Real-time surgical navigation

Apparatus for surgical navigation, comprising:

• an electromagnetic (EM) device that creates a reference frame for EM tracking in three dimensions;
• one or more localization devices adapted to be attached to tissue and to provide EM tracking of local deformation and movement of a tissue volume;
• an EM sensor adapted to be attached to a surgical tool;
• a processor that receives images of the tissue volume in real time from an EM tracked imaging device, wherein the images of the tissue volume are only generated intraoperatively, EM tracking data of the one or more localization devices, and EM tracking data of the surgical tool, intraoperatively generates a three-dimensional delineation of a portion of the tissue volume using only data points in the images of the tissue volume, and three-dimensionally registers the intraoperatively delineated portion of the tissue volume with the surgical tool in real time;
• and
• an output device.

Programmed media for use with a processor, comprising:

• code stored on non-transitory storage media compatible with the processor, the code containing instructions to direct the processor to:
• receive images of a tissue volume in real time from an EM tracked imaging device, wherein the images of the tissue volume are only generated intraoperatively, and intraoperatively generate a three-dimensional delineation of a portion of the tissue volume using only data points in the images of the tissue volume;
• receive EM tracking data of one or more EM-tracked localization devices and of an EM-tracked surgical tool, and use the EM tracking data to three-dimensionally register the intraoperatively delineated portion of the tissue volume with the EM-tracked surgical tool in real time;
• and
• produce an output comprising feedback about the location of the EM-tracked surgical tool relative to the intraoperatively delineated portion of the tissue volume in real time.