Laparoscopic image-based navigation for microwave ablation of liver tumors—A multi-center study

Tinguely, Pascale; Fusaglia, Matteo; Freedman, Jacob; Banz, Vanessa; Weber, Stefan; Candinas, Daniel; Nilsson, Henrik

doi:10.1007/s00464-017-5458-4

Cited by 35 publications

(29 citation statements)

References 46 publications

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“…Success was indicated by the 3D model maintaining an anatomically appropriate and stable position. It has been previously reported that liver mobilisation results in significant positional shift of landmarks and therefore necessitates repeat registration [43]. Although not formally quantified, this was also the case in the current study.…”

Section: Discussionsupporting

confidence: 54%

Comparison of manual and semi-automatic registration in augmented reality image-guided liver surgery: a clinical feasibility study

et al. 2020

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Background The laparoscopic approach to liver resection may reduce morbidity and hospital stay. However, uptake has been slow due to concerns about patient safety and oncological radicality. Image guidance systems may improve patient safety by enabling 3D visualisation of critical intra- and extrahepatic structures. Current systems suffer from non-intuitive visualisation and a complicated setup process. A novel image guidance system (SmartLiver), offering augmented reality visualisation and semi-automatic registration has been developed to address these issues. A clinical feasibility study evaluated the performance and usability of SmartLiver with either manual or semi-automatic registration. Methods Intraoperative image guidance data were recorded and analysed in patients undergoing laparoscopic liver resection or cancer staging. Stereoscopic surface reconstruction and iterative closest point matching facilitated semi-automatic registration. The primary endpoint was defined as successful registration as determined by the operating surgeon. Secondary endpoints were system usability as assessed by a surgeon questionnaire and comparison of manual vs. semi-automatic registration accuracy. Since SmartLiver is still in development no attempt was made to evaluate its impact on perioperative outcomes. Results The primary endpoint was achieved in 16 out of 18 patients. Initially semi-automatic registration failed because the IGS could not distinguish the liver surface from surrounding structures. Implementation of a deep learning algorithm enabled the IGS to overcome this issue and facilitate semi-automatic registration. Mean registration accuracy was 10.9 ± 4.2 mm (manual) vs. 13.9 ± 4.4 mm (semi-automatic) (Mean difference − 3 mm; p = 0.158). Surgeon feedback was positive about IGS handling and improved intraoperative orientation but also highlighted the need for a simpler setup process and better integration with laparoscopic ultrasound. Conclusion The technical feasibility of using SmartLiver intraoperatively has been demonstrated. With further improvements semi-automatic registration may enhance user friendliness and workflow of SmartLiver. Manual and semi-automatic registration accuracy were comparable but evaluation on a larger patient cohort is required to confirm these findings.

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Section: Discussionsupporting

confidence: 54%

Comparison of manual and semi-automatic registration in augmented reality image-guided liver surgery: a clinical feasibility study

et al. 2020

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“…Hence, the precision of ablation might represent a crucial factor for treatment success, relying directly on optimal visualization of intrahepatic lesions and accurate placement of ablation probes within the tumour targets. To optimize guidance of the ablation probe and thus precision in tumour targeting and ablation, advanced stereotactic navigation technology has been introduced, and several navigation systems are now available for image‐guided interventions . First reports on stereotactic percutaneous computed tomography (CT)‐guided ablation of liver tumours have been published, suggesting a safe and accurate treatment .…”

Section: Introductionmentioning

confidence: 99%

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Lachenmayer

Tinguely

Maurer

et al. 2019

Liver International

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Background & Aims:Ablation plays an important role in the treatment of hepatocellular carcinoma. Because image-guided navigation technology has recently entered the clinical setting, we aimed to analyse its safety, therapeutic and procedural efficiency. Methods: Retrospective analysis of patients treated with stereotactic image-guided microwave ablation (SMWA) between January 2015 and December 2017. Interventions were performed using computertomography-guidance with needle trajectory, ablation planning and automatic single-marker patient registration. Needle placement and ablation coverage was controlled by image fusion under general anaesthesia with jet-ventilation. Results: In total 174 ablations were performed in 88 patients during 119 interventions. Mean age was 66 (46-84) years, 74 (84.1%) were men and 74% were Child Pugh Class A. Median tumour size was 16 (4-45) mm, 62.2% were BCLC A. Median lateral and longitudinal error of needle placement were 3.2 (0.2-14.1) and 1.6 (0-15.8) mm.Median one tumour (1-4) was ablated per session. One patient developed a Dindo IIIb (0.8%) complication, six minor complications. After re-ablation of 12 lesions, an efficacy rate of 96.3% was achieved. Local tumour progression was 6.3% (11/174).Close proximity to major vessels was significantly correlated with local tumour progression (P < .05). Median overall follow-up was 17.5 months after intervention and 24 months after initial diagnosis. BCLC stage, child class and previous treatment were significantly correlated with overall survival (P < .05). Conclusion:Stereotactic image-guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable because of difficult anatomic locations. K E Y W O R D Shepatocellular carcinoma, microwave ablation, navigation, stereotactic

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“…Recent applications for image-guided ablation procedures have reported enhanced localization of tumors and improved accuracy of ablation antenna placement in open [13][14][15][16] and laparoscopic procedures. [17][18][19][20] These methods have employed a variety of electromagnetic (EM) tracking, optical tracking, and registration methods to provide enhanced image-guidance. However, to date, image-guided ablation methods providing image-to-physical registration in open and laparoscopic settings have been limited to rigid registration approaches, which neglect soft-tissue deformations that occur from organ mobilization during these procedures and can cause substantial registration error.…”

Section: Localization and Therapy Guidancementioning

confidence: 99%

Multiphysics modeling toward enhanced guidance in hepatic microwave ablation: a preliminary framework

2019

J. Med. Imag.

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We compare a surface-driven, model-based deformation correction method to a clinically relevant rigid registration approach within the application of image-guided microwave ablation for the purpose of demonstrating improved localization and antenna placement in a deformable hepatic phantom. Furthermore, we present preliminary computational modeling of microwave ablation integrated within the navigational environment to lay the groundwork for a more comprehensive procedural planning and guidance framework. To achieve this, we employ a simple, retrospective model of microwave ablation after registration, which allows a preliminary evaluation of the combined therapeutic and navigational framework. When driving registrations with full organ surface data (i.e., as could be available in a percutaneous procedure suite), the deformation correction method improved average ablation antenna registration error by 58.9% compared to rigid registration (i.e., 2.5 AE 1.1 mm, 5.6 AE 2.3 mm of average target error for corrected and rigid registration, respectively) and on average improved volumetric overlap between the modeled and ground-truth ablation zones from 67.0 AE 11.8% to 85.6 AE 5.0% for rigid and corrected, respectively. Furthermore, when using sparse-surface data (i.e., as is available in an open surgical procedure), the deformation correction improved registration error by 38.3% and volumetric overlap from 64.8 AE 12.4% to 77.1 AE 8.0% for rigid and corrected, respectively. We demonstrate, in an initial phantom experiment, enhanced navigation in image-guided hepatic ablation procedures and identify a clear multiphysics pathway toward a more comprehensive thermal dose planning and deformation-corrected guidance framework.

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Laparoscopic image-based navigation for microwave ablation of liver tumors—A multi-center study

Cited by 35 publications

References 46 publications

Comparison of manual and semi-automatic registration in augmented reality image-guided liver surgery: a clinical feasibility study

Comparison of manual and semi-automatic registration in augmented reality image-guided liver surgery: a clinical feasibility study

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Multiphysics modeling toward enhanced guidance in hepatic microwave ablation: a preliminary framework

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