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Surgical Endoscopy

, Volume 32, Issue 7, pp 3410–3419 | Cite as

Design and implementation of an electromagnetic ultrasound-based navigation technique for laparoscopic ablation of liver tumors

  • Iwan Paolucci
  • Marius Schwalbe
  • Gian Andrea Prevost
  • Anja Lachenmayer
  • Daniel Candinas
  • Stefan Weber
  • Pascale Tinguely
New Technology

Abstract

Background

Efficient laparoscopic ablation of liver tumors relies on precise tumor visualization and accurate positioning of ablation probes. This study evaluates positional accuracy and procedural efficiency of a dynamic navigation technique based on electromagnetic-tracked laparoscopic ultrasound (ELUS) for laparoscopic ablation of liver tumors.

Methods

The proposed navigation approach combines intraoperative 2D ELUS-based planning for navigated positioning of ablation probes, with immediate 3D ELUS-based validation of intrahepatic probe position. The environmental influence on electromagnetic-tracking stability was evaluated in the operation room. Accuracy of navigated ablation probe positioning assessed as the target-positioning error (TPE), and procedural efficiency defined as time efforts for target definition/navigated targeting and number of probe repositionings, were evaluated in a laparoscopic model and compared with conventional laparoscopic ultrasound (LUS) guidance.

Results

The operation-room environment showed interferences < 1 mm on the EM-tracking system. A total of 60 targeting attempts were conducted by three surgeons, with ten targeting attempts using ELUS and ten using conventional LUS each. Median TPE and time for targeting using ELUS and LUS were 4.2 mm (IQR 2.9–5.3 mm) versus 6 mm (IQR 4.7–7.5 mm), and 39 s (IQR 24–47 s) versus 76 s (IQR 47–121 s), respectively (p < 0.01 each). With ELUS, median time for target definition was 48.5 s, with 0 ablation probe repositionings compared to 17 when using LUS. The navigation technique was rated with a mean score of 85.5 on a Standard Usability Scale.

Conclusions

The proposed ELUS-based navigation approach allows for accurate and efficient targeting of liver tumors in a laparoscopic model. Focusing on a dynamic and tumor-targeted navigation technique relying on intraoperative imaging, this avoids potential inaccuracies due to organ deformation and yields a user-friendly technique for efficient laparoscopic ablation of liver tumors.

Keywords

Ablation techniques Computer-assisted surgery Laparoscopy Ultrasonography Three-dimensional imaging Liver neoplasms 

Notes

Acknowledgements

The authors thank Matteo Fusaglia and Denise Baumann for their support in the conduction of the EM-tracking stability experiment.

Compliance with ethical standards

Disclosures

Mr. Iwan Paolucci, Marius Schwalbe, Drs. Gian Andrea Prevost, Anja Lachenmayer, Daniel Candinas, Stefan Weber, and Pascale Tinguely have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.ARTORG Center for Biomedical Engineering ResearchUniversity of BernBernSwitzerland
  2. 2.Department of Visceral Surgery and Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland

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