Laparoscopic Liver Surgery Guided by Virtual Real-time CT-Guided Volume Navigation
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ORIGINAL ARTICLE
Laparoscopic Liver Surgery Guided by Virtual Real-time CT-Guided Volume Navigation Takeshi Aoki 1 & Doaa A. Mansour 1,2 & Tomotake Koizumi 1 & Yusuke Wada 1 & Yuta Enami 1 & Akira Fujimori 1 & Tomokazu Kusano 1 & Kazuhiro Matsuda 1 & Koji Nogaki 1 & Yoshihiko Tashiro 1 & Tomoki Hakozaki 1 & Hideki Shibata 1 & Kodai Tomioka 1 & Takahito Hirai 1 & Tatsuya Yamazaki 1 & Kazuhiko Saito 1 & Satoru Goto 1 & Makoto Watanabe 1 & Koji Otsuka 1 & Masahiko Murakami 1 Received: 26 May 2020 / Accepted: 27 August 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Recently, virtual navigation system has been applied to hepatic surgery, enabling better visualization of intrahepatic vascular branches and location of tumor. Intraoperative ultrasonography (IOUS) is the most common form of image guidance during liver surgery. However, during laparoscopic hepatectomies (LH), IOUS has several limitations and its reliability has been poorly evaluated. The objective of this work is to evaluate VRCT (virtual real-time CT-guided volume navigation) during LH. This system aims to provide accurate anatomical orientation for surgeons enhancing the safety of LH. Methods Twenty-seven hepatic neoplasms were resected laparoscopically at our institution under reference guidance of VRCT. During operation, electromagnetic tracking of the surgical instrument was used for navigating the direction of accurate liver transection. Results Twenty-six (96.3%) of the 27 lesions (mean diameter 11 mm) were successfully performed under VRCT guidance. Average registration time was < 2 min. Average setup time was approximately 7 min per procedure. VRCT allows the surgeon to navigate liver transection with acceptable accuracy. The mean error was 12 mm. All surgical margins were negative and the mean histologic resection margin was 9 mm. Conclusions VRCT-guided LH is feasible and provides valuable real-time anatomical feedback during hepatic resections. Advancement of such systems to improve accuracy might greatly compensate for the limitation of laparoscopic IOUS. Keywords Hepatectomy . Laparoscopy . Image-guided surgery . Electromagnetics . Ultrasonography
Introduction
Presentation at a scientific meeting: This paper was not presented at any scientific meeting. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-020-04784-3) contains supplementary material, which is available to authorized users. * Takeshi Aoki [email protected] 1
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
2
General Surgery Department, Cairo University Hospitals, Kasr Alainy, Al-Saray Street, El-Manial, Cairo 11956, Egypt
Intraoperative ultrasonography (IOUS) is considered an inte1 gral component of modern hepatic surgery. –3 3D reconstruction of CT images allows accurate pre- and intraoperative display of hepatic vasculature, relevant tumor-vessel relationships, and e
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