.

In one embodiment of the method, in method step f), when calculating the current position and orientation of the insertion channel and, if appropriate, additionally the tissue structures or the organ to be operated on, deformations of the tissue are taken into account, which are due to changes in the position of the patient compared to a position of the patient during the admission of the reference data in method step b) or as a result of natural movements of the patient, the calculation of the spatial positioning and orientation of the insertion channel being adapted to the deformations. It can thus be taken into account that, for example, the position of the patient in a CT scanner was different from that on the operating table, or natural movements of the patient, for example breathing, can be taken into account.

The patient's changes in position are preferably recorded using the positions of the radiopaque markers recorded in live fluoroscopy. Based on changes in the position of the radio-opaque markers, this procedure allows an accurate detection of changes in position, which can affect the positional relationships of the organs and the planned insertion channel. Corresponding algorithms, which movements of the internal organs occur, for example in response to breathing or other movements, are known and can be implemented in the calculation of the virtual model.

In one aspect of the invention, an acoustic, optical or tactile warning signal is emitted if the surgical instrument deviates from the insertion channel during insertion into the patient's tissue. This helps to avoid injury to the patient.

According to a further aspect of the invention, the surgeon is granted an influence for the preparatory calculation of the insertion channel on the virtual 3-dimensional model, in particular in the case of a percutaneous nephrolithotomy, through which kidney cup the patient to be operated must be selected Kidney the insertion channel should run. For this purpose, the calculated virtual model can be displayed to the surgeon, and the surgeon can either position the virtual insertion channel themselves, or the program searches for a suitable insertion channel, which the surgeon can still move according to his experience, or a selection from various possible insertion channels, which is particularly important for Percutaneous nephrolithotomy may be useful, since there may be a choice of access through different kidney cups, one of which must be selected.

The object on which the invention is based is also achieved by a system for operation-supporting visualization for an intervention on a patient, in particular for the visual support of a percutaneous nephrolithotomy, comprising at least one first imaging scanner, in particular CT scanner or X-ray scanner, at least three radiopaque markers , a data processing device, AR glasses and a fluoroscopic imaging system with a C-arm, wherein the radiopaque markers are designed and set up to be attached to the skin surface of a patient, and the data processing device is designed and set up one or more of the method steps of the perform the inventive method described above and its various aspects. The system thus realizes the advantages, features and properties mentioned for the method according to the invention.

In a further aspect, the system comprises a surgical instrument, in particular a hollow needle or an endoscope, which in particular has a specific radiopaque structure which stands out on fluoroscopic live recordings. Such a specific radiopaque structure can favor an exact localization of the tip of the hollow needle, which is particularly useful during operations in complicated and narrow tissue structures, but also under other conditions allows a good estimate of whether the positioning and compliance with the insertion channel are guaranteed.

The object on which the invention is based is also achieved by a computer program product, in particular a computer program with program code means, which, when executed on a data processing device of a system according to the invention described above, carry out one or more method steps of the method described above and its various aspects. This also realizes the same properties, features and advantages as in the method and system according to the invention described above.

Further features of the invention will become apparent from the description of embodiments according to the invention together with the claims and the accompanying drawings. Embodiments according to the invention can fulfill individual features or a combination of several features.

• 1 eine schematische Darstellung der Einführung einer Hohlnadel in eine Niere,
• 2 ein Röntgen-Kontrastbild einer Niere,
• 3 eine Querschnittsdarstellung durch einen menschlichen Oberkörper,
• 4 eine Virtualisierung eines 3D-Modells von inneren Organen,
• 5 die Sicht eines Operateurs durch eine AR-Brille mit erfindungsgemäßer visueller Unterstützung und
• 6 eine schematische Darstellung eines erfindungsgemäßen Systems.

The invention is described below without restricting the general inventive concept on the basis of exemplary embodiments with reference to the drawings, reference being expressly made to the drawings with regard to all details according to the invention not explained in more detail in the text. Show it:

• 1 1 shows a schematic representation of the introduction of a hollow needle into a kidney,
• 2nd an X-ray contrast image of a kidney,
• 3rd a cross-sectional view through a human torso,
• 4th a virtualization of a 3D model of internal organs,
• 5 the view of an operator through AR glasses with visual support according to the invention and
• 6 is a schematic representation of a system according to the invention.

In the drawings, the same or similar elements and / or parts are provided with the same reference numerals, so that a renewed presentation is not given.

1 shows in schematic cross section a part of a human body in horizontal section through a kidney 30th . The surface of the skin can be seen 20th of the back, the inner tissue 22 , a vertebra 24th as well as kidney cortex 31 , Kidney pelvis 32 , Kidney cup 34 and renal parenchyma 36 the kidney 30th . A hollow needle 10th To prepare a PCNL for removing a kidney stone, not shown, is through the skin surface 20th and the tissue in between 22 in the kidney 30th inserted and passes through a kidney cup 34 into the kidney pelvis 32 , which may contain a kidney stone to be removed (not shown).

