Use of the Resection Map system as guidance during hepatectomy

Abstract

BackgroundThe objective of this work is to evaluate a new concept of intraoperative three-dimensional (3D) visualization system to support hepatectomy. The Resection Map aims to provide accurate cartography for surgeons, who can therefore anticipate risks, increase their confidence and achieve safer liver resection.MethodsIn an experimental prospective cohort study, ten consecutive patients admitted for hepatectomy to three European hospitals were selected. Liver structures (portal veins, hepatic veins, tumours and parenchyma) were segmented from a recent computed tomography (CT) study of each patient. The surgeon planned the resection preoperatively and read the Resection Map as reference guidance during the procedure. Objective (amount of bleeding, tumour resection margin and operating time) and subjective parameters were retrieved after each case.ResultsThree different surgeons operated on seven patients with the navigation aid of the Resection Map. Veins displayed in the Resection Map were identified during the surgical procedure in 70.1% of cases, depending mainly on size. Surgeons were able to track resection progress and experienced improved orientation and increased confidence during the procedure.ConclusionsThe Resection Map is a pragmatic solution to enhance the orientation and confidence of the surgeon. Further studies are needed to demonstrate improvement in patient safety.

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

“…Its integration in the Operating Room is seamless, and preliminary results show a perceivedincrease in the safety and confidence of the surgeon (Lamata et al, 2009a). We believe that the Resection Map could be very helpful for the education of inexperienced liver surgeons, for the adoption of a laparoscopic approach, for an easier implantation of a living donor programme, and for the complex cases of an experienced surgeon.…”

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“…One solution to the deformation produced by the movement of the organ was described by Zhang et al [11], who compensate organ motion using an electromagnetic tracking system. Despite all efforts, the simulation of deformations in some interventions such as liver surgery is a complicated task and actually some improvements are required [12]. Lamata et al [12] propose an intermediate system for assisting minimally invasive liver resection.…”

Impact of model-based risk analysis for liver surgery planning

“…To this end, methods for model-based risk analysis in liver surgery were developed [1][2][3][4]. We briefly describe the important steps for model-based risk analysis in liver surgery as introduced by Preim et al (2002) [1]: vascular structures in the liver are segmented semi-automatically using a thresholdbased region-growing technique.…”