Design and implementation of an electromagnetic ultrasound-based navigation technique for laparoscopic ablation of liver tumors

Paolucci, Iwan; Schwalbe, Marius; Prevost, Gian Andrea; Lachenmayer, Anja; Candinas, Daniel; Weber, Stefan; Tinguely, Pascale

doi:10.1007/s00464-018-6088-1

Cited by 11 publications

(7 citation statements)

References 33 publications

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“…22,23 Other studies have reported targeting accuracy of ablation antennas on the order of 5 to 10 mm, with the current best being a median accuracy of 4.2 mm. 19 In comparison, our presented method of deformation correction has produced favorable accuracies of 2.5 AE 1.1 and 3.7 AE 1.4 mm when using full-and sparse-surface data, respectively. While this work was directed toward the open surgical setting, we show that these methods can enhance image-guidance for percutaneous, laparoscopic, and open hepatic ablation procedures.…”

Section: Discussionmentioning

confidence: 84%

“…In summary, our results suggest that this application is a significant advancement in the field of open hepatic image-guided ablation, as soft-tissue deformation is a considerable limitation to current modeling and guidance frameworks for liver tumor treatments. 57 While EM-iUS methods 18,19 take a purely intraoperative imaging approach to this soft-tissue deformation problem, they fail to provide additional information concerning relevant critical anatomy, a common desire given the availability of preoperative imaging data. Furthermore, EM-iUS approaches are restricted to US-visible tumors, which restrict its applicability when considering nonechogenic tumors that can present following neoadjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Recent applications for image-guided ablation procedures have reported enhanced localization of tumors and improved accuracy of ablation antenna placement in open [13][14][15][16] and laparoscopic procedures. [17][18][19][20] These methods have employed a variety of electromagnetic (EM) tracking, optical tracking, and registration methods to provide enhanced image-guidance. However, to date, image-guided ablation methods providing image-to-physical registration in open and laparoscopic settings have been limited to rigid registration approaches, which neglect soft-tissue deformations that occur from organ mobilization during these procedures and can cause substantial registration error.…”

Section: Localization and Therapy Guidancementioning

confidence: 99%

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Multiphysics modeling toward enhanced guidance in hepatic microwave ablation: a preliminary framework

2019

J. Med. Imag.

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We compare a surface-driven, model-based deformation correction method to a clinically relevant rigid registration approach within the application of image-guided microwave ablation for the purpose of demonstrating improved localization and antenna placement in a deformable hepatic phantom. Furthermore, we present preliminary computational modeling of microwave ablation integrated within the navigational environment to lay the groundwork for a more comprehensive procedural planning and guidance framework. To achieve this, we employ a simple, retrospective model of microwave ablation after registration, which allows a preliminary evaluation of the combined therapeutic and navigational framework. When driving registrations with full organ surface data (i.e., as could be available in a percutaneous procedure suite), the deformation correction method improved average ablation antenna registration error by 58.9% compared to rigid registration (i.e., 2.5 AE 1.1 mm, 5.6 AE 2.3 mm of average target error for corrected and rigid registration, respectively) and on average improved volumetric overlap between the modeled and ground-truth ablation zones from 67.0 AE 11.8% to 85.6 AE 5.0% for rigid and corrected, respectively. Furthermore, when using sparse-surface data (i.e., as is available in an open surgical procedure), the deformation correction improved registration error by 38.3% and volumetric overlap from 64.8 AE 12.4% to 77.1 AE 8.0% for rigid and corrected, respectively. We demonstrate, in an initial phantom experiment, enhanced navigation in image-guided hepatic ablation procedures and identify a clear multiphysics pathway toward a more comprehensive thermal dose planning and deformation-corrected guidance framework.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Localization and Therapy Guidancementioning

confidence: 99%

See 1 more Smart Citation

Multiphysics modeling toward enhanced guidance in hepatic microwave ablation: a preliminary framework

2019

J. Med. Imag.

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“…Paolucci et al analysed an experimental electromagnetic ultrasound-based navigation technique for experimental laparoscopic ablation of liver tumor mimics. They could show with an experimental electromagnetic ultrasound-based navigation technique a significant reduction in time for positioning of the ablation probe and a significant reduction in needed repositioning attempts of the ablation needle [ 15 ]. However no real ablation of a tumour was performed in this study: only the adequate positioning of the needle was calculated based on a 3D ultrasound image.…”

