Intraoperative modification of resection plans for liver surgery

ObjectiveRecent surgical planning software provides valuable tools for evaluating different resection strategies preoperatively. With such virtual resections, predictions and quantitative analyses may be carried out to assess the resection feasibility with respect to tumors and risk structures. In oncologic liver surgery, additional tumors that were not seen in the preoperative images are often found during the intervention using intraoperative ultrasound (IOUS). Due to such findings, the resection strategy must be updated or completely revised.Materials and methodsTherefore, we have developed methods for the intraoperative modification of resection plans. The probe of an ultrasound-based navigation system and alternatively the pointing device Wiimote are proposed as intraoperative interaction devices. Fast adaptation of planning information and the communication with both interaction devices is supported by our system, the Intraoperative Planning Assistant (IPA). The IPA has been evaluated in the operation room (OR) during laparoscopic liver interventions on pigs.ResultsOur preliminary results confirm that intraoperative modifications of resection plans are both feasible and beneficial for liver surgery. After the intraoperative modification task, updated remaining liver volume and resection volume were displayed and quantified within 10 s.ConclusionFor the first time, surgeons are provided with a system for intraoperative modification of resection plans that offers a crucial decision support, is easy to use and integrates smoothly into the clinical workflow. The new system provides major support for decision making in the OR and thus improves the safety of surgical interventions.

[1]  Benoit M. Dawant,et al.  Development of preoperative liver and vascular system segmentation and modeling tool for image-guided surgery and surgical planning , 2008, SPIE Medical Imaging.

[2]  A Schweikard,et al.  Prototype of an intraoperative navigation and documentation system for laparoscopic radiofrequency ablation: first experiences. , 2008, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[3]  Bernhard Preim,et al.  Virtual Resection with a Deformable Cutting Plane , 2004, SimVis.

[4]  Steven A Curley,et al.  Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. , 2002, Archives of surgery.

[5]  Heinz-Otto Peitgen,et al.  Clinical relevance of model based computer-assisted diagnosis and therapy , 2008, SPIE Medical Imaging.

[6]  Mark Schneider,et al.  Development and testing of a new magnetic-tracking device for image guidance , 2007, SPIE Medical Imaging.

[7]  Thomas Lange,et al.  Image registration for CT and intra-operative ultrasound data of the liver , 2008, SPIE Medical Imaging.

[8]  Marco Nolden,et al.  The Medical Imaging Interaction Toolkit , 2005, Medical Image Anal..

[9]  Paulo Herman,et al.  [The impact of intra operative ultrasound in metastases liver surgery]. , 2005, Arquivos de gastroenterologia.

[10]  Daniel B. Jones,et al.  Intraoperative ultrasonography during planned liver resections: why are we still performing it? , 2007, Surgical Endoscopy.

[11]  Dieter Schmalstieg,et al.  Liver Surgery Planning Using Virtual Reality , 2006, IEEE Computer Graphics and Applications.

[12]  K. Cleary,et al.  Assessment of hepatic motion secondary to respiration for computer assisted interventions. , 2002, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[13]  Marcela Pecora Cohen,et al.  IMPACTO DA ULTRA-SONOGRAFIA INTRA-OPERATÓRIA NAS CIRURGIAS PARA RESSECÇÃO DE METÁSTASES HEPÁTICAS , 2005 .

[14]  Heinz-Otto Peitgen,et al.  Impact of virtual tumor resection and computer-assisted risk analysis on operation planning and intraoperative strategy in major hepatic resection. , 2005, Archives of surgery.

[15]  Heinz-Otto Peitgen,et al.  Intraoperative adaptation and visualization of preoperative risk analyses for oncologic liver surgery , 2008, SPIE Medical Imaging.