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Initial results of MR-guided liver resection in a high-field open MRI

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Abstract

Background

The goal of this study was to evaluate high-field open magnetic resonance imaging (MRI) for intraoperative real-time imaging during hand-assisted laparoscopic liver resection. MR guidance has several advantages compared to ultrasound and may represent a future technique for abdominal surgery. Various MRI-safe and -compatible instruments were developed, tested, and applied to realize minimally invasive liver surgery under MR guidance. As proof of the concept, liver resection was performed in a porcine model.

Methods

All procedures were conducted in a 1.0-T open MRI unit. Imaging quality and surgical results were documented during three cadaveric and two live animal procedures. A nonferromagnetic hand port was used for manual access and the liver tissue was dissected using a Nd:YAG laser.

Results

The intervention time ranged from 126 to 145 min, with a dissection time from 11 to 15 min. Both live animals survived the intervention with a blood loss of 250 and 170 ml and a specimen weight of 138 and 177 g. A dynamic T2W fast spin-echo sequence allowed real-time imaging (1.5 s/image) with good delineation of major and small hepatic vessels. The newly developed MR-compatible instruments and camera system caused only minor interferences and artifacts of the MR image.

Conclusion

MR-guided liver resection is feasible and provides additional image information to the surgeon. We conclude that MR-guided laparoscopic liver resection improves the anatomical orientation and may increase the safety of future minimally invasive liver surgery.

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Acknowledgments

The project was funded by the TSB Technologiestiftung Berlin–Zukunftsfonds Berlin, Germany, and the European Union–European Fund for regional development, Berlin, Germany. Official project partners were Philips Medical Systems, Hamburg, Germany (open MR, MR monitors); WOM, World of Medicine AG, Berlin, Germany (camera prototype, ORCAP documentation system); MGB, Berlin, Germany (laparoscope prototype); Somatex, Teltow, Germany (MR-compatible needle).

Disclosures

Authors S. S. Chopra, S. C. Schmidt, R. Eisele, U. Teichgräber, I. Van der Voort, C. Seebauer, F. Streitparth, and G. Schumacher have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General-, Visceral- and Transplantation Surgery, Charité Campus Virchow Clinic, University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Sascha Santosh Chopra, Sven Christian Schmidt, Robert Eisele & Guido Schumacher

  2. Department of Radiology, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany

    Ulf Teichgräber & Florian Streitparth

  3. Department of Gastroenterology, Charité Campus Virchow Clinic, University Medicine Berlin, Berlin, Germany

    Ivo Van der Voort

  4. Department of Traumatology, Charité Campus Virchow Clinic, University Medicine Berlin, Berlin, Germany

    Christian Seebauer

Authors
  1. Sascha Santosh Chopra
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  2. Sven Christian Schmidt
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  3. Robert Eisele
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  4. Ulf Teichgräber
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  5. Ivo Van der Voort
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  6. Christian Seebauer
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  7. Florian Streitparth
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  8. Guido Schumacher
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Correspondence to Sascha Santosh Chopra.

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Chopra, S.S., Schmidt, S.C., Eisele, R. et al. Initial results of MR-guided liver resection in a high-field open MRI. Surg Endosc 24, 2506–2512 (2010). https://doi.org/10.1007/s00464-010-0994-1

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  • DOI: https://doi.org/10.1007/s00464-010-0994-1

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