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Ultrasound-based navigation for open liver surgery using active liver tracking

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Despite extensive preoperative imaging, intraoperative localization of liver lesions after systemic treatment can be challenging. Therefore, an image-guided navigation setup is explored that links preoperative diagnostic scans and 3D models to intraoperative ultrasound (US), enabling overlay of detailed diagnostic images on intraoperative US. Aim of this study is to assess the workflow and accuracy of such a navigation system which compensates for liver motion.

Methods

Electromagnetic (EM) tracking was used for organ tracking and movement of the transducer. After laparotomy, a sensor was attached to the liver surface while the EM-tracked US transducer enabled image acquisition and landmark digitization. Landmarks surrounding the lesion were selected during patient-specific preoperative 3D planning and identified for registration during surgery. Endpoints were accuracy and additional times of the investigative steps. Accuracy was computed at the center of the target lesion.

Results

In total, 22 navigated procedures were performed. Navigation provided useful visualization of preoperative 3D models and their overlay on US imaging. Landmark-based registration resulted in a mean fiducial registration error of 10.3 ± 4.3 mm, and a mean target registration error of 8.5 ± 4.2 mm. Navigation was available after an average of 12.7 min.

Conclusion

We developed a navigation method combining ultrasound with active liver tracking for organ motion compensation, with an accuracy below 10 mm. Fixation of the liver sensor near the target lesion compensates for local movement and contributes to improved reliability during navigation. This represents an important step forward in providing surgical navigation throughout the procedure.

Trial Registration: This study is registered in the Netherlands Trial Register (number NL7951).

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References

  1. Torzilli G, Botea F, Donadon M, Cimino M, Procopio F, Pedicini V, Poretti D, Montorsi M (2014) Criteria for the selective use of contrast-enhanced intra-operative ultrasound during surgery for colorectal liver metastases. HPB 16(11):994–1001. https://doi.org/10.1111/hpb.12272

    Article  PubMed  PubMed Central  Google Scholar 

  2. Van Vledder MG, Pawlik TM, Munireddy S, Hamper U, De Jong MC, Choti MA (2010) Factors determining the sensitivity of intraoperative ultrasonography in detecting colorectal liver metastases in the modern era. Ann Surg Oncol 17(10):2756–2763. https://doi.org/10.1245/s10434-010-1108-y

    Article  PubMed  Google Scholar 

  3. Choti MA, Kaloma F, De Oliveira ML, Nour S, Garrett-Mayer ES, Sheth S, Pawlik TM (2008) Patient variability in intraoperative ultrasonographic characteristics of colorectal liver metastases. Arch Surg 143(1):29–34. https://doi.org/10.1001/archsurg.2007.5

    Article  PubMed  Google Scholar 

  4. Auer RC, White RR, Kemeny NE, Schwartz LH, Shia J, Blumgart LH, Dematteo RP, Fong Y, Jarnagin WR, D’Angelica MI (2010) Predictors of a true complete response among disappearing liver metastases from colorectal cancer after chemotherapy. Cancer 116(6):1502–1509. https://doi.org/10.1002/cncr.24912

    Article  PubMed  Google Scholar 

  5. van Vledder MG, de Jong MC, Pawlik TM, Schulick RD, Diaz LA, Choti MA (2010) Disappearing colorectal liver metastases after chemotherapy: should we be concerned? J Gastrointest Surg 14(11):1691–1700. https://doi.org/10.1007/s11605-010-1348-y

    Article  PubMed  Google Scholar 

  6. Kingham TP, Pak LM, Simpson AL, Leung U, Doussot A, D’Angelica MI, DeMatteo RP, Allen PJ, Jarnagin WR (2018) 3D image guidance assisted identification of colorectal cancer liver metastases not seen on intraoperative ultrasound: results from a prospective trial. HPB 20:260–267. https://doi.org/10.1016/j.hpb.2017.08.035

    Article  PubMed  Google Scholar 

  7. Banz VM, Müller PC, Tinguely P, Inderbitzin D, Ribes D, Peterhans M, Candinas D, Weber S (2016) Intraoperative image-guided navigation system: development and applicability in 65 patients undergoing liver surgery. Langenbeck’s Arch Surg 401:495–502. https://doi.org/10.1007/s00423-016-1417-0

