title: Image-guided surgery: preliminary feasibility studies of frameless stereotactic liver surgery.
abstract: BACKGROUND
  Liver surgery can be difficult because there are few external landmarks defining hepatic anatomy and because the liver has significant vascularity. Although preoperative tomographic imaging (computed tomography or magnetic resonance imaging) provides essential anatomical information for operative planning, at present it cannot be used actively for precise localization during surgery. Interactive image-guided surgery involves the simultaneous real-time display of intraoperative instrument location on preoperative images (computed or positron-emission tomography or magnetic resonance imaging). Interactive image-guided surgery has been described for tumor localization in the brain (frameless stereotactic surgery) and allows for interactive use of preoperative images during resections or biopsies.
  
  
  OBJECTIVE
  The application of interactive image-guided surgery (IIGS) is feasible for hepatic procedures from a biomedical engineering standpoint.
  
  
  METHODS
  We developed an interactive image-guided surgery system for liver surgery and tested a porcine liver model for tracking liver motion during insufflation; liver motion during respiration in open procedures in patients undergoing hepatic resection; and tracking accuracy of general surgical instruments, including a laparoscope and an ultrasound probe.
  
  
  RESULTS
  Liver motion due to insufflation can be quantified; average motion was 2.5+/-1.4 mm. Average total liver motion secondary to respiration in patients was 10.8 +/-2.5 mm. Instruments of varying lengths, including a laparoscope, can be tracked to accuracies ranging from 1.4 to 2.1 mm within a 27-m3 (3 X 3 X 3-m) space.
  
  
  CONCLUSIONS
  Interactive image-guided surgery appears to be feasible for open and laparoscopic hepatic procedures and may enhance future operative localization.
authors.affiliation: Department of Hepatobiliary Surgery, Vanderbilt University, Nashville, Tenn 37232-4753, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Herline
authors.forename: J D
authors.initials: JD
authors.lastname: Stefansic
authors.forename: J P
authors.initials: JP
authors.lastname: Debelak
authors.forename: S L
authors.initials: SL
authors.lastname: Hartmann
authors.forename: C W
authors.initials: CW
authors.lastname: Pinson
authors.forename: R L
authors.initials: RL
authors.lastname: Galloway
authors.forename: W C
authors.initials: WC
authors.lastname: Chapman
mesh_terms: D000818:Animals; D013505:Digestive System Surgical Procedures / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D008099:Liver / Q000033:anatomy & histology / Q000502:physiology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D012119:Respiration; D013552:Swine; D014057:Tomography, X-Ray Computed