Intraoperative image-guided navigation system: development and applicability in 65 patients undergoing liver surgery
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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
VMB, DC, MP and SW were responsible for study conception and design and PCM and PT for acquisition of data; VMB, PCM and SW analysed the data; VMB, PCM and SW drafted the manuscript; and DI, DR, MP and DC performed a critical revision of the manuscript.
Compliance with ethical standards
Source of funding
SNSF NCCR COME, Eurostars E!6201, CTI 12196.
Conflict of interest
Vanessa Banz, Philip Müller, Pasquale Tinguely, Daniel Inderbitzin, Delphine Ribes: None.
Daniel Candinas, Stefan Weber: Co-Founder of CAScination.
Matthias Peterhans: CEO and Co-Founder of CAScination.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (KEK 63/11 and KEK 168/11) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standard. For this type of study, formal consent is not required.
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