Current Evidence in Image-Guided Liver Surgery

Al, Simpson; Kingham, T. Peter

doi:10.1007/s11605-016-3101-7

Cited by 15 publications

(13 citation statements)

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“…Surgical navigation through use of image guidance has proven effective in sinus 15,16 , skull base 17 , and neurosurgery 18 , reducing complications and surgical morbidity. This technology has also been examined in thoracic 19 , hepatic 20 , and urological surgery 21–23 , among others. It stands to reason that surgical navigation with image guidance would also be beneficial in TOS.…”

Section: Discussionmentioning

confidence: 99%

Initial experience with image‐guided surgical navigation in transoral surgery

Paydarfar

Halter

2018

Head & Neck

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Background Surgical navigation using image guidance may improve the safety and efficacy of trans-oral surgery (TOS); however, pre-operative imaging cannot be accurately registered to the intra-operative state due to deformations resulting from placement of the laryngoscope or retractor. This proof of concept study explores feasibility and registration accuracy of surgical navigation for TOS by utilizing intraoperative imaging.. Methods Four patients undergoing TOS were recruited. Suspension laryngoscopy was performed with a CT-compatible laryngoscope. An intraoperative contrast enhanced CT scan was obtained and registered to fiducials placed on the neck, face and laryngoscope. Results All patients were successfully scanned and registered. Registration accuracy within the pharynx and larynx was 1 mm or less. Target registration was confirmed by localizing endoscopic and surface structures to the CT images. Successful tracking was performed in all four patients. Conclusions For surgical navigation during TOS, although a high level of registration accuracy can be achieved by utilizing intra-operative imaging, significant limitations of the existing technology have been identified. These limitations, as well as areas for future investigation, are discussed.

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Section: Discussionmentioning

confidence: 99%

Initial experience with image‐guided surgical navigation in transoral surgery

Paydarfar

Halter

2018

Head & Neck

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“…Recent work focused on either simplifying the registration process [8] or correcting the deformations by incorporating biomechanical deformation models [9]- [12]. However, in clinical studies none of these approaches have proven to be accurate enough or applicable in a real life setting [6], [13]. Tissue deformation is the major obstacle, that needs to be overcome to successfully introduce an image-guided surgery system [13], [14].…”

Section: Introductionmentioning

confidence: 99%

“…However, in clinical studies none of these approaches have proven to be accurate enough or applicable in a real life setting [6], [13]. Tissue deformation is the major obstacle, that needs to be overcome to successfully introduce an image-guided surgery system [13], [14]. Large deformations occur between the preoperative image acquisition for the pre-operative model and the intra-operative field, especially after mobilization of the liver.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Based Planning and Navigation for Non-Anatomical Liver Resections – An Ex-Vivo Study

Paolucci

Sandu

Sahli

et al. 2020

IEEE Open J. Eng. Med. Biol.

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Non-anatomical resections of liver tumors can be very challenging as the surgeon cannot use anatomical landmarks on the liver surface or in the ultrasound image for guidance. This makes it difficult to achieve negative resection margins (R0) and still preserve as much healthy liver tissue as possible. Even though image-guided surgery systems have been introduced to overcome this challenge, they are still rarely used due to their inaccuracy, time-effort and complexity in usage and setup. Methods: We have developed a novel approach, which allows us to create an intra-operative resection plan using navigated ultrasound. First, the surface is scanned using a navigated ultrasound, followed by tumor segmentation on a midsection ultrasound image. Based on this information, the navigation system calculates an optimal resection strategy and displays it along with the tracked surgical instruments. In this study, this approach was evaluated by three experienced hepatobiliary surgeons on ex-vivo porcine models. Results: Using this technique, an R0 resection could be achieved in 22 out of 23 (95.7% R0 resection rate) cases with a median resection margin of 5.9 mm (IQR 3.5-7.7 mm). The resection margin between operators 1, 2 and 3 was 7.8 mm, 4.15 mm and 5.1 mm respectively (p = 0.054). Conclusions: This approach could represent a useful tool for intra-operative guidance in non-anatomical resection alongside conventional ultrasound guidance. However, instructions and training are essential especially if the operator has not used an image-guidance system before.

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“…Surgical navigation of this type has proven effective in sinus 8 , skull base 10 , and neurosurgery 12 , reducing complications and surgical morbidity. This technology has also been explored in thoracic 34 , hepatic 33 , and urological surgery 16,17,26 , among others. It stands to reason that surgical navigation would also be beneficial in TOS.…”

Section: Introductionmentioning

confidence: 99%

Quantifying Anatomic Deformations During Laryngoscopy

Paydarfar

Halter

2018

Ann Biomed Eng

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For a variety of head and neck cancers, specifically those of the oropharynx, larynx, and hypopharynx, minimally invasive trans-oral approaches have been developed to reduce perioperative and long-term morbidity. However, in trans-oral surgical approaches anatomical deformation due to instrumentation, specifically placement of laryngoscopes and retractors, present a significant challenge for surgeons relying on preoperative imaging to resect tumors to negative margins. Quantifying the deformation due to instrumentation is needed in order to develop predictive models of operative deformation. In order to study this deformation, we used a CT/MR-compatible laryngoscopy system in concert with intraoperative CT imaging. 3D models of preoperative and intraoperative anatomy were generated. Mandible and hyoid displacements as well as tongue deformations were quantified for eight patients undergoing diagnostic laryngoscopy. Across patients, we found on average 1.3 cm of displacement for these anatomic structures due to laryngoscope insertion. On average, the maximum displacement for certain tongue regions exceeded 4 cm. The anatomical deformations quantified here can serve as a reference for describing how the upper aerodigestive tract anatomy changes during instrumentation and may be helpful in developing predictive models of intraoperative upper aerodigestive tract deformation.

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Current Evidence in Image-Guided Liver Surgery

Cited by 15 publications

References 50 publications

Initial experience with image‐guided surgical navigation in transoral surgery

Initial experience with image‐guided surgical navigation in transoral surgery

Ultrasound Based Planning and Navigation for Non-Anatomical Liver Resections – An Ex-Vivo Study

Quantifying Anatomic Deformations During Laryngoscopy

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