Interactive determination of robust safety margins for oncologic liver surgery.
OBJECTIVE
Complex oncologic interventions in the liver require an extensive and careful preoperative analysis. Particularly the achievement of an optimal safety margin around tumors remains a difficult task for surgeons.


METHODS
We present new methods for evaluating different safety margins and their effect on the associated interruption of vascular supply or drainage. The characteristic of vascular risk distributions can be evaluated in real-time by exploiting precomputed safety maps that provide a volume curve for each vascular system. By applying fast visualization methods in 3D it is possible to assist the surgeon in the determination of a tumor-free safety margin while preserving sufficient vital hepatic parenchyma. The combination of risk analysis from different vascular systems and their sensitivity is considered.


RESULTS
We provide physicians with a novel computer-aided planning tool that allows for interactive determination of safety margins in real-time. The planning tool integrates smoothly into the preoperative workflow. Preliminary evaluations confirm that the width of safety margins can be determined more precisely, which may affect the proposed resection strategy.


CONCLUSIONS
Our new methods provide interactive feedback and support for decision making during the preoperative planning stage and thus might potentially improve the outcome of surgical interventions.
Hansen
Christian
C
Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany. Christian.Hansen@mevis.fraunhofer.de
Zidowitz
Stephan
S
Hindennach
Milo
M
Schenk
Andrea
A
Hahn
Horst
H
Peitgen
Heinz-Otto
HO
D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D015203:Reproducibility of Results; D018570:Risk Assessment; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed