Abstract
Purpose: Actually the technique of laparoscopic liver resection has been mostly performed in high volume centers with hepatobiliary and laparoscopic expertise in highly selected patients. For better intraoperative visualization we developed a laparoscopic navigation system (LapAssistent) to register preoperative 3D-CT or MRI Scans to the intraoperative field. Intraoperative the laparoscopic instruments were connected to the LapAssistent with real-time ultrasound B-Mode screen and real-time laparoscopic video screen. Material and methods: Preoperative planning data were performed by Fraunhofer MeVis Bremen/Germany. After calibration of the system including camera, laparoscopic instruments and the intraoperative ultrasound probe we registered the surface of the liver. By the navigated ultrasound the preoperatively planned resection plane has then been overlain with the patient's liver. The laparoscopic navigation system has been able to use under sterile conditions and it has been possible to register and visualize the preoperative planned resection plane. Results: After experimental development of the navigation system we started in January 2010 with the clinical use of navigation-assisted laparoscopic liver surgery. We report about the technical aspects of the navigation system and the clinical use in three cases. One patient with a large benign adenoma was resected by laparoscopic navigated atypical liver resection. By a metastatic mammacarcinom one thermal ablation was done and in a third case two atypical resections in the right liver lobe. Conclusion: By the navigated ultrasound the preoperatively planned resection plane has then been overlain with the patient's liver. The laparoscopic navigation system has been able to use under sterile conditions and it has been possible to register and visualize the preoperative planned resection plane. These first results now have to be proven in a larger patient collective and we performed a German wide multicenter study (ProNavic I).
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Schedule a callMore From: Ultraschall in der Medizin - European Journal of Ultrasound
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