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Navigierte Leberchirurgie

Aktueller Stand und Bedeutung in der Zukunft

Navigated liver surgery

Current state and importance in the future

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Zusammenfassung

Die präoperative computergestützte Resektionsplanung ist die Grundlage für jede Navigation. Dank moderner Algorithmen sind die Voraussetzungen geschaffen, eine virtuelle Resektionsplanung und Risikoanalyse vorzunehmen. So sind individuelle Segmentresektionen in jeder denkbaren Kombination exakt planbar. Problematisch ist nach wie vor, Planungsinformationen und Resektionsvorschläge in den Operationssaal zu transferieren. Die sog. stereotaktische Lebernavigation unterstützt die genaue, intraoperative Umsetzung der geplanten Resektionsstrategie und stellt dem Chirurgen während der Resektion dreidimensionale Information zu Resektionsgrenzen und kritischen Strukturen dar. Dies wird durch ein chirurgisches Navigationssystem ermöglicht, das die Position von chirurgischen Instrumenten misst und diese dann zusammen mit den präoperativen chirurgischen Planungsdaten darstellt. Obwohl chirurgische Navigationssysteme in der Neuro- und Wirbelsäulenchirurgie seit Jahren nicht mehr wegzudenken sind, konnten diese Verfahren bis jetzt in der Leberchirurgie nicht als Standard etabliert werden. Dies liegt v. a. an der technischen Herausforderung der Navigation an einem beweglichen Organ. Da sich die Leber während der Operation durch Atmung und chirurgische Manipulation laufend bewegt und verformt, muss das chirurgische Navigationssystem diese Deformation messen können, um die präoperativen Navigationsdaten laufend an die aktuelle Situation anzupassen. Trotz dieser Fortschritte bedarf es noch weiterer Entwicklungen, bis die navigierte Leberresektion in die klinische Routine kommt. Es lässt sich jetzt jedoch schon absehen, dass die laparoskopische Leberchirurgie und die Roboterchirurgie am meisten von der Navigationstechnologie profitieren werden.

Abstract

The preoperative computer-assisted resection planning is the basis for every navigation. Thanks to modern algorithms, the prerequisites have been created to carry out a virtual resection planning and a risk analysis. Thus, individual segment resections can be precisely planned in any conceivable combination. The transfer of planning information and resection suggestions to the operating theater is still problematic. The so-called stereotactic liver navigation supports the exact intraoperative implementation of the planned resection strategy and provides the surgeon with real-time three-dimensional information on resection margins and critical structures during the resection. This is made possible by a surgical navigation system that measures the position of surgical instruments and then presents them together with the preoperative surgical planning data. Although surgical navigation systems have been indispensable in neurosurgery and spinal surgery for many years, these procedures have not yet become established as standard in liver surgery. This is mainly due to the technical challenge of navigating a moving organ. As the liver is constantly moving and deforming during surgery due to respiration and surgical manipulation, the surgical navigation system must be able to measure these alterations in order to adapt the preoperative navigation data to the current situation. Despite these advances, further developments are required until navigated liver resection enters clinical routine; however, it is already clear that laparoscopic liver surgery and robotic surgery will benefit most from navigation technology.

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Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, Asklepios Klinik Barmbek, Hamburg, Deutschland

    K. J. Oldhafer, A. Kantas, G. Makridis & K. C. Wagner

  2. Semmelweis Universität Budapest, Campus Hamburg, Hamburg, Deutschland

    K. J. Oldhafer, A. Kantas, G. Makridis, K. C. Wagner & M. Donati

  3. CAScination AG, Bern, Schweiz

    M. Peterhans

  4. Fraunhofer-Institut für Bildgestützte Medizin MEVIS, Bremen, Deutschland

    A. Schenk

  5. apoQlar, Hamburg, Deutschland

    S. Pelzl

  6. University of Bern, ARTORG Center for Biomedical Engineering Research, Bern, Schweiz

    S. Weber

  7. Klinik für Allgemein‑, Viszeralchirurgie, Thorax- und Kinderchirurgie, Klinikum Saarbrücken, Saarbrücken, Deutschland

    G. A. Stavrou

  8. Department of Surgery and Medical Surgical Specialties, University of Catania, Catania, Italien

    M. Donati

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  1. K. J. Oldhafer
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  2. M. Peterhans
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  7. K. C. Wagner
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  8. S. Weber
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  9. G. A. Stavrou
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  10. M. Donati
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Correspondence to K. J. Oldhafer.

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Interessenkonflikt

K.J. Oldhafer, M. Peterhans, A. Kantas, A. Schenk, G. Makridis, S. Pelzl, K.C. Wagner, S. Weber, G.A. Stavrou und M. Donati geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Oldhafer, K.J., Peterhans, M., Kantas, A. et al. Navigierte Leberchirurgie. Chirurg 89, 769–776 (2018). https://doi.org/10.1007/s00104-018-0713-3

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  • DOI: https://doi.org/10.1007/s00104-018-0713-3

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