Real-time image guidance in laparoscopic liver surgery: first clinical experience with a guidance system based on intraoperative CT imaging

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• 作者：Hannes G. Kenngott (1)
  Martin Wagner (1)
  Matthias Gondan (2)
  Felix Nickel (1)
  Marco Nolden (3)
  Andreas Fetzer (3)
  Jürgen Weitz (1)
  Lars Fischer (1)
  Stefanie Speidel (4)
  Hans-Peter Meinzer (3)
  Dittmar B?ckler (5)
  Markus W. Büchler (1)
  Beat P. Müller-Stich (1)
  
• 关键词：Navigation ; Liver surgery ; Liver resection ; Augmented reality ; Intraoperative imaging ; Computer assistance
• 刊名：Surgical Endoscopy
• 出版年：2014
• 出版时间：March 2014
• 年：2014
• 卷：28
• 期：3
• 页码：933-940
• 全文大小：983 KB
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• 作者单位：Hannes G. Kenngott (1)
  Martin Wagner (1)
  Matthias Gondan (2)
  Felix Nickel (1)
  Marco Nolden (3)
  Andreas Fetzer (3)
  Jürgen Weitz (1)
  Lars Fischer (1)
  Stefanie Speidel (4)
  Hans-Peter Meinzer (3)
  Dittmar B?ckler (5)
  Markus W. Büchler (1)
  Beat P. Müller-Stich (1)
  
  1. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
  2. Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
  3. Division of Medical and Biological Informatics, German Cancer Research Centre, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
  4. Institute for Anthropomatics IFA, Karlsruhe Institute of Technology KIT, Adenauerring 2, 76131, Karlsruhe, Germany
  5. Department of Vascular and Endovascular Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
  
• ISSN：1432-2218

文摘

Background Laparoscopic liver surgery is particularly challenging owing to restricted access, risk of bleeding, and lack of haptic feedback. Navigation systems have the potential to improve information on the exact position of intrahepatic tumors, and thus facilitate oncological resection. This study aims to evaluate the feasibility of a commercially available augmented reality (AR) guidance system employing intraoperative robotic C-arm cone-beam computed tomography (CBCT) for laparoscopic liver surgery. Methods A human liver-like phantom with 16 target fiducials was used to evaluate the Syngo iPilot? AR system. Subsequently, the system was used for the laparoscopic resection of a hepatocellular carcinoma in segment 7 of a 50-year-old male patient. Results In the phantom experiment, the AR system showed a mean target registration error of 0.96?±?0.52?mm, with a maximum error of 2.49?mm. The patient successfully underwent the operation and showed no postoperative complications. Conclusion The use of intraoperative CBCT and AR for laparoscopic liver resection is feasible and could be considered an option for future liver surgery in complex cases.