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Abstract
In laparoscopic liver resection, surgeons conventionally rely on anatomical landmarks detected through a laparoscope, preoperative volumetric images and laparoscopic ultrasound to compensate for the challenges of minimally invasive access. Image guidance using optical tracking and registration procedures is a promising tool, although often undermined by its inaccuracy. This study evaluates a novel surgical navigation solution that can compensate for liver deformations using an accurate and effective registration method. The proposed solution relies on a robotic C-arm to perform registration to preoperative CT/MRI image data and allows for intraoperative updates during resection using fluoroscopic images. Navigation is offered both as a 3D liver model with real-time instrument visualization, as well as an augmented reality overlay on the laparoscope camera view. Testing was conducted through a pre-clinical trial which included four porcine models. Accuracy of the navigation system was measured through two evaluation methods: liver surface fiducials reprojection and a comparison between planned and navigated resection margins. Target Registration Error with the fiducials evaluation shows that the accuracy in the vicinity of the lesion was 3.78±1.89mm. Resection margin evaluations resulted in an overall median accuracy of 4.44mm with a maximum error of 9.75mm over the four subjects. The presented solution is accurate enough to be potentially clinically beneficial for surgical guidance in laparoscopic liver surgery.
Highlights
The laparoscopic approach for liver surgery has become more widely accepted within the growing list of procedures Hilal et al (2018) with patients reporting higher quality of life after laparoscopic compared to open liver resections Fretland et al (2019)
Approved by the National Animal Experimentation Board [project ID: 12633] and in accordance with Norwegian regulations concerning the use of animals in experiments [FOR-2015-06-18761], a pre-clinical trial was conducted on four porcine models from 2019 to 2020 to evaluate the presented navigation system
Four intraoperative CT augmented reality evaluations were performed whereas a total of 20 fluoroscopic updates Augmented Reality (AR) evaluations were conducted
Summary
The laparoscopic approach for liver surgery has become more widely accepted within the growing list of procedures Hilal et al (2018) with patients reporting higher quality of life after laparoscopic compared to open liver resections Fretland et al (2019). For colorectal metastasis (CRM), parenchyma-sparing liver resections focus on removal of lesions while preserving as much healthy liver tissue as possible, with only the sufficient margins around the lesions. These procedures can be relatively simple for small lesions located superficially. To follow the surgical plan, during laparoscopic liver surgery, surgeons conventionally rely on visualised anatomical landmarks detected through the laparoscope camera or the laparoscopic ultrasound. These structures are used by the surgeon to correlate, in their mind, the prepared surgical plan with the intraoperative space. To bridge the gap between planning and surgery, as well as to aid the surgeon in conducting a safe and accurate procedure, surgical navigation solutions are being tested clinically Ntourakis et al (2016) Hallet et al (2015) and emerging in the market Thompson et al (2018) Prevost et al (2019)
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