Abstract
PurposeThe surgical navigation system that provides guidance throughout the surgery can facilitate safer and more radical liver resections, but such a system should also be able to handle organ motion. This work investigates the accuracy of intraoperative surgical guidance during open liver resection, with a semi‐rigid organ approximation and electromagnetic tracking of the target area.MethodsThe suggested navigation technique incorporates a preoperative 3D liver model based on diagnostic 4D MRI scan, intraoperative contrast‐enhanced CBCT imaging and electromagnetic (EM) tracking of the liver surface, as well as surgical instruments, by means of six degrees‐of‐freedom micro‐EM sensors.ResultsThe system was evaluated during surgeries with 35 patients and resulted in an accurate and intuitive real‐time visualization of liver anatomy and tumor's location, confirmed by intraoperative checks on visible anatomical landmarks. Based on accuracy measurements verified by intraoperative CBCT, the system’s average accuracy was 4.0 ± 3.0 mm, while the total surgical delay due to navigation stayed below 20 min.ConclusionsThe electromagnetic navigation system for open liver surgery developed in this work allows for accurate localization of liver lesions and critical anatomical structures surrounding the resection area, even when the liver was manipulated. However, further clinically integrating the method requires shortening the guidance‐related surgical delay, which can be achieved by shifting to faster intraoperative imaging like ultrasound. Our approach is adaptable to navigation on other mobile and deformable organs, and therefore may benefit various clinical applications.
Highlights
In this work, we develop and evaluate a new surgical navigation setup that incorporated CBCT-based registration between the preoperative 3D model and the liver’s intraoperative pose, while the target resection area is approximated as a rigid object and its motion is tracked via a single electromagnetic micro sensor
Selected patients were scheduled for open liver surgery, had superficial liver lesion(s) with a diameter of at least 2 cm, had recent CT or MR scans, did not have a pacemaker or metal implant, were not allergic to iodine contrast, and their estimated glomerular filtration level was above 60 ml/min
Our assumption was that already a semi-rigid organ model will result in clinically acceptable accuracy of the navigation (e.g.,
Summary
This detailed plan is developed in consideration of the tumors’ locations with respect to major blood vessels and biliary anatomy.[5,6,7] Despite the extensive pre-operative resection planning, the resection itself is still primarily based on the surgeon’s recollection of the preoperative images, intraoperative tactile feedback and its correlation with live 2D ultrasound images This lack of detailed imaging information during the procedure increases probability of intra- or postoperative hepatic complications, which occur in up to 23% of open liver resections,[8,9] while up to 15% of procedures result in irradical resections.
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