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Efficiency, Accuracy and Clinical Applicability of a New Image-Guided Surgery System in 3D Laparoscopic Liver Surgery

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

To investigate efficiency, accuracy and clinical benefit of a new augmented reality system for 3D laparoscopic liver surgery.

Methods

All patients who received laparoscopic liver resection by a new image-guided surgery system with augmented 3D-imaging in a university hospital were included for analysis. Digitally processed preoperative cross-sectional imaging was merged with the laparoscopic image. Intraoperative efficiency of the procedure was measured as time needed to achieve sufficient registration accuracy. Technical accuracy was reported as fiducial registration error (FRE). Clinical benefit was assessed trough a questionnaire, reporting measures in a 5-point Likert scale format ranging from 1 (high) to 5 (low).

Results

From January to March 2018, ten laparoscopic liver resections of a total of 18 lesions were performed using the novel augmented reality system. Median time for registration was 8:50 min (range 1:31–23:56). The mean FRE was reduced from 14.0 mm (SD 5.0) in the first registration attempt to 9.2 mm (SD 2.8) in the last attempt. The questionnaire revealed the ease of use of the system (1.2, SD 0.4) and the benefit for resection of vanishing lesions (1.0, SD 0.0) as convincing positive aspects, whereas image registration accuracy for resection guidance was consistently judged as too inaccurate.

Conclusions

Augmented reality in 3D laparoscopic liver surgery with landmark-based registration technique is feasible with only little impact on the intraoperative workflow. The benefit for detecting particularly vanishing lesions is high. For an additional benefit during the resection process, registration accuracy has to be improved and non-rigid registration algorithms will be required to address intraoperative anatomical deformation.

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Author information

Authors and Affiliations

  1. Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland

    Gian Andrea Prevost, Guido Beldi, Daniel Candinas & Anja Lachenmayer

  2. ARTORG Center for Biomedical Engineering Research, University of Bern, 3010, Bern, Switzerland

    Benjamin Eigl, Iwan Paolucci & Stefan Weber

  3. CAScination AG, 3008, Bern, Switzerland

    Benjamin Eigl, Tobias Rudolph & Matthias Peterhans

Authors
  1. Gian Andrea Prevost
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  2. Benjamin Eigl
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  3. Iwan Paolucci
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  4. Tobias Rudolph
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  5. Matthias Peterhans
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  6. Stefan Weber
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  7. Guido Beldi
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  8. Daniel Candinas
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  9. Anja Lachenmayer
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Contributions

GAP, MP, SW, GB, DC and AL made substantial contributions to conception and design of the study and interpretation of data. GAP, BE, IP and TR collected and analysed the data. GAP was a major contributor in writing the manuscript. All authors revised and approved the final manuscript.

Corresponding author

Correspondence to Gian Andrea Prevost.

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Disclosures

Benjamin Eigl is employed at CAScination as a PhD student with the salary covered by the European Union’s Horizon 2020 Research and Innovation programme. Tobias Rudolph and Matthias Peterhans received personal fees from CAScination AG during the conduct of the study. Stefan Weber was receiving a grant from the European Commission Horizon 2020 during the conduct of the study. He owns shares from CAScination AG and co-founded this commercial entity. Daniel Candinas owns shares from CAScination AG and co-founded this commercial entity. Gian Andrea Prevost, Iwan Paolucci, Guido Beldi and Anja Lachenmayer have no conflicts of interest or financial ties to disclose.

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Prevost, G.A., Eigl, B., Paolucci, I. et al. Efficiency, Accuracy and Clinical Applicability of a New Image-Guided Surgery System in 3D Laparoscopic Liver Surgery. J Gastrointest Surg 24, 2251–2258 (2020). https://doi.org/10.1007/s11605-019-04395-7

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  • DOI: https://doi.org/10.1007/s11605-019-04395-7

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