2nd shows an X-ray contrast image of a kidney. Vertebrae of the spine are visible in the left area, while the renal pelvis filled with an X-ray contrast medium is central 32 is shown. You can see those from the kidney pelvis 32 branching kidney cups, which are also filled with X-ray contrast media. From the right side of the picture is a hollow needle 10th recognizable which up to the kidney pelvis 32 is introduced.

3rd shows in a cross section a horizontal section through the upper body of a person, at the level of the heart and lungs. Next to a vertebra 24th and the rib cage 26 with multiple vertebrae are on the skin surface 20th several radiopaque markers 12 attached, which also contrast strongly in the underlying CT scan and are therefore well localized. Such CT scans, optionally also X-ray scans, are used according to the invention to create a virtual 3-dimensional model of the structure of the tissue to be operated on, which is then made available to the surgeon as an overlay in AR glasses.

In 4th A representation of such a virtual 3D model is shown, organs and blood vessels being clearly recognizable inside the body.

In 5 the view of an surgeon armored with AR glasses is shown. It is a picture of the camera of AR glasses, which takes the perspective of the surgeon. The picture is in a central section 44 a representation of the virtual model of the tissue is superimposed in the correct perspective, so that the surgeon has an impression of the spatial and organic context in which the puncture takes place at this time.

The insertion channel is also highlighted with framing points 14 into which the hollow needle 10th is introduced.

In 6 is schematically a system 50 shown according to the invention, which in this case is a CT scanner 52 as the first imaging device and an X-ray scanner 54 with a C-arm, not shown, which during the process of inserting a hollow needle 10th takes pictures of the inside of the body in the patient. Instead of a CT scanner 52 can also use the X-ray scanner 54 for the task of the first or preparatory imaging to create the virtual model 40 be used.

Both scanners are equipped with a data processing device 56 connected, which is trained and set up to carry out the necessary procedural steps. This includes the creation of a virtual 3-dimensional model 40 from those from the CT scanner 52 captured image data, the calculation or determination of an insertion channel using the virtual 3-dimensional model 40 processing by the x-ray scanner 54 Data recorded during the operation as well as the representation of the model and possibly the data of the X-ray scanner 54 in AR glasses 58 . For this purpose, the AR glasses 58 via a wireless connection to the data processing device 56 connected. The AR glasses 58 not only receives the image data from the data processing device 56 to the AR glasses 58 are transmitted, but also transmits position data and image data from the glasses own camera to the data processing device 56 which uses this data to calculate which view of the virtual 3-dimensional model 40 in AR glasses 58 must be represented.

The hollow needle 10th has in the 6 shown embodiment also at its distal tip via a radiopaque structure 11 which have an easily identifiable image signal in the image data from the X-ray scanner 54 generated, and thus the progress of the introduction of the hollow needle 10th traceable in the patient.

Furthermore, as part of the system 50 three radiopaque markers 12 shown. However, more radiopaque markers can also be used 12 to be available. These are equipped, for example, in a form sold by the applicant that a radiopaque ball is applied in a package on a plaster or adhesive strip, which are glued to the surface of the skin for the duration of the preparation and the operation of the patient and are thus fixed in terms of their positioning . The markers can also have optical structures, for example concentric circles, crosses, etc., which are used in an optical image processing of images by the camera of the AR glasses 58 can be recognized, the position of the radiopaque marker 12 in the pictures of the AR glasses 58 To identify a basis for the comparison with the virtual 3-dimensional model 40 to accomplish. This comparison forms the basis for the calculation of the view that is displayed to the operating doctor using the AR glasses, so that the doctor can see through the AR glasses 58 experiences an overlay on the natural environment with an image reproduced by the AR glasses. This “augmentation” of reality is used in the present case to support the visualization of an insertion channel for the hollow needle or an endoscope.

All of the features mentioned, including those that can be seen in the drawings alone and also individual features that are disclosed in combination with other features, are considered to be essential to the invention, alone and in combination. Embodiments according to the invention can be fulfilled by individual features or a combination of several features. In the context of the invention, features that are labeled “in particular” or “preferably” are to be understood as optional features.

Reference symbol list

10th

Hollow needle

11

radiopaque structure

12

radiopaque markers

14

Insertion channel

20th

Skin surface

22

tissue

24th

Dorsal vertebrae

26

Rib cage

30th

kidney

31

Renal cortex

32

Renal pelvis

34

Kidney cup

36

Renal parenchyma

40

virtual 3-dimensional model

44

central neckline

50

system

52

CT scanner

54

X-ray scanner with C-arm

56

Data processing equipment

58

AR glasses

Claims (15)

