Initial results of MR-guided liver resection in a high-field open MRI.
BACKGROUND
The goal of this study was to evaluate high-field open magnetic resonance imaging (MRI) for intraoperative real-time imaging during hand-assisted laparoscopic liver resection. MR guidance has several advantages compared to ultrasound and may represent a future technique for abdominal surgery. Various MRI-safe and -compatible instruments were developed, tested, and applied to realize minimally invasive liver surgery under MR guidance. As proof of the concept, liver resection was performed in a porcine model.


METHODS
All procedures were conducted in a 1.0-T open MRI unit. Imaging quality and surgical results were documented during three cadaveric and two live animal procedures. A nonferromagnetic hand port was used for manual access and the liver tissue was dissected using a Nd:YAG laser.


RESULTS
The intervention time ranged from 126 to 145 min, with a dissection time from 11 to 15 min. Both live animals survived the intervention with a blood loss of 250 and 170 ml and a specimen weight of 138 and 177 g. A dynamic T2W fast spin-echo sequence allowed real-time imaging (1.5 s/image) with good delineation of major and small hepatic vessels. The newly developed MR-compatible instruments and camera system caused only minor interferences and artifacts of the MR image.


CONCLUSIONS
MR-guided liver resection is feasible and provides additional image information to the surgeon. We conclude that MR-guided laparoscopic liver resection improves the anatomical orientation and may increase the safety of future minimally invasive liver surgery.
Department of General-, Visceral- and Transplantation Surgery, Charité Campus Virchow Clinic, University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. sascha.chopra@charite.de
Sascha Santosh
SS
Chopra
Sven Christian
SC
Schmidt
Robert
R
Eisele
Ulf
U
Teichgräber
Ivo
I
Van der Voort
Christian
C
Seebauer
Florian
F
Streitparth
Guido
G
Schumacher
D000818:Animals; D002102:Cadaver; D058733:Hand-Assisted Laparoscopy; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007432:Intraoperative Period; D053783:Magnetic Resonance Imaging, Interventional; D034421:Sus scrofa