    Article  Google Scholar 

  8. Schneider C, Allam M, Stoyanov D, Hawkes DJ, Gurusamy K, Davidson BR (2021) Performance of image guided navigation in laparoscopic liver surgery—A systematic review. Surg Oncol 38:101637. https://doi.org/10.1016/j.suronc.2021.101637

    Article  CAS  PubMed  Google Scholar 

  9. Song R, Tipirneni A, Johnson P, Loeffler RB, Hillenbrand CM (2011) Evaluation of respiratory liver and kidney movements for MRI navigator gating. J Magn Reson Imaging 33(1):143–148. https://doi.org/10.1002/jmri.22418

    Article  PubMed  PubMed Central  Google Scholar 

  10. Schneider C, Thompson S, Totz J, Song Y, Allam M, Sodergren MH, Desjardins AE, Barratt D, Ourselin S, Gurusamy K, Stoyanov D, Clarkson MJ, Hawkes DJ, Davidson BR (2020) Comparison of manual and semi-automatic registration in augmented reality image-guided liver surgery: a clinical feasibility study. Surg Endosc 34(10):4702–4711. https://doi.org/10.1007/s00464-020-07807-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Golse N, Petit A, Lewin M, Vibert E, Cotin S (2020) Augmented reality during open liver surgery using a markerless non-rigid registration system. J Gastrointest Surg 25(3):662–671. https://doi.org/10.1007/s11605-020-04519-4

    Article  PubMed  Google Scholar 

  12. Markert M, Koschany A, Lueth T (2010) Tracking of the liver for navigation in open surgery. Int J Comput Assist Radiol Surg 5:229–235. https://doi.org/10.1007/s11548-009-0395-x

    Article  PubMed  Google Scholar 

  13. Adagolodjo Y, Golse N, Vibert E, De Mathelin M, Cotin S, Courtecuisse H (2018) Marker-based registration for large deformations—application to open liver surgery. In: Proceedings—IEEE international conference on robotics and automation (ICRA). pp 4007–4012

  14. Pelanis E, Teatini A, Eigl B, Regensburger A, Alzaga A, Kumar RP, Rudolph T, Aghayan DL, Riediger C, Kvarnström N, Elle OJ, Edwin B (2021) Evaluation of a novel navigation platform for laparoscopic liver surgery with organ deformation compensation using injected fiducials. Med Image Anal 69:101946. https://doi.org/10.1016/j.media.2020.101946

    Article  PubMed  Google Scholar 

  15. Beller S, Hünerbein M, Lange T, Eulenstein S, Gebauer B, Schlag PM (2007) Image-guided surgery of liver metastases by three-dimensional ultrasound-based optoelectronic navigation. Br J Surg 94:866–875. https://doi.org/10.1002/bjs.5712

    Article  CAS  PubMed  Google Scholar 

  16. Ivashchenko OV, Kuhlmann KFD, Veen R, Pouw B, Kok NFM, Hoetjes NJ, Smit JN, Klompenhouwer EG, Nijkamp J, Ruers TJM (2021) CBCT-based navigation system for open liver surgery: accurate guidance toward mobile and deformable targets with a semi-rigid organ approximation and electromagnetic tracking of the liver. Med Phys 48:2145–2159. https://doi.org/10.1002/mp.14825

    Article  PubMed  Google Scholar 

  17. Ivashchenko OV, Rijkhorst E-J, ter Beek LC, Hoetjes NJ, Pouw B, Nijkamp J, Kuhlmann KFD, Ruers TJM (2020) A workflow for automated segmentation of the liver surface, hepatic vasculature and biliary tree anatomy from multiphase MR images. Magn Reson Imaging 68:53–65. https://doi.org/10.1016/j.mri.2019.12.008

    Article  PubMed  Google Scholar 

  18. Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin JC, Pujol S, Bauer C, Jennings D, Fennessy F, Sonka M, Buatti J, Aylward S, Miller JV, Pieper S, Kikinis R (2012) 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging 30(9):1323–1341. https://doi.org/10.1016/j.mri.2012.05.001

    Article  PubMed  PubMed Central  Google Scholar 

  19. Reimer P, Schneider G, Schima W (2004) Hepatobiliary contrast agents for contrast-enhanced MRI of the liver: properties, clinical development and applications. Eur Radiol 14(4):559–578. https://doi.org/10.1007/s00330-004-2236-1

