Accurate surgical navigation with real-time tumor tracking in cancer surgery

Abstract

In the past decades, image-guided surgery has evolved rapidly. In procedures with a relatively fixed target area, like neurosurgery and orthopedics, this has led to improved patient outcomes. In cancer surgery, intraoperative guidance could be of great benefit to secure radical resection margins since residual disease is associated with local recurrence and poor survival. However, most tumor lesions are mobile with a constantly changing position. Here, we present an innovative technique for real-time tumor tracking in cancer surgery. In this study, we evaluated the feasibility of real-time tumor tracking during rectal cancer surgery. The application of real-time tumor tracking using an intraoperative navigation system is feasible and safe with a high median target registration accuracy of 3 mm. This technique allows oncological surgeons to obtain real-time accurate information on tumor location, as well as critical anatomical information. This study demonstrates that real-time tumor tracking is feasible and could potentially decrease positive resection margins and improve patient outcome.

Current trends in three-dimensional visualization and real-time navigation as well as robot-assisted technologies in hepatobiliary surgery

“…Kok et al [ 76 ] evaluated the feasibility and safety of an internally developed EM navigation system for real-time rectal tumor tracking using the NDI Aurora V2 EM tracking system (Northern Digital Inc, Waterloo, Ontario, Canada), employing a patient tracker with an EM sensor (Philips Traxtal/Percunav, Philips, Best, the Netherlands) patient tracker to determine the patient's position during surgery and to place tracking sensors on the tumor to adjust for real-time tumor motion, providing continuous interpretable navigation data for rectal surgery, this prospective study demonstrates that real-time tumor tracking with EM navigation is feasible, safe and accurate and provides direction for wider clinical implementation and contributes to further research to improve workflow and demonstrate clinical benefit[ 76 ].…”

Augmented Reality in Orthopedic Surgery Is Emerging from Proof of Concept Towards Clinical Studies: a Literature Review Explaining the Technology and Current State of the Art

“…Computer-driven approaches have been established in many areas of orthopedic surgery to support the surgeon in facilitating preoperative planning or improving surgical execution [ 1 , 2 ]. Different technological innovations have been implemented in orthopedic surgery such as robotic surgery [ 3 ], 3D-printed patient-specific instrumentation (PSI) [ 1 ], navigation tools with tracking visualized on monitors [ 4 ], and the emerging technology of augmented reality which allow a human-computer interface [ 5 ]. Robotic surgery still has significant limitations that prevent broader clinical use, as devices are very expensive [ 6 ], spacious, and their setup and maintenance are time-consuming and cost-intensive [ 7 ].…”

Surgical navigation for challenging recurrent or pretreated intra‐abdominal and pelvic soft tissue sarcomas

“…Our group has successfully implemented this technique in the OR for multiple abdominal studies. [4][5][6] The system provides the surgeon with real-time intra-operative information on the location of the tumor(s) and critical anatomical structures. 6 Theoretically, surgical navigation could shorten surgery time due to faster localization of the tumor, might make the tumor resection safer by identifying critical anatomical structures, and thereby prevent damage to vital surrounding structures.…”