- 作者：Nicolas C. Buchs ; Francesco Volonte ; Fran?ois Pugin ; Christian Toso ; Matteo Fusaglia ; Kate Gavaghan ; Pietro E. Majno ; Matthias Peterhans ; Stefan Weber ; Philippe Morel
- 关键词：Virtual reality ; Robotic ; Liver resection ; Hepatic mass ; Computer surgery
- 刊名：Journal of Surgical Research
- 出版年：2013
- 出版时间：October, 2013
- 年：2013
- 卷：184
- 期：2
- 页码：825-831
- 全文大小：1181 K
Background
Stereotactic navigation technology can enhance guidance during surgery and enable the precise reproduction of planned surgical strategies. Currently, specific systems (such as the CAS-One system) are available for instrument guidance in open liver surgery. This study aims to evaluate the implementation of such a system for the targeting of hepatic tumors during robotic liver surgery.Material and methods
Optical tracking references were attached to one of the robotic instruments and to the robotic endoscopic camera. After instrument and video calibration and patient-to-image registration, a virtual model of the tracked instrument and the available three-dimensional images of the liver were displayed directly within the robotic console, superimposed onto the endoscopic video image. An additional superimposed targeting viewer allowed for the visualization of the target tumor, relative to the tip of the instrument, for an assessment of the distance between the tumor and the tool for the realization of safe resection margins.
Results
Two cirrhotic patients underwent robotic navigated atypical hepatic resections for hepatocellular carcinoma. The augmented endoscopic view allowed for the definition of an accurate resection margin around the tumor. The overlay of reconstructed three-dimensional models was also used during parenchymal transection for the identification of vascular and biliary structures. Operative times were 240 min in the first case and 300 min in the second. There were no intraoperative complications.
Conclusions
The da Vinci Surgical System provided an excellent platform for image-guided liver surgery with a stable optic and instrumentation. Robotic image guidance might improve the surgeon's orientation during the operation and increase accuracy in tumor resection. Further developments of this technological combination are needed to deal with organ deformation during surgery.