First application of intraoperative MRI of the liver during ALPPS procedure for colorectal liver metastases

Abstract

Purpose Intraoperative detection of intrahepatic lesions can be demanding. The use of preoperative contrast-enhanced magnetic resonance imaging (MRI) or computer tomography (CT) combined with intraoperative ultrasound of the liver is state of the art. Near totally regressed colorectal liver metastases (CRLM) after neoadjuvant chemotherapy or nodules in severely altered liver tissue as steatosis or cirrhosis are often hard to detect during the operative procedure. Especially differentiation between benign atypical nodules and malignant tumors can be very difficult. The intraoperative use of contrast-enhanced ultrasound or intraoperative navigation are helpful tools. However, both methods show relevant limitations. The use of intraoperative MRI (ioMRI) can overcome this problem. Relevant structures can be marked within the operative site or immediate control of complete tumor resection can be achieved. This might allow immediate surgical optimization in case of failure. Methods We report the intraoperative application of ioMRI in a case of a 61-year-old male patient suffering from rectal cancer with 10 synchronous bilobar CRLM who was treated stepwise by multimodal treatment and staged hepatectomy. Intraoperative contrast-enhanced MRI of the liver was used during completion procedure of an extended right hemihepatectomy performed as “Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS)”. Results ioMRI provided excellent images and showed absence of liver metastases in the liver remnant. Procedure of ioMRI was safe, fast and feasible. Conclusion To the best of our knowledge, we describe the first case of intraoperative application of a contrast-enhanced MRI during open liver surgery at the University Hospital of Dresden.

Feasibility, safety, and efficacy of intraoperative magnetic resonance imaging-guided hepatectomy for small hepatocellular carcinoma: A retrospective study

“…To the best of our knowledge, this is the first report on a series of iMRI-guided hepatectomies. Riediger et al reported the first intraoperative use of iMRI for confirming the excision of the liver tumor while associating liver partition and portal vein ligation for staged hepatectomy [ 27 ]. iMRI was safe and feasible even in a patient with a provisory-closed abdomen during liver surgery.…”

Generic surgical process model for minimally invasive liver treatment methods

“…Durations and occurrence frequencies of surgical steps and deviations from nominal surgery paths can be used as criteria for learning curve analysis, as well as surgeons' skills evaluations. In recent years navigation platforms for guiding surgeons in performing MILT attracted broad attention [83][84][85][86][87][88] . Analysis of the proposed surgical process model can reveal the optimal treatment options to guide surgical teams using navigation systems by suggesting/predicting next surgical steps and the time required for performing each surgical action 5,13,89,90 .…”