Image-guided surgery of liver metastases by three-dimensional ultrasound-based optoelectronic navigation.
BACKGROUND
Vessel-oriented surgery and tumour-free resection margins are essential for resection of liver metastases to preserve liver parenchyma and improve oncological outcome. Preoperative three-dimensional models reconstructed from imaging data could facilitate surgical planning with the use of navigation technology.


METHODS
Thirty-three patients with central and/or impalpable liver metastases were scheduled for navigated hepatic resection. Intraoperative three-dimensional ultrasonography and an infrared-based optical tracking system were used for data registration and image-guided surgery. Postoperative three-dimensional data were compared with the preoperative virtual surgical plan to assess the accuracy of navigation, and clinical results were compared with those of a matched control group of 32 patients.


RESULTS
Navigation was successful in 32 of 33 patients. Realization of the preoperative plan and R0 resection was achieved in 30 of these 32 patients. The median discrepancy between the planned and actual vascular dissection level was 6 (range 0-11) mm. There was a reduced rate of R1 resection in the navigated group compared with the control group (two versus four patients), and more parenchyma was preserved.


CONCLUSIONS
Three-dimensional ultrasound-based optoelectronic navigation technology improves intraoperative orientation and enables parenchyma-preserving surgery with high precision.
Beller
S
S
Department of Surgery and Surgical Oncology, Charité Universitätsmedizin Berlin, Robert Rössle Klinik, Campus Berlin-Buch, Berlin, Germany.
Hünerbein
M
M
Lange
T
T
Eulenstein
S
S
Gebauer
B
B
Schlag
P M
PM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004867:Equipment Design; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007430:Intraoperative Care / Q000379:methods; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography