Laparoscopic Liver Surgery Guided by Virtual Real-time CT-Guided Volume Navigation.
Electromagnetics
Hepatectomy
Image-guided surgery
Laparoscopy
Ultrasonography
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
26
05
2020
accepted:
27
08
2020
pubmed:
10
9
2020
medline:
6
8
2021
entrez:
9
9
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32901425
doi: 10.1007/s11605-020-04784-3
pii: 10.1007/s11605-020-04784-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1779-1786Informations de copyright
© 2020. The Society for Surgery of the Alimentary Tract.
Références
Makuuchi M, Hasegawa H, Yamazaki S. Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 1985; 161: 346-350.
pubmed: 2996162
Torzilli G, Takayama T, Hui AM, Kubota K, Harihara Y, Makuuchi M. A new technical aspect of ultrasound-guided liver surgery. Am J Surg. 1999 Oct;178(4):341-3.
doi: 10.1016/S0002-9610(99)00193-2
Araki K, Conrad C, Ogiso S, et al. Intraoperative ultrasonography of laparoscopic hepatectomy: key technique for safe liver transection. J Am Coll Surg 2014;218:e37-41.
doi: 10.1016/j.jamcollsurg.2013.10.022
Aoki T, Murakami M, Koizumi T, Fujimori A, Gareer H, Enami Y, Koike R, Watanabe M, Otsuka K. Three-Dimensional Virtual Endoscopy for Laparoscopic and Thoracoscopic Liver Resection. J Am Coll Surg. 2015 Aug;221(2):e21-6.
doi: 10.1016/j.jamcollsurg.2015.04.012
Aoki T, Murakami M, Fujimori A, Koizumi T, Enami Y, Kusano T, Matsuda K, Yamada K, Nogaki K, Wada Y, Hakozaki T, Goto S, Watanabe M, Otsuka K. Routes for virtually guided endoscopic liver resection of subdiaphragmatic liver tumors. Langenbecks Arch Surg. 2016 Mar;401(2):263-73.
doi: 10.1007/s00423-016-1385-4
Soler L, Delingette H, Malandain G, Ayache N, Koehl C, Clément JM, Dourthe O, Marescaux J. An automatic virtual patient reconstruction from CT-scans for hepatic surgical planning. Stud Health Technol Inform. 2000;70:316-22.
pubmed: 10977563
Shuhaiber JH. Augmented reality in surgery. Arch Surg. 2004;139:170-4.
doi: 10.1001/archsurg.139.2.170
Nakamoto M, Nakada K, Sato Y, Konishi K, Hashizume M, Tamura S. Intraoperative magnetic tracker calibration using a magneto-optic hybrid tracker for 3-D ultrasound-based navigation in laparoscopic surgery. IEEE Trans Med Imaging. 2008;27:255–70.
doi: 10.1109/TMI.2007.911003
Ferrero A, Lo Tesoriere R, Russolillo N. Ultrasound Liver Map Technique for Laparoscopic Liver Resections. World J Surg. 2019 Oct;43(10):2607-2611.
doi: 10.1007/s00268-019-05046-3
Våpenstad C, Rethy A, Langø T, Selbekk T, Ystgaard B, Hernes TA, Mårvik R. Laparoscopic ultrasound: A survey of its current and future use, requirements, and integration with navigation technology. Surg Endosc. 2010 Dec;24(12):2944-53.
doi: 10.1007/s00464-010-1135-6
Krücker J, Xu S, Venkatesan A, Locklin JK, Amalou H, Glossop N, Wood BJ. Clinical utility of real-time fusion guidance for biopsy and ablation. J Vasc Interv Radiol. 2011;22(4):515-24.
doi: 10.1016/j.jvir.2010.10.033
Venkatesan AM, Kadoury S, Abi-Jaoudeh N, Levy EB, Maass-Moreno R, Krücker J, Dalal S, Xu S, Glossop N, Wood BJ. Real-time FDG PET guidance during biopsies and radiofrequency ablation using multimodality fusion with electromagnetic navigation. Radiology. 2011;260(3):848-56.
doi: 10.1148/radiol.11101985
Lee MW. Fusion imaging of real-time ultrasonography with CT or MRI for hepatic intervention. Ultrasonography. 2014;33(4):227-39.
doi: 10.14366/usg.14021
Aoki T, Murakami M, Koizumi T, Fujimori A, Enami Y, Kusano T, Matsuda K, Yamada K, Nogaki K, Tashiro Y, Wada Y, Hakozaki T, Tomioka K, Goto S, Watanabe M, Otsuka K. Ultrasound with Electromagnetic Tracking Navigation and Image Fusion System in Laparoscopic Liver Surgery: An Initial Clinical Experience. Am Surg. 2016;82(12):e366-368.
doi: 10.1177/000313481608201214
Kucukkaya F, Aribal E, Tureli D, Altas H, Kaya H. Use of a Volume Navigation Technique for Combining Real-Time Ultrasound and Contrast-Enhanced MRI: Accuracy and Feasibility of a Novel Technique for Locating Breast Lesions. AJR Am J Roentgenol. 2016;206(1):217-25.
doi: 10.2214/AJR.14.14101
Jakimowicz JJ. Intraoperative ultrasonography in open and laparoscopic abdominal surgery: an overview. Surg Endosc. 2006 Apr;20 Suppl 2:S425-35.
doi: 10.1007/s00464-006-0035-2
Sofuni A, Itoi T, Itokawa F, Tsuchiya T, Kurihara T, Ishii K, Tsuji S, Ikeuchi N, Tanaka R, Umeda J, Tonozuka R, Honjo M, Mukai S, Moriyasu F. Real-time virtual sonography visualization and its clinical application in biliopancreatic disease. World J Gastroenterol 2013; 19(42): 7419-7425.
doi: 10.3748/wjg.v19.i42.7419
Satou S, Aoki T, Kaneko J, et al. Initial experience of intraoperative three-dimensional navigation for liver resection using real-time virtual sonography. Surgery 2014;155:255–62.
doi: 10.1016/j.surg.2013.08.009
Huber T, Baumgart J, Peterhans M, Weber S, Heinrich S, Lang H. Computer-assisted 3D-navigated laparoscopic resection of a vanished colorectal liver metastasis after chemotherapy. Z Gastroenterol. 2016;54(1):40-3.
doi: 10.1055/s-0041-107542
Beller S, Hünerbein M, Eulenstein S, et al. Feasibility of navigated resection of liver tumors using multiplanar visualization of intraoperative 3-dimensional ultrasound data. Ann Surg 2007; 246:288–94.
doi: 10.1097/01.sla.0000264233.48306.99
Sergeeva O, Uhlemann F, Schackert G, et al. Integration of intraoperative 3D-ultrasound in a commercial navigation system. Zentralbl neurochir. 2006;67:197-203.
doi: 10.1055/s-2006-942186