Laparoscopic Liver Surgery Guided by Virtual Real-time CT-Guided Volume Navigation

• Published in: Journal of gastrointestinal surgery Vol. 25; no. 7; pp. 1779 - 1786
• Main Authors: Aoki, Takeshi, Mansour, Doaa A., Koizumi, Tomotake, Wada, Yusuke, Enami, Yuta, Fujimori, Akira, Kusano, Tomokazu, Matsuda, Kazuhiro, Nogaki, Koji, Tashiro, Yoshihiko, Hakozaki, Tomoki, Shibata, Hideki, Tomioka, Kodai, Hirai, Takahito, Yamazaki, Tatsuya, Saito, Kazuhiko, Goto, Satoru, Watanabe, Makoto, Otsuka, Koji, Murakami, Masahiko
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-07-2021; Springer Nature B.V
• Subjects: Ablation; Biopsy; Gastroenterology; Hepatectomy; Humans; Laparoscopy; Liver; Liver - diagnostic imaging; Liver - surgery; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - surgery; Medicine; Medicine & Public Health; Navigation systems; Original Article; Patients; Reproducibility of Results; Simulation; Surgeons; Surgery; Surgery, Computer-Assisted; Surgical apparatus & instruments; Surgical outcomes; Tomography, X-Ray Computed; Ultrasonic imaging; Laparoscopy; Image-guided surgery; Electromagnetics; Ultrasonography; Hepatectomy
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-020-04784-3

Background
Recently, virtual navigation system has been applied to hepatic surgery, enabling better visualization of intrahepatic vascular branches and location of tumor. Intraoperative ultrasonography (IOUS) is the most common form of image guidance during liver surgery. However, during laparoscopic hepatectomies (LH), IOUS has several limitations and its reliability has been poorly evaluated. The objective of this work is to evaluate VRCT (virtual real-time CT-guided volume navigation) during LH. This system aims to provide accurate anatomical orientation for surgeons enhancing the safety of LH.
Methods
Twenty-seven hepatic neoplasms were resected laparoscopically at our institution under reference guidance of VRCT. During operation, electromagnetic tracking of the surgical instrument was used for navigating the direction of accurate liver transection.
Results
Twenty-six (96.3%) of the 27 lesions (mean diameter 11 mm) were successfully performed under VRCT guidance. Average registration time was < 2 min. Average setup time was approximately 7 min per procedure. VRCT allows the surgeon to navigate liver transection with acceptable accuracy. The mean error was 12 mm. All surgical margins were negative and the mean histologic resection margin was 9 mm.
Conclusions
VRCT-guided LH is feasible and provides valuable real-time anatomical feedback during hepatic resections. Advancement of such systems to improve accuracy might greatly compensate for the limitation of laparoscopic IOUS.