The Resection Map, a proposal for intraoperative hepatectomy guidance

Abstract

Objective To propose a new concept of an intra-operative 3D visualisation system to support hepatectomies. This system aims at improving the transfer of pre-operative planning into the intra-operative stage, both in laparoscopic and open approaches. Materials and methods User (surgeon) centred developmental process to identify the surgical requirements is applied. The surgical workflow of hepatectomy is analyzed, including observations of liver surgeries and focus group sessions. Based on this analysis, specifications for the "Resection Map" are defined. A first implementation is developed, and preliminary clinical acceptance results are gathered. Results Control of main veins and tumour margins are the two critical aspects. The "Resection Map" provides an intuitive visualisation of structures nearby the resection plane without any registration to the patient space.

Laparoscopic Liver Resection for Malignant and Benign Lesions

“…This may further improve intraoperative navigation. [40][41][42] It may also contribute to learning by enabling interactive intraoperative discussion between expert and fellow surgeons to adjust surgical tactics based on analysis of preoperative and intraoperative imaging and current procedural circumstances.…”

Collaborative co-design of emerging multi-technologies for surgery

“…Meanwhile Lamata, a new member to ARIS*ER, had begun field observations and had identified many issues with an informal ethnography approach. The two researchers fused their combined insights and developed the 'Resection Map', a 3D guide for resection [39,40] (see Fig. 4).…”

“…Liver resection surgery is planned, but deviations from the plan are prepared because circumstances change during surgery. Lamata et al [39] describe the principle challenges facing surgeons in this procedure: ''Localization of the inner structures is very hard to anticipate by the surgeon, who therefore resects the liver very carefully, step by step, looking for the next inner structure to appear. Moreover, identification of these hidden structures is difficult since the operating field becomes really confusing due to the presence of bleeding and burnt tissue .…”

Augmented Reality for Minimally Invasive Surgery: Overview and Some Recent Advances

“…The system thus relies on the surgeon's capacity to perform a mental alignment between the Resection Map and the operating field. A detailed description of the design process and concept of this system can be found in (Lamata et al, 2008b).…”