Navigated laparoscopy – liver shift and deformation due to pneumoperitoneum in an animal model

Zijlmans, Mariken; Langø, Thomas; Hofstad, Erlend Fagertun; Swol, Christiaan F. P. van; Rethy, Anna

doi:10.3109/13645706.2012.665805

Cited by 26 publications

(18 citation statements)

References 12 publications

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“…Barriers to precise and accurate registration pertain to the inherent characteristics of the liver and hepatectomy. The liver surface and intra‐hepatic anatomy is subject to constant deformation during surgery, due to mobilization of the organ, manipulation, pneumoperitoneum, or extreme positions necessary for exposure . To provide accurate real‐time navigation, registration would therefore have to accommodate liver deformation.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the use of pre-operative simulation and navigation for hepatectomy: current status and future perspectives

Hallet

Gayet

Tsung

et al. 2015

J Hepatobiliary Pancreat Sci

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Pre-operative simulation using three-dimensional (3D) reconstructions have been suggested to enhance surgical planning of hepatectomy. Evidence on its benefits for hepatectomy patients remains limited. This systematic review examined the use and impact of pre-operative simulation and intraoperative navigation on hepatectomy outcomes. A systematical searched electronic databases for studies reporting on the use and results of simulation and navigation for hepatectomy was performed. The primary outcome was change in operative plan based on simulation. Secondary outcomes included operating time (min), estimated blood loss, surgical margins, 30-day postoperative morbidity and mortality, and study-specific outcomes. From 222 citations, we included 11 studies including 497 patients. All were observational cohort studies. No study compared hepatectomy with and without simulation. All studies performed 3D reconstruction and segmentation, most commonly with volumetrics measurements. In six studies reporting intraoperative navigation, five relied on ultrasound, and one on a resection map. Of two studies reporting on it, the resection line was changed intraoperatively in one third of patients, based on simulation. Virtually predicted liver volumes (Pearson correlation r = 0.917 to 0.995) and surgical margins (r = 0.84 to 0.967) correlated highly with actual ones in eight studies. Heterogeneity of the included studies precluded meta-analysis. Pre-operative simulation seems accurate in measuring volumetrics and surgical margins. Current studies lack intraoperative transposition of simulation for direct navigation. Simulation appears useful planning of hepatectomies, but further work is warranted focusing on the development of improved tools and appraisal of their clinical impact compared to traditional resection.

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Section: Discussionmentioning

confidence: 99%

Systematic review of the use of pre-operative simulation and navigation for hepatectomy: current status and future perspectives

Hallet

Gayet

Tsung

et al. 2015

J Hepatobiliary Pancreat Sci

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“…IGT and laparoscopic ultrasound can help localize the exact intraoperative location of the tumor, its relative position to important vessels and the boundaries of vascular regions making laparoscopic surgery more precise and safer [ 34 , 35 ]. One of the challenges with navigation technology in laparoscopic surgery is the movements of soft tissue organs, which have to be accounted for in IGT [ 36 ].…”

Section: Clinical Applicationsmentioning

confidence: 99%

CustusX: an open-source research platform for image-guided therapy

et al. 2015

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PurposeCustusX is an image-guided therapy (IGT) research platform dedicated to intraoperative navigation and ultrasound imaging. In this paper, we present CustusX as a robust, accurate, and extensible platform with full access to data and algorithms and show examples of application in technological and clinical IGT research.MethodsCustusX has been developed continuously for more than 15 years based on requirements from clinical and technological researchers within the framework of a well-defined software quality process. The platform was designed as a layered architecture with plugins based on the CTK/OSGi framework, a superbuild that manages dependencies and features supporting the IGT workflow. We describe the use of the system in several different clinical settings and characterize major aspects of the system such as accuracy, frame rate, and latency.ResultsThe validation experiments show a navigation system accuracy of 1.1 mm, a frame rate of 20 fps, and latency of 285 ms for a typical setup. The current platform is extensible, user-friendly and has a streamlined architecture and quality process. CustusX has successfully been used for IGT research in neurosurgery, laparoscopic surgery, vascular surgery, and bronchoscopy.ConclusionsCustusX is now a mature research platform for intraoperative navigation and ultrasound imaging and is ready for use by the IGT research community. CustusX is open-source and freely available at http://www.custusx.org.

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“…More specifically, in a clinical scenario, we plan to utilize mechanical high-frequency jet ventilation; this results in small tidal movements and a larger respiratory rate, which allows reduction in the cranio-caudal movements, constituting the predominant liver respiratory motion, 30 from 20 to 5 mm. 31,32 Additionally, a study performed by Zijlmans et al 33 resulted in a modeling of the cranio-caudal movement, which can be described as a rigid transformation. These studies suggest that respiratory-related movements of the liver do not constitute the most critical part in the characterization of liver motion and deformation.…”

Section: Discussionmentioning

confidence: 99%

A Novel Ultrasound-Based Registration for Image-Guided Laparoscopic Liver Ablation

et al. 2016

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Background. Patient-to-image registration is a core process of image-guided surgery (IGS) systems. We present a novel registration approach for application in laparoscopic liver surgery, which reconstructs in real time an intraoperative volume of the underlying intrahepatic vessels through an ultrasound (US) sweep process. Methods. An existing IGS system for an open liver procedure was adapted, with suitable instrument tracking for laparoscopic equipment. Registration accuracy was evaluated on a realistic phantom by computing the target registration error (TRE) for 5 intrahepatic tumors. The registration work flow was evaluated by computing the time required for performing the registration. Additionally, a scheme for intraoperative accuracy assessment by visual overlay of the US image with preoperative image data was evaluated. Results. The proposed registration method achieved an average TRE of 7.2 mm in the left lobe and 9.7 mm in the right lobe. The average time required for performing the registration was 12 minutes. A positive correlation was found between the intraoperative accuracy assessment and the obtained TREs. Conclusions. The registration accuracy of the proposed method is adequate for laparoscopic intrahepatic tumor targeting. The presented approach is feasible and fast and may, therefore, not be disruptive to the current surgical work flow.

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Navigated laparoscopy – liver shift and deformation due to pneumoperitoneum in an animal model

Abstract: The findings indicate a need for anatomic shift correction of preoperative images before they are used in combination with LUS guidance during a laparoscopic liver resection procedure.

Cited by 26 publications

References 12 publications

Systematic review of the use of pre-operative simulation and navigation for hepatectomy: current status and future perspectives

Systematic review of the use of pre-operative simulation and navigation for hepatectomy: current status and future perspectives

CustusX: an open-source research platform for image-guided therapy

A Novel Ultrasound-Based Registration for Image-Guided Laparoscopic Liver Ablation

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