TY - JOUR
T1 - Ultrasound based planning and navigation for non-anatomical liver resections - An ex-vivo study
AU - Paolucci, Iwan
AU - Sandu, Raluca Maria
AU - Sahli, Luca
AU - Prevost, Gian Andrea
AU - Storni, Federico
AU - Candinas, Daniel
AU - Weber, Stefan
AU - Lachenmayer, Anja
N1 - Publisher Copyright:
© 2020 IEEE Open Journal of Engineering in Medicine and Biology. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Goal: Non-anatomical resections of liver tumors can be very challenging as the surgeon cannot use anatomical landmarks on the liver surface or in the ultrasound image for guidance. This makes it difficult to achieve negative resection margins (R0) and still preserve as much healthy liver tissue as possible. Even though image-guided surgery systems have been introduced to overcome this challenge, they are still rarely used due to their inaccuracy, time-effort and complexity in usage and setup. Methods: We have developed a novel approach, which allows us to create an intra-operative resection plan using navigated ultrasound. First, the surface is scanned using a navigated ultrasound, followed by tumor segmentation on a midsection ultrasound image. Based on this information, the navigation system calculates an optimal resection strategy and displays it along with the tracked surgical instruments. In this study, this approach was evaluated by three experienced hepatobiliary surgeons on ex-vivo porcine models. Results: Using this technique, an R0 resection could be achieved in 22 out of 23 (95.7% R0 resection rate) cases with a median resectionmargin of 5.9 mm (IQR 3.5-7.7 mm). The resection margin between operators 1, 2 and 3 was 7.8 mm, 4.15 mm and 5.1 mm respectively (p = 0.054). Conclusions: This approach could represent a useful tool for intra-operative guidance in non-anatomical resection alongside conventional ultrasound guidance. However, instructions and training are essential especially if the operator has not used an image-guidance system before.
AB - Goal: Non-anatomical resections of liver tumors can be very challenging as the surgeon cannot use anatomical landmarks on the liver surface or in the ultrasound image for guidance. This makes it difficult to achieve negative resection margins (R0) and still preserve as much healthy liver tissue as possible. Even though image-guided surgery systems have been introduced to overcome this challenge, they are still rarely used due to their inaccuracy, time-effort and complexity in usage and setup. Methods: We have developed a novel approach, which allows us to create an intra-operative resection plan using navigated ultrasound. First, the surface is scanned using a navigated ultrasound, followed by tumor segmentation on a midsection ultrasound image. Based on this information, the navigation system calculates an optimal resection strategy and displays it along with the tracked surgical instruments. In this study, this approach was evaluated by three experienced hepatobiliary surgeons on ex-vivo porcine models. Results: Using this technique, an R0 resection could be achieved in 22 out of 23 (95.7% R0 resection rate) cases with a median resectionmargin of 5.9 mm (IQR 3.5-7.7 mm). The resection margin between operators 1, 2 and 3 was 7.8 mm, 4.15 mm and 5.1 mm respectively (p = 0.054). Conclusions: This approach could represent a useful tool for intra-operative guidance in non-anatomical resection alongside conventional ultrasound guidance. However, instructions and training are essential especially if the operator has not used an image-guidance system before.
KW - Computer-assisted surgery
KW - Liver neoplasms
KW - Resection techniques
KW - Ultrasonography
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U2 - 10.1109/OJEMB.2019.2961094
DO - 10.1109/OJEMB.2019.2961094
M3 - Article
C2 - 35402957
AN - SCOPUS:85121057852
SN - 2644-1276
VL - 1
SP - 3
EP - 8
JO - IEEE Open Journal of Engineering in Medicine and Biology
JF - IEEE Open Journal of Engineering in Medicine and Biology
M1 - 8937521
ER -