Laparoscopic image-based navigation for microwave ablation of liver tumors-A multi-center study.
Stereotactic navigation technology has been proposed to augment accuracy in targeting intrahepatic lesions for local ablation therapy. This retrospective study evaluated accuracy, efficacy, and safety when using laparoscopic image-guided microwave ablation (LIMA) for malignant liver tumors.



All patients treated for malignant liver lesions using LIMA at two European centers between 2013 and 2015 were included for analysis. A landmark-based registration technique was applied for intraoperative tumor localization and positioning of ablation probes. Intraoperative efficiency of the procedure was measured as number of registration attempts and time needed to achieve sufficient registration accuracy. Technical accuracy was assessed as Fiducial Registration Error (FRE). Outcome at 90 days including mortality, postoperative morbidity, rates of incomplete ablations, and early intrahepatic recurrences were reported.



In 34 months, 54 interventions were performed comprising a total of 346 lesions (median lesions per patient 3 (1-25)). Eleven patients had concomitant laparoscopic resections of the liver or the colorectal primary tumor. Median time for registration was 4:38 min (0:26-19:34). Average FRE was 8.1 ± 2.8 mm. Follow-up at 90 days showed one death, 24% grade I/II, and 4% grade IIIa complications. Median length of hospital stay was 2 days (1-11). Early local recurrence was 9% per lesion and 32% per patient. Of these, 63% were successfully re-ablated within 6 months.



LIMA does not interfere with the intraoperative workflow and results in low complication and early local recurrence rates, even when simultaneously targeting multiple lesions. LIMA may represent a valid therapy option for patients with extensive hepatic disease within a multimodal treatment approach.
Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland. pascale.tinguely@insel.ch.
Pascale
P
Tinguely
ARTORG Center for Biomedical Engineering Research, University of Bern, 3010, Bern, Switzerland.
Matteo
M
Fusaglia
Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden.
Jacob
J
Freedman
Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland.
Vanessa
V
Banz
ARTORG Center for Biomedical Engineering Research, University of Bern, 3010, Bern, Switzerland.
Stefan
S
Weber
Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland.
Daniel
D
Candinas
Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden.
Henrik
H
Nilsson
D055011:Ablation Techniques; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008872:Microwaves / Q000627:therapeutic use*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted
Ablation; Image-guided surgery; Laparoscopy; Liver; Minimal invasive surgery; Surgical navigation