Software Assistance for Intra-Operative Guidance in Liver Surgery

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Abstract

Computational support in intervention planning promises to support the subjective interpretation of data with reproducible measurements. Moreover, it is possible to develop and apply models that provide additional information which is not directly visible in the data. Based on computer-tomography multi-slice images of the liver, the planning software developed by Fraunhofer MEVIS offers tools to evaluate different interventional strategies preoperatively. In identifying patient individual risks, an optimized interventional plan is developed. The identification and quantitative assessment of regions, which are functionally endangered, guides the preoperative evaluation of surgical strategies. The clinical relevance of the method was approved in several evaluation studies of our medical partners and more than 2900 complex surgical cases have been analyzed since 2002.

To transfer these pre-operative planning information into the intra-operative stage, it is of crucial importance to understand the user needs and workflow details in the restricted setting of the operation theatre clearly. Proper visualizations of the planning data help to identify critical structures, and allow for a better control of the intraoperative situation. Moreover, an intra-operative adaptation of the surgical planning is addressed: In oncologic liver surgery, additional tumors that were not visible in the preoperative images are often found during the intervention. With such findings, the resection strategy must be updated or completely revised. The planning software allows for an automated adaption of the surgical planning. The aim is to provide surgeons with an efficient tool for the quantitative assessment of planning, which is integrated in the workflow of oncologic liver interventions. To provide a meaningful procedural support of the surgical workflow, the cognitive needs of the surgeons have to be taken into account.