Intraoperative image-guided navigation system: development and applicability in 65 patients undergoing liver surgery.
BACKGROUND
Image-guided systems have recently been introduced for their application in liver surgery. We aimed to identify and propose suitable indications for image-guided navigation systems in the domain of open oncologic liver surgery and, more specifically, in the setting of liver resection with and without microwave ablation.


METHODS
Retrospective analysis was conducted in patients undergoing liver resection with and without microwave ablation using an intraoperative image-guided stereotactic system during three stages of technological development (accuracy: 8.4 ± 4.4 mm in phase I and 8.4 ± 6.5 mm in phase II versus 4.5 ± 3.6 mm in phase III). It was evaluated, in which indications image-guided surgery was used according to the different stages of technical development.


RESULTS
Between 2009 and 2013, 65 patients underwent image-guided surgical treatment, resection alone (n = 38), ablation alone (n = 11), or a combination thereof (n = 16). With increasing accuracy of the system, image guidance was progressively used for atypical resections and combined microwave ablation and resection instead of formal liver resection (p < 0.0001).


CONCLUSIONS
Clinical application of image guidance is feasible, while its efficacy is subject to accuracy. The concept of image guidance has been shown to be increasingly efficient for selected indications in liver surgery. While accuracy of available technology is increasing pertaining to technological advancements, more and more previously untreatable scenarios such as multiple small, bilobar lesions and so-called vanishing lesions come within reach.
Inselspital Berne, Department of Visceral Surgery and Medicine, Inselspital, Berne, Switzerland.
Vanessa M
VM
Banz
ARTORG Center for Computer-Aided Surgery, University of Berne, 3010 Berne, Switzerland.
Philip C
PC
Müller
Inselspital Berne, Department of Visceral Surgery and Medicine, Inselspital, Berne, Switzerland.
Pascale
P
Tinguely
Inselspital Berne, Department of Visceral Surgery and Medicine, Inselspital, Berne, Switzerland.
Daniel
D
Inderbitzin
ARTORG Center for Computer-Aided Surgery, University of Berne, 3010 Berne, Switzerland.
Delphine
D
Ribes
ARTORG Center for Computer-Aided Surgery, University of Berne, 3010 Berne, Switzerland.|CAScination AG, Steigerhubelstrasse 3, 3008, Berne, Switzerland.
Matthias
M
Peterhans
Inselspital Berne, Department of Visceral Surgery and Medicine, Inselspital, Berne, Switzerland.
Daniel
D
Candinas
ARTORG Center for Computer-Aided Surgery, University of Berne, 3010 Berne, Switzerland. stefan.weber@artorg.unibe.ch.
Stefan
S
Weber
D000368:Aged; D005260:Female; D006498:Hepatectomy; D006801:Humans; D021621:Imaging, Three-Dimensional; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
Image guidance; Intraoperative navigation; Liver ablation; Liver surgery