Ex-vivo evaluation of an ultrasound-based planning and navigation method for non-anatomical liver resections

Abstract

Non-anatomical resections of liver tumors are 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 maintain a negative resection margin to achieve an R0 resection and still preserve as much healthy liver tissue as possible, especially for inexperienced surgeons. Even though image-guided surgery systems have been introduced to overcome these challenges, they are rarely used due to their inaccuracy, time-effort and complexity in usage and setup. We have developed a novel approach, which allows to create a surgical plan intra-operatively using navigated ultrasound. In this study, we have evaluated this approach on ex-vivo porcine models. We found that using this technique, an R0 resection could be achieved in 11 out of 12 cases with an average resection margin of 4.1 mm. In conclusion, this approach might represent a useful tool for intra-operative guidance in non-anatomical resection along with conventional ultrasound guidance.