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Ultrasound-based navigation for open liver surgery using active liver tracking

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Despite extensive preoperative imaging, intraoperative localization of liver lesions after systemic treatment can be challenging. Therefore, an image-guided navigation setup is explored that links preoperative diagnostic scans and 3D models to intraoperative ultrasound (US), enabling overlay of detailed diagnostic images on intraoperative US. Aim of this study is to assess the workflow and accuracy of such a navigation system which compensates for liver motion.

Methods

Electromagnetic (EM) tracking was used for organ tracking and movement of the transducer. After laparotomy, a sensor was attached to the liver surface while the EM-tracked US transducer enabled image acquisition and landmark digitization. Landmarks surrounding the lesion were selected during patient-specific preoperative 3D planning and identified for registration during surgery. Endpoints were accuracy and additional times of the investigative steps. Accuracy was computed at the center of the target lesion.

Results

In total, 22 navigated procedures were performed. Navigation provided useful visualization of preoperative 3D models and their overlay on US imaging. Landmark-based registration resulted in a mean fiducial registration error of 10.3 ± 4.3 mm, and a mean target registration error of 8.5 ± 4.2 mm. Navigation was available after an average of 12.7 min.

Conclusion

We developed a navigation method combining ultrasound with active liver tracking for organ motion compensation, with an accuracy below 10 mm. Fixation of the liver sensor near the target lesion compensates for local movement and contributes to improved reliability during navigation. This represents an important step forward in providing surgical navigation throughout the procedure.

Trial Registration: This study is registered in the Netherlands Trial Register (number NL7951).

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Acknowledgements

We would like to thank Niels Liberton and Maureen van Eijnatten from VUmc for their help with the optical scanning of the US transducer. We thank Ole Vegard Solberg and Lars Eirik Bø from SINTEF for their help with the robotic ultrasound calibration and software integration.

Funding

This work was supported by a grant from KWF—De Vriendenloterij (Grant Number NKI2016-8162).

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands

    Jasper N. Smit, Koert F. D. Kuhlmann, Oleksandra V. Ivashchenko, Bart R. Thomson, Niels F. M. Kok, Matteo Fusaglia & Theo J. M. Ruers

  2. Department of Radiology, Medical Physics Group, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

    Oleksandra V. Ivashchenko

  3. Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland

    Bart R. Thomson

  4. Research Group for Medical Technology, SINTEF, Trondheim, Norway

    Thomas Langø

  5. Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim, Norway

    Thomas Langø

  6. Faculty of Science and Technology (TNW), Nanobiophysics Group (NBP), University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands

    Theo J. M. Ruers

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  1. Jasper N. Smit
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Correspondence to Jasper N. Smit.

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The authors have no relevant financial or non-financial interests to disclose.

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The study was performed in accordance with the ethical standards of the institutional medical ethics committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual patients included in the study.

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Smit, J.N., Kuhlmann, K.F.D., Ivashchenko, O.V. et al. Ultrasound-based navigation for open liver surgery using active liver tracking. Int J CARS 17, 1765–1773 (2022). https://doi.org/10.1007/s11548-022-02659-3

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  • DOI: https://doi.org/10.1007/s11548-022-02659-3

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