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Laparoscopic Liver Surgery Guided by Virtual Real-time CT-Guided Volume Navigation

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Recently, virtual navigation system has been applied to hepatic surgery, enabling better visualization of intrahepatic vascular branches and location of tumor. Intraoperative ultrasonography (IOUS) is the most common form of image guidance during liver surgery. However, during laparoscopic hepatectomies (LH), IOUS has several limitations and its reliability has been poorly evaluated. The objective of this work is to evaluate VRCT (virtual real-time CT-guided volume navigation) during LH. This system aims to provide accurate anatomical orientation for surgeons enhancing the safety of LH.

Methods

Twenty-seven hepatic neoplasms were resected laparoscopically at our institution under reference guidance of VRCT. During operation, electromagnetic tracking of the surgical instrument was used for navigating the direction of accurate liver transection.

Results

Twenty-six (96.3%) of the 27 lesions (mean diameter 11 mm) were successfully performed under VRCT guidance. Average registration time was < 2 min. Average setup time was approximately 7 min per procedure. VRCT allows the surgeon to navigate liver transection with acceptable accuracy. The mean error was 12 mm. All surgical margins were negative and the mean histologic resection margin was 9 mm.

Conclusions

VRCT-guided LH is feasible and provides valuable real-time anatomical feedback during hepatic resections. Advancement of such systems to improve accuracy might greatly compensate for the limitation of laparoscopic IOUS.

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Author information

Authors and Affiliations

  1. Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan

    Takeshi Aoki, Doaa A. Mansour, Tomotake Koizumi, Yusuke Wada, Yuta Enami, Akira Fujimori, Tomokazu Kusano, Kazuhiro Matsuda, Koji Nogaki, Yoshihiko Tashiro, Tomoki Hakozaki, Hideki Shibata, Kodai Tomioka, Takahito Hirai, Tatsuya Yamazaki, Kazuhiko Saito, Satoru Goto, Makoto Watanabe, Koji Otsuka & Masahiko Murakami

  2. General Surgery Department, Cairo University Hospitals, Kasr Alainy, Al-Saray Street, El-Manial, Cairo, 11956, Egypt

    Doaa A. Mansour

Authors
  1. Takeshi Aoki
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  2. Doaa A. Mansour
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  3. Tomotake Koizumi
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  4. Yusuke Wada
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  5. Yuta Enami
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  6. Akira Fujimori
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  7. Tomokazu Kusano
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  8. Kazuhiro Matsuda
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  9. Koji Nogaki
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  10. Yoshihiko Tashiro
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  11. Tomoki Hakozaki
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  12. Hideki Shibata
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  13. Kodai Tomioka
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  14. Takahito Hirai
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  15. Tatsuya Yamazaki
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  16. Kazuhiko Saito
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  17. Satoru Goto
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  18. Makoto Watanabe
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  19. Koji Otsuka
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  20. Masahiko Murakami
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Contributions

Study conception and design: Takeshi Aoki.

Acquisition and analysis of data: Tomotake Koizumi, Yusuke Wada, Yuta Enami, Akira Fujimori, Tomokazu Kusano, Kazuhiro Matsuda, Koji Nogaki, Yoshihiko Tashiro, Tomoki Hakozaki, Hideki Shibata, Kodai Tomioka, Takahito Hirai, Tatsuya Yamazaki, Kazuhiko Saito, Satoru Goto, Makoto Watanabe, and Koji Otsuka.

Interpretation of data: Takeshi Aoki, Doaa A. Mansour, Tomotake Koizumi, Yusuke Wada, Satoru Goto, Makoto Watanabe, Koji Otsuka, and Masahiko Murakami.

Drafting of manuscript: Takeshi Aoki, Doaa A. Mansour, Tomotake Koizumi, Yusuke Wada, and Masahiko Murakami.

Critical revision of manuscript: Takeshi Aoki, Doaa A. Mansour, Tomotake Koizumi, Yusuke Wada, Yuta Enami, Akira Fujimori, Tomokazu Kusano, Kazuhiro Matsuda, Koji Nogaki, Yoshihiko Tashiro, Tomoki Hakozaki, Hideki Shibata, Kodai Tomioka, Takahito Hirai, Tatsuya Yamazaki, Kazuhiko Saito, Satoru Goto, Makoto Watanabe, Koji Otsuka, and Masahiko Murakami.

Final approval of the version to be published: Takeshi Aoki, Doaa A. Mansour, Tomotake Koizumi, Yusuke Wada, Yuta Enami, Akira Fujimori, Tomokazu Kusano, Kazuhiro Matsuda, Koji Nogaki, Yoshihiko Tashiro, Tomoki Hakozaki, Hideki Shibata, Kodai Tomioka, Takahito Hirai, Tatsuya Yamazaki, Kazuhiko Saito, Satoru Goto, Makoto Watanabe, Koji Otsuka, and Masahiko Murakami.

Agreement to be accountable for all aspects of the work: Takeshi Aoki, Doaa A. Mansour, Tomotake Koizumi, Yusuke Wada, Yuta Enami, Akira Fujimori, Tomokazu Kusano, Kazuhiro Matsuda, Koji Nogaki, Yoshihiko Tashiro, Tomoki Hakozaki, Hideki Shibata, Kodai Tomioka, Takahito Hirai, Tatsuya Yamazaki, Kazuhiko Saito, Satoru Goto, Makoto Watanabe, Koji Otsuka, and Masahiko Murakami.

Corresponding author

Correspondence to Takeshi Aoki.

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Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards (statement of approval of IRB: Showa University Ethics Committee; notice of approval of IRB protocol number, 2944).

Additional information

List of Instruments

SOMATON Definition AS SIEMENS, Munich, Germany

omniTRAX™ CIVCO Medical Solutions, Coralville, IA, USA

Ziostation2 AMIN, Tokyo, Japan.

LOGIQ™ E9 GE Healthcare, Boston, MA, USA

VirtuTRAX™, CIVCO Medical Solutions, Coralville, IA, USA

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Aoki, T., Mansour, D.A., Koizumi, T. et al. Laparoscopic Liver Surgery Guided by Virtual Real-time CT-Guided Volume Navigation. J Gastrointest Surg 25, 1779–1786 (2021). https://doi.org/10.1007/s11605-020-04784-3

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  • DOI: https://doi.org/10.1007/s11605-020-04784-3

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