Section: Discussionmentioning

confidence: 99%

Navigated laparoscopic microwave ablation of tumour mimics in pig livers: a randomized ex-vivo experimental trial

et al. 2020

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Background In order to efficiently perform laparoscopic microwave ablation of liver tumours precise positioning of the ablation probe is mandatory. This study evaluates the precision and ablation accuracy using the innovative laparoscopic stereotactic navigation system CAS-One-SPOT in comparison to 2d ultrasound guided laparoscopic ablation procedures. Methods In a pig liver ablation model four surgeons, experienced (n = 2) and inexperienced (n = 2) in laparoscopic ablation procedures, were randomized for 2d ultrasound guided laparoscopic or stereotactic navigated laparoscopic ablation procedures. Each surgeon performed a total of 20 ablations. Total attempts of needle placements, time from tumor localization till beginning of ablation and ablation accuracy were analyzed. Results The use of the laparoscopic stereotactic navigation system led to a significant reduction in total attempts of needle placement. The experienced group of surgeons reduced the mean number of attempts from 2.75 ± 2.291 in the 2d ultrasound guided ablation group to 1.45 ± 1.191 (p = 0.0302) attempts in the stereotactic navigation group. Comparable results could be observed in the inexperienced group with a reduction of 2.5 ± 1.50 to 1.15 ± 0.489 (p = 0.0005). This was accompanied by a significant time saving from 101.3 ± 112.1 s to 48.75 ± 27.76 s (p = 0.0491) in the experienced and 165.5 ± 98.9 s to 66.75 ± 21.96 s (p < 0.0001) in the inexperienced surgeon group. The accuracy of the ablation process was hereby not impaired as postinterventional sectioning of the ablation zone revealed. Conclusion The use of a stereotactic navigation system for laparoscopic microwave ablation procedures of liver tumors significantly reduces the attempts and time of predicted correct needle placement for novices and experienced surgeons without impairing the accuracy of the ablation procedure.

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“…The use of electromagnetic tracking can be seen as an alternative to conventional optical tracking and was previously described in preclinical studies for laparoscopic ultrasound-guided ablation of hepatic tumors. [66,67] It is likely that with the improvement of IG surgery, not only the quality of the diagnosis can be improved, but also the safety of the intervention. In the future, a steep further technical progress can be expected, that brings novel and improved concepts of image guidance to endopancreatic interventions, making the use of this access more accurate, more intuitive and therefore safer.…”

Section: Image-guided Endopancreatic Interventionsmentioning

confidence: 99%

A narrative review on endopancreatic interventions: an innovative access to the pancreas

Frey

Eigl²,

Steinemann

et al. 2021

Journal of Pancreatology

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The natural connection between the duodenum and the pancreatic duct enables a minimally invasive access to the pancreas. Endoscopically this access is already regularly used, mainly for diagnostic and even for certain therapeutic purposes. With per-oral pancreatoscopy the endopancreatic approach allows the direct visualization of the pancreatic duct system potentially improving the diagnostic work-up of pancreatic cystic neoplasms, intrapancreatic strictures and removal of pancreatic duct stones. However, the endopancreatic access can equally be applied for surgical interventions. The objective of this review is to summarize endoscopic and surgical interventions using the endopancreatic access. Endopancreatic surgery stands for a further development of the endoscopic technique: a rigid endoscope is transabdominally introduced over the duodenum and the papilla to enable resections of strictures and inflamed tissue from inside the pancreas under visual control. While the orientation and localization of target structures using this minimally invasive approach is difficult, the development of an accurate image guidance system will play a key role for the clinical implementation and widespread use of endoscopic and surgical endopancreatic interventions.

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Design and implementation of an electromagnetic ultrasound-based navigation technique for laparoscopic ablation of liver tumors

Cited by 11 publications

References 33 publications

Multiphysics modeling toward enhanced guidance in hepatic microwave ablation: a preliminary framework

Multiphysics modeling toward enhanced guidance in hepatic microwave ablation: a preliminary framework

Navigated laparoscopic microwave ablation of tumour mimics in pig livers: a randomized ex-vivo experimental trial

A narrative review on endopancreatic interventions: an innovative access to the pancreas

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