Laparoscopic Navigated Liver Resection: Technical Aspects and Clinical Practice in Benign Liver Tumors

Kleemann, Markus; Deichmann, Steffen; Esnaashari, Hamed; Besirevic, Armin; Shahin, Osama R.; Bruch, Hans–Peter; Laubert, Tilman

doi:10.1155/2012/265918

Cited by 12 publications

(8 citation statements)

References 21 publications

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“…These features may improve the performance and usability of navigated image guidance. The current study tests the feasibility of using the new IGS, Smart Liver, in a clinical setting and is the first study to compare manual with semi-automatic registration [28].…”

Section: Dmentioning

confidence: 99%

Comparison of manual and semi-automatic registration in augmented reality image-guided liver surgery: a clinical feasibility study

et al. 2020

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Background The laparoscopic approach to liver resection may reduce morbidity and hospital stay. However, uptake has been slow due to concerns about patient safety and oncological radicality. Image guidance systems may improve patient safety by enabling 3D visualisation of critical intra- and extrahepatic structures. Current systems suffer from non-intuitive visualisation and a complicated setup process. A novel image guidance system (SmartLiver), offering augmented reality visualisation and semi-automatic registration has been developed to address these issues. A clinical feasibility study evaluated the performance and usability of SmartLiver with either manual or semi-automatic registration. Methods Intraoperative image guidance data were recorded and analysed in patients undergoing laparoscopic liver resection or cancer staging. Stereoscopic surface reconstruction and iterative closest point matching facilitated semi-automatic registration. The primary endpoint was defined as successful registration as determined by the operating surgeon. Secondary endpoints were system usability as assessed by a surgeon questionnaire and comparison of manual vs. semi-automatic registration accuracy. Since SmartLiver is still in development no attempt was made to evaluate its impact on perioperative outcomes. Results The primary endpoint was achieved in 16 out of 18 patients. Initially semi-automatic registration failed because the IGS could not distinguish the liver surface from surrounding structures. Implementation of a deep learning algorithm enabled the IGS to overcome this issue and facilitate semi-automatic registration. Mean registration accuracy was 10.9 ± 4.2 mm (manual) vs. 13.9 ± 4.4 mm (semi-automatic) (Mean difference − 3 mm; p = 0.158). Surgeon feedback was positive about IGS handling and improved intraoperative orientation but also highlighted the need for a simpler setup process and better integration with laparoscopic ultrasound. Conclusion The technical feasibility of using SmartLiver intraoperatively has been demonstrated. With further improvements semi-automatic registration may enhance user friendliness and workflow of SmartLiver. Manual and semi-automatic registration accuracy were comparable but evaluation on a larger patient cohort is required to confirm these findings.

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Section: Dmentioning

confidence: 99%

Comparison of manual and semi-automatic registration in augmented reality image-guided liver surgery: a clinical feasibility study

et al. 2020

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“…Inaccurate localization may result in a less efficient procedure or unnecessary patient harm. Techniques are being developed to optimize AR image reconstruction, including overcoming respiratory motion and organ deformation (60,(92)(93)(94). In addition to accurate image localization, the device must feel like a "natural extension" of the operator's senses (95).…”

Section: Limitations and Ethical Considerations In Vr And Armentioning

confidence: 99%

Virtual and augmented reality: potential applications in radiology

et al. 2020

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The modern-day radiologist must be adept at image interpretation, and the one who most successfully leverages new technologies may provide the highest value to patients, clinicians, and trainees. Applications of virtual reality (VR) and augmented reality (AR) have the potential to revolutionize how imaging information is applied in clinical practice and how radiologists practice. This review provides an overview of VR and AR, highlights current applications, future developments, and limitations hindering adoption.

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“…In 2012, for example, Kleemann et al [6] published a case report on navigated liver surgery where the orientation of the liver was registered by laparoscopic ultrasound facilitating repetitive recalibration of the system during the intervention ( fig. 2) [6,7].…”

Section: Augmented Realitymentioning

confidence: 99%

Enhanced Visualization: From Intraoperative Tissue Differentiation to Augmented Reality

et al. 2018

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Background: Optimal visualization of the operative field and methods that additionally provide supportive optical information form the basis for target-directed and successful surgery. This article strives to give an overview of current enhanced visualization techniques in visceral surgery and to highlight future developments. Methods: The article was written as a comprehensive review on this topic and is based on a MEDLINE search and ongoing research from our own group and from other working groups. Results: Various techniques for enhanced visualization are described comprising augmented reality, unspecific and targeted staining methods, and optical modalities such as narrow-band imaging. All facilitate our surgical performance; however, due to missing randomized controlled studies for most of the innovations reported on, the available evidence is low. Conclusion: Many new visualization technologies are emerging with the aim to improve our perception of the surgical field leading to less invasive, target-oriented, and elegant treatment forms that are of significant benefit to our patients.

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Laparoscopic Navigated Liver Resection: Technical Aspects and Clinical Practice in Benign Liver Tumors

Cited by 12 publications

References 21 publications

Comparison of manual and semi-automatic registration in augmented reality image-guided liver surgery: a clinical feasibility study

Comparison of manual and semi-automatic registration in augmented reality image-guided liver surgery: a clinical feasibility study

Virtual and augmented reality: potential applications in radiology

Enhanced Visualization: From Intraoperative Tissue Differentiation to Augmented Reality

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