Laparoscopic image-based navigation for microwave ablation of liver tumors—A multi-center study
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Stereotactic navigation technology has been proposed to augment accuracy in targeting intrahepatic lesions for local ablation therapy. This retrospective study evaluated accuracy, efficacy, and safety when using laparoscopic image-guided microwave ablation (LIMA) for malignant liver tumors.
All patients treated for malignant liver lesions using LIMA at two European centers between 2013 and 2015 were included for analysis. A landmark-based registration technique was applied for intraoperative tumor localization and positioning of ablation probes. Intraoperative efficiency of the procedure was measured as number of registration attempts and time needed to achieve sufficient registration accuracy. Technical accuracy was assessed as Fiducial Registration Error (FRE). Outcome at 90 days including mortality, postoperative morbidity, rates of incomplete ablations, and early intrahepatic recurrences were reported.
In 34 months, 54 interventions were performed comprising a total of 346 lesions (median lesions per patient 3 (1–25)). Eleven patients had concomitant laparoscopic resections of the liver or the colorectal primary tumor. Median time for registration was 4:38 min (0:26–19:34). Average FRE was 8.1 ± 2.8 mm. Follow-up at 90 days showed one death, 24% grade I/II, and 4% grade IIIa complications. Median length of hospital stay was 2 days (1–11). Early local recurrence was 9% per lesion and 32% per patient. Of these, 63% were successfully re-ablated within 6 months.
LIMA does not interfere with the intraoperative workflow and results in low complication and early local recurrence rates, even when simultaneously targeting multiple lesions. LIMA may represent a valid therapy option for patients with extensive hepatic disease within a multimodal treatment approach.
KeywordLiver Ablation Image-guided surgery Surgical navigation Laparoscopy Minimal invasive surgery
The authors would like to acknowledge Dr. Matthias Peterhans, Delphine Ribes, Denise Baumann and Iwan Paolucci for their contribution to this project. We also thank Prof. Dr. med. Guido Beldi and PD Dr. med. Anja Lachenmayer for their continuous support.
Compliance with ethical standards
Drs. Stefan Weber and Daniel Candinas report grants from CTI and from Eurostars-Eureka during the conduct of the study and are co-founders and shareholders in CAScination AG, manufacturer of the navigation technology under investigation in this study. Drs. Pascale Tinguely, Matteo Fusaglia, Jacob Freedman, Vanessa Banz and Henrik Nilsson have no conflicts of interest or financial ties to disclose.
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