    Article  PubMed  Google Scholar 

  20. Coulon P, de Brouwer F, Müller D, Steinberg A, Valette P (2013) Clinical uses for CT Liver Analysis application. https://www.knowledgescape.philips.com/CBTSite/Media/HighlightsCTLiverAnalysis.pdf. Accessed 7 July 2021

  21. Askeland C, Solberg OV, Bakeng JBL, Reinertsen I, Tangen GA, Hofstad EF, Iversen DH, Våpenstad C, Selbekk T, Langø T, Hernes TAN, Olav Leira H, Unsgård G, Lindseth F (2016) CustusX: an open-source research platform for image-guided therapy. Int J Comput Assist Radiol Surg 11:505–519. https://doi.org/10.1007/s11548-015-1292-0

    Article  PubMed  Google Scholar 

  22. Bø LE, Hofstad EF, Lindseth F, Hernes TAN (2015) Versatile robotic probe calibration for position tracking in ultrasound imaging. Phys Med Biol 60:3499–3513. https://doi.org/10.1088/0031-9155/60/9/3499

    Article  PubMed  Google Scholar 

  23. Besl PJ, McKay ND (1992) Method for registration of 3-D shapes. IEEE Trans Pattern Anal Mach Intell 14(2):586–606. https://doi.org/10.1109/34.121791

    Article  Google Scholar 

  24. Gobbi DG, Peters TM (2002) Interactive intra-operative 3D ultrasound reconstruction and visualization. In: International conference on medical image computing and computer-assisted intervention 2002, LNCS, vol 2489, pp 156–163. https://doi.org/10.1007/3-540-45787-9_20

  25. Sakata K, Kijima T, Arai O (2020) Initial report: a novel intraoperative navigation system for laparoscopic liver resection using real-time virtual sonography. Sci Rep 10(1):1–6. https://doi.org/10.1038/s41598-020-63131-3

    Article  CAS  Google Scholar 

  26. Prevost GA, Eigl B, Paolucci I, Rudolph T, Peterhans M, Weber S, Beldi G, Candinas D, Lachenmayer A (2020) Efficiency, accuracy and clinical applicability of a new image-guided surgery system in 3D laparoscopic liver surgery. J Gastrointest Surg. https://doi.org/10.1007/s11605-019-04395-7

    Article  PubMed  Google Scholar 

  27. Thomson BR, Smit JN, Ivashchenko OV, Kok NFM, Kuhlmann KFD, Ruers TJM, Fusaglia M (2020) MR-to-US Registration Using Multiclass Segmentation of Hepatic Vasculature with a Reduced 3D U-Net. In: LNCS, volume 12263—Medical Image Computing and Computer Assisted Intervention—MICCAI 2020, pp 275–284. https://doi.org/10.1007/978-3-030-59716-0_27

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Acknowledgements

We would like to thank Niels Liberton and Maureen van Eijnatten from VUmc for their help with the optical scanning of the US transducer. We thank Ole Vegard Solberg and Lars Eirik Bø from SINTEF for their help with the robotic ultrasound calibration and software integration.

Funding

This work was supported by a grant from KWF—De Vriendenloterij (Grant Number NKI2016-8162).

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands

    Jasper N. Smit, Koert F. D. Kuhlmann, Oleksandra V. Ivashchenko, Bart R. Thomson, Niels F. M. Kok, Matteo Fusaglia & Theo J. M. Ruers

  2. Department of Radiology, Medical Physics Group, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

    Oleksandra V. Ivashchenko

  3. Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland

    Bart R. Thomson

  4. Research Group for Medical Technology, SINTEF, Trondheim, Norway

    Thomas Langø

  5. Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim, Norway

    Thomas Langø

  6. Faculty of Science and Technology (TNW), Nanobiophysics Group (NBP), University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands

    Theo J. M. Ruers

Authors
  1. Jasper N. Smit
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Correspondence to Jasper N. Smit.

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The study was performed in accordance with the ethical standards of the institutional medical ethics committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual patients included in the study.

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Smit, J.N., Kuhlmann, K.F.D., Ivashchenko, O.V. et al. Ultrasound-based navigation for open liver surgery using active liver tracking. Int J CARS 17, 1765–1773 (2022). https://doi.org/10.1007/s11548-022-02659-3

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  • DOI: https://doi.org/10.1007/s11548-022-02659-3

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