Prospective study on image‐guided navigation surgery for pelvic malignancies

Abstract

Background and objectives Surgery of advanced tumors and lymph nodes in the pelvis can be challenging due to the narrow pelvic space and vital surrounding structures. This study explores the application of a novel electromagnetic navigation system to guide pelvic surgery. Methods This was a prospective study on surgery for malignancies in the pelvis. Preoperatively obtained imaging was used to create a patient‐specific three‐dimensional (3D) roadmap. In the operating room, the 3D roadmap was registered to an intraoperative computed tomography scan. A tracked pointer was used during surgery for guidance. Primary endpoint was safety and feasibility, secondary endpoints were accuracy and usability. Results Twenty‐eight colorectal, four liposarcomas, and one gynecological patient were included. There were no safety issues. Navigation was feasible in 31 patients. The mean target registration errors of 4.0 and 6.3 mm were achieved for straight and French position, respectively. In seven of seven patients with a locally advanced rectal tumor and in seven of eight patients with recurrences, negative margins were achieved. Thirty‐three of 36 target lymph nodes were successfully removed. Surgeons using the system indicated faster localization of the tumor and improved decisiveness. Conclusion This novel surgical navigation system was safe and feasible during pelvic surgery and can facilitate its users.

Association of Image-Guided Navigation With Complete Resection Rate in Patients With Locally Advanced Primary and Recurrent Rectal Cancer

“…One study tested image-guided navigation in a large group. 13 Outcomes of this pilot study were encouraging, showing the navigation system was safe, feasible, and accurate (mean target registration error: 4.0 mm). However, the study included a wide variety of pelvic tumors and mainly focused on the feasibility and accuracy of the navigation system.…”

“…Image-guided navigation in pelvic surgical procedures has been described previously. 13 , 16 , 17 , 18 , 19 Two separate groups investigated the feasibility of navigation in pilot studies for Transanal Minimal Invasive Surgery–Total Mesorectal Excision (TAMIS-TME). 16 , 17 , 18 , 19 Both groups concluded that navigation was feasible and safe, with satisfactory accuracy for clinical use.…”

“…However, the study included a wide variety of pelvic tumors and mainly focused on the feasibility and accuracy of the navigation system. 13 The current study aimed to evaluate the clinical outcomes of surgical navigation specifically in patients with rectal cancer. To our knowledge, this is the first study to compare the resection margin rates of patients receiving rectal resection with or without image-guided navigation.…”

“…Full details of the navigation setup have been published elsewhere. 13 Briefly, a patient-specific 3-dimensional model based on preoperative imaging (computed tomography and magnetic resonance imaging) was created. In the operating room, a cone-beam computed tomography scan of the patient in surgical position was acquired.…”

“…This system was shown to be safe, feasible, and accurate. 13 In the current study, we evaluated the clinical performance of this image-guided navigation technique. We hypothesized that surgical navigation during advanced and recurrent rectal cancer resection would allow for the full use of preoperative imaging during the surgical procedure and would improve surgical outcome by a higher complete resection rate compared with results in a historical cohort.…”