3D planning of irreversible electroporation treatment in pancreatic carcinoma: a use case

Abstract

Introduction: Irreversible-electroporation (IRE) is an ablation technique that spares vessels and is therefore suitable for treatment of locally advanced pancreatic cancer. Our surgery planning software supports pre-operative simulation of possible needle configurations in 3D to prepare for the ablation treatment. We present herein the application of the proposed software tool to one out of five cases which we already planned within a proof of concept study. Method: For planning of an open IRE treatment of a carcinoma located in the body of the pancreas, pre-operative CT image data was analyzed with a commercial surgery planning tool. The resulting 3D anatomy models as well as the original CT data were loaded into our tablet-based software. We then performed simulation of two different IRE needle configurations (Figure 1) and evaluated them with respect to vicinity to critical structures versus achieving the recommended needle spacing and parallelism for IRE. Results: During the surgery the decision was to target according to plan # 1 as the superior mesenteric vein was not mobilizable enough to obtain a window for the inferior right needle in #2. The number and placement of the needles relative to each other did not significantly depart from the pre-operatively defined plan. Conclusions: Our software gives to surgeon the possibility to pre-operatively verify the feasibility of needle placement strategies and enables a better orientation of the upcoming situs. Our next step is to enable intraoperative computer-assisted navigation to target according to the pre-operative plan.