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Intraoperative image-guided navigation system: development and applicability in 65 patients undergoing liver surgery

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Abstract

Background

Image-guided systems have recently been introduced for their application in liver surgery. We aimed to identify and propose suitable indications for image-guided navigation systems in the domain of open oncologic liver surgery and, more specifically, in the setting of liver resection with and without microwave ablation.

Method

Retrospective analysis was conducted in patients undergoing liver resection with and without microwave ablation using an intraoperative image-guided stereotactic system during three stages of technological development (accuracy: 8.4 ± 4.4 mm in phase I and 8.4 ± 6.5 mm in phase II versus 4.5 ± 3.6 mm in phase III). It was evaluated, in which indications image-guided surgery was used according to the different stages of technical development.

Results

Between 2009 and 2013, 65 patients underwent image-guided surgical treatment, resection alone (n = 38), ablation alone (n = 11), or a combination thereof (n = 16). With increasing accuracy of the system, image guidance was progressively used for atypical resections and combined microwave ablation and resection instead of formal liver resection (p < 0.0001).

Conclusion

Clinical application of image guidance is feasible, while its efficacy is subject to accuracy. The concept of image guidance has been shown to be increasingly efficient for selected indications in liver surgery. While accuracy of available technology is increasing pertaining to technological advancements, more and more previously untreatable scenarios such as multiple small, bilobar lesions and so-called vanishing lesions come within reach.

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Authors’ contributions

VMB, DC, MP and SW were responsible for study conception and design and PCM and PT for acquisition of data; VMB, PCM and SW analysed the data; VMB, PCM and SW drafted the manuscript; and DI, DR, MP and DC performed a critical revision of the manuscript.

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Authors and Affiliations

  1. Inselspital Berne, Department of Visceral Surgery and Medicine, Inselspital, Berne, Switzerland

    Vanessa M. Banz, Pascale Tinguely, Daniel Inderbitzin & Daniel Candinas

  2. ARTORG Center for Computer-Aided Surgery, University of Berne, 3010 Berne, Switzerland

    Philip C. Müller, Delphine Ribes, Matthias Peterhans & Stefan Weber

  3. CAScination AG, Steigerhubelstrasse 3, 3008, Berne, Switzerland

    Matthias Peterhans

Authors
  1. Vanessa M. Banz
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  2. Philip C. Müller
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  3. Pascale Tinguely
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  4. Daniel Inderbitzin
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  5. Delphine Ribes
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  6. Matthias Peterhans
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  7. Daniel Candinas
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  8. Stefan Weber
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Corresponding author

Correspondence to Stefan Weber.

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Source of funding

SNSF NCCR COME, Eurostars E!6201, CTI 12196.

Conflict of interest

Vanessa Banz, Philip Müller, Pasquale Tinguely, Daniel Inderbitzin, Delphine Ribes: None.

Daniel Candinas, Stefan Weber: Co-Founder of CAScination.

Matthias Peterhans: CEO and Co-Founder of CAScination.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (KEK 63/11 and KEK 168/11) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standard. For this type of study, formal consent is not required.

Additional information

Vanessa M. Banz and Philip C. Müller contributed equally to the publication.

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Banz, V.M., Müller, P.C., Tinguely, P. et al. Intraoperative image-guided navigation system: development and applicability in 65 patients undergoing liver surgery. Langenbecks Arch Surg 401, 495–502 (2016). https://doi.org/10.1007/s00423-016-1417-0

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  • DOI: https://doi.org/10.1007/s00423-016-1417-0

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