Initial Report: A Novel Intraoperative Navigation System for Laparoscopic Liver Resection Using Real-Time Virtual Sonography

Abstract

Recent progress in navigation has revealed problems involving non-rigid registration for hepatic surgery. With the increasing popularity of laparoscopic liver surgery, a new laparoscopic navigation system is necessary. this study involved an in-vitro demonstration of a 3-dimensional printer model and in vivo demonstration in four patients. for the in vitro examination, a position detecting unit attached at 33 cm and 13 cm distance conditions from the tip of the electrocautery was examined eight times at the marked points on the liver surface eight times respectively. The differences between the simulation and the authentic dissecting plane were conventionally investigated in vivo. In vitro, the errors of the 33 cm and 13 cm distance model were7.8 ± 3.5 mm (mean ± SD), and 3.3 ± 1.0 mm, respectively. The mean differences of the dissection plane were within 10 mm. The potentiality and safety of the novel navigation system was confirmed, although further investigation is recommended.

Ultrasound-based navigation for open liver surgery using active liver tracking

“…Whilst for each procedure different levels of accuracy can be sufficient, we determine a TRE < 10 mm as a measure of successful navigation since this accuracy is considered as the current state of the art for US-guided or video-based navigation systems [8,25,26]. This defined the success rate of the study, by aiming for a TRE of lower than 10 mm in more than 70% (p) of the procedures.…”

History of liver surgery

“…[70] There is an opportunity for these 3D modeling methods to translate into intraoperative advanced navigation techniques, which will provide real-time guidance to intrahepatic structures during liver transection, in the operating room. [71,72] The investigations just described have had a profound effect on enhancing the safety of liver surgery, by improving staging, as well as defining indications and patient selection criteria for surgery.…”

Feasibility of novel intraoperative navigation for anatomical liver resection using real-time virtual sonography combined with indocyanine green fluorescent imaging technology

“…RVS fuses the images of ultrasound and CT/MRI, and thus is able to combine the good spatial resolution of CT/MRI with the advantages of real-time dynamic observation of ultrasound (19). Adopting the method of spatial magnetic positioning, RVS is able to achieve realtime correspondence between ultrasound images and CT/ MRI images through image position registration, and then the IOUS and fusion images are simultaneously displayed on the RVS operation interface (20). On the basis of image fusion, the RVS system uses the electromagnetic sensor fixed on the ultrasound probe and the electromagnetic generator of the navigation system to precisely match the image of ultrasound with CT/MRI to realize free tracking of spatial positioning.…”