Process for visualization to support surgery on a patient, in particular for visual support of a percutaneous nephrolithotomy, comprising the following process steps: a) creating a 3-dimensional pattern of at least three radiopaque markers (12) by placing the radiopaque markers (12) on the skin surface (20) of a patient to be prepared for the operation at several locations in the area of a planned access to an organ to be operated on ( 30), b) creating 3-dimensional reference data by means of one or more imaging scans of the area to be operated with the radiopaque markers (12), c) creating, supplementing or comparing a virtual 3-dimensional model (40) of the tissue (22), in particular an organ (30) to be operated on, of the patient in the area to be operated on, with the positions of the radiopaque markers (12), d) determining the spatial positioning and orientation of an insertion channel (14) for a surgical instrument, in particular a hollow needle (10) or an endoscope, on the virtual 3-dimensional model (40), e) detecting current positions of the radiopaque markers (12) on the patient using AR glasses (58) and comparing the detected positions with the positions of the radiopaque markers (12) in the virtual 3-dimensional model (40), f) calculation of a current position and orientation of the insertion channel (14) relative to the AR glasses (58) on the basis of the comparison from method step e) with the detected current positions of the radio-opaque markers (12) and g) displaying a positionally correct representation of the insertion channel (14) and / or an extension of the insertion channel (14) outside the patient's body in a superimposition of visual information in the AR glasses (58). Procedure according to Claim 1 , characterized in that before creating the 3-dimensional pattern of at least three radiopaque markers in step a) a virtual 3-dimensional model (40) of the tissue (22), in particular of an organ to be operated, of the patient in the area to be operated on, is created, which is supplemented in step c) with the positions of the radiopaque markers or with which the positions of the radiopaque markers are compared and / or registered. Procedure according to Claim 1 or 2nd , characterized in that the insertion channel (14), and in particular a puncture site, is or are visually highlighted, in particular framed or marked in color. Procedure according to one of the Claims 1 to 3rd , characterized in that the process steps e), f) and g) are carried out continuously during an operative intervention. Procedure according to one of the Claims 1 to 4th , characterized in that a CT scan is carried out as imaging scans in method step b) and / or one or more X-ray scans are carried out in several planes from which a spatial distribution of the tissue (22) is extracted. Procedure according to one of the Claims 1 to 5 , characterized in that in method step f) additionally an instantaneous position and orientation of tissue structures or the organ (30) to be operated is calculated from the virtual 3-dimensional model (40) and the tissue structures or organ (30) to be operated is calculated from the 3rd -dimensional model (40) in method step g) is represented in the correct position in the AR glasses (58). Procedure according to one of the Claims 1 to 6 , characterized in that running images of a live Fluoroscopy, which also detects the radiopaque markers (12), is converted into the spatial system of the virtual 3-dimensional model (40) based on the positions of the radiopaque markers (12) recorded in live fluoroscopy and in the AR glasses (58 ) are displayed in the correct position. Procedure according to Claim 7 , characterized in that the scans of the live fluoroscopy are generated in one plane of the insertion channel (14). Procedure according to one of the Claims 1 to 8th , characterized in that in method step f) when calculating the current position and orientation of the insertion channel (14) and, if appropriate, additionally the tissue structures or the organ (30) to be operated, deformations of the tissue (22) are calculated which are due to changes in the position of the Patients appear in relation to a position of the patient when recording the reference data in method step b) or by natural movements of the patient, and the calculation of the spatial positioning and orientation of the insertion channel (14) is adapted to the deformations. Procedure according to the Claims 7 and 9 or after the Claims 7 , 8th and 9 , characterized in that the position changes of the patient are recorded on the basis of the positions of the radiopaque markers (12) recorded in the live fluoroscopy. Procedure according to one of the Claims 1 to 10th that an acoustic, optical or tactile warning signal is emitted if the surgical instrument (10) deviates from the insertion channel (14) during insertion into the patient's tissue (22). Procedure according to one of the Claims 1 to 11 , characterized in that the surgeon is granted an influence for the preparatory calculation of the insertion channel (14) on the virtual 3-dimensional model (40), in particular in the case of a percutaneous nephrolithotomy it is necessary to select the kidney cup (34) of the kidney to be operated on ( 30) the insertion channel should run. System (50) for operation-supporting visualization for an intervention on a patient, in particular for the visual support of a percutaneous nephrolithotomy, comprising at least one first imaging scanner, in particular CT scanner (52) or X-ray scanner, at least three radiopaque markers (12), one Data processing device (56), AR glasses (58) and a fluoroscopic imaging system (54) with a C-arm, the radiopaque markers (12) being designed and set up to be attached to the skin surface (20) of a patient, and the data processing device (56) is designed and set up, one or more of the in the Claims 1 to 12 perform the above-mentioned process steps. System according to Claim 13 , characterized in that a surgical instrument is included, in particular a hollow needle (10) or an endoscope, which in particular has a specific radiopark structure (11) which stands out on fluoroscopic live recordings. Computer program product, in particular computer program with program code means, which, when executed on a data processing device (56) of a system (50) Claim 13 or 14 one or more of the method steps of the method according to one of the Claims 1 to 12 To run.

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