Intraoperative image-guided navigation system: development and applicability in 65 patients undergoing liver surgery
Image-guided systems have recently been introduced for their application in liver surgery. We aimed to identify and propose suitable indications for image-guided navigation systems in the domain of open oncologic liver surgery and, more specifically, in the setting of liver resection with and without microwave ablation.
Retrospective analysis was conducted in patients undergoing liver resection with and without microwave ablation using an intraoperative image-guided stereotactic system during three stages of technological development (accuracy: 8.4 ± 4.4 mm in phase I and 8.4 ± 6.5 mm in phase II versus 4.5 ± 3.6 mm in phase III). It was evaluated, in which indications image-guided surgery was used according to the different stages of technical development.
Between 2009 and 2013, 65 patients underwent image-guided surgical treatment, resection alone (n = 38), ablation alone (n = 11), or a combination thereof (n = 16). With increasing accuracy of the system, image guidance was progressively used for atypical resections and combined microwave ablation and resection instead of formal liver resection (p < 0.0001).
Clinical application of image guidance is feasible, while its efficacy is subject to accuracy. The concept of image guidance has been shown to be increasingly efficient for selected indications in liver surgery. While accuracy of available technology is increasing pertaining to technological advancements, more and more previously untreatable scenarios such as multiple small, bilobar lesions and so-called vanishing lesions come within reach.
KeywordsIntraoperative navigation Liver surgery Image guidance Liver ablation
- 10.Peterhans M, Anderegg S, Gaillard P, Oliveira-Santos T, Weber S (2010) A fully automatic calibration framework for navigated ultrasound imaging. Conf Proc IEEE Eng Med Biol Soc. 1242–1245Google Scholar
- 12.Ribes D, Peterhans M, Anderegg S, Wallach D, Banz V, Kim-Fuchs C et al (2012) Towards higher precision in instrument guided liver surgery: automatic registration of 3D ultrasound with pre-operative MeVis-CT. Intl J Comput Assist Radiol Surg 7(Suppl 1):141–145Google Scholar
- 21.Gillams A, Goldberg N, Ahmed M, Bale R, Breen D, Callstrom M et al (2015) Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the interventional oncology sans frontières meeting 2013. Eur Radiol 25:3438–3453CrossRefPubMedPubMedCentralGoogle Scholar