Integration of Three-Dimensional Liver Models in a Multimodal Image-Guided Robotic Liver Surgery Cockpit

Abstract

Background: Robotic liver surgery represents the most recent evolution in the field of minimally-invasive liver surgery. For planning and guidance of liver resections, surgeons currently rely on preoperative 2-dimensional (2D) CT and/or MR imaging and intraoperative ultrasonography. Translating 2D images into digital 3-dimensional (3D) models may improve both preoperative planning and surgical guidance. The da Vinci® robotic surgical system is a platform suitable for the integration of multiple imaging modalities into one single view. In this study, we describe multimodal imaging options and introduce the Robotic Liver Surgery Cockpit; Methods: in-house developed software was used and validated for segmentation and registration to create a virtual reality 3D model of the liver based on preoperative imaging. The accuracy of the 3D models in the clinical setting was objectively assessed in 15 patients by measuring tumor diameters and subjectively with a postoperative conducted questionnaire; Results: Implementation and applicability of the 3D model in the surgical cockpit was feasible in all patients and the quality of the 3D reconstructions was high in 14 (93%) of cases. Tumor diameters measured on CT and/or MR imaging were comparable to automated measurements using the segmentation software and 3D models; Conclusions: the 3D model was successfully incorporated in the robotic surgery console as part of a multimodality imaging platform and aided the surgeon in planning and guidance of the resection. Future studies should focus on further automation of 3D rendering and progress into augmented reality.

Computer-assisted intraoperative 3D-navigation for liver surgery: a prospective randomized-controlled pilot study

“…Impact of soft tissue navigation systems on learning curves and educational values especially with an increased use of robotic technologies are part of future investigations. Especially, since the robotic consoles enable a multimodal display during liver surgery ( 16 ). Since the calibration of the CUSA is mainly performed on the liver surface, the projection into the 3D-reconstructions best works on the liver surface and in the anterior parts of the resection.…”

A rare hepatic artery variant reporting and a new classification

“…However, we think about reasons why this variant has not been previously described, except that it has an extremely low incidence and may also be associated with limited 2D CT techniques. 2D technologies very test the spatial imagination of surgeons ( 18 ), except for conventional variants such as left gastric artery and superior mesenteric artery, other rare variants are difficult to find. In this case, the accessory left hepatic artery originating from the inferior phrenic artery is short and concealed, and we only exposed its course completely after excising part of the left lobe, so it is easily overlooked.…”

Hybrid operating room applications for precision hepatobiliary surgery: A narrative review

“…So far, 3D liver models have mainly been utilized adjacent to the operation images, without image overlay 43,44,50 . Real‐time integration of liver models with optical surgical field images has proven difficult.…”

“…47 So far, 3D liver models have mainly been utilized adjacent to the operation images, without image overlay. 43,44,50 Real-time integration of liver models with optical surgical field images has proven difficult. The challenge lies in the constant deformation of tissue due to factors such as movement, pneumoperitoneum, and tissue manipulation, making the preoperative scans less applicable as the operation progresses.…”