Banz Wüthrich, Vanessa; Müller, Philip; Tinguely, Pascale Marie-Pia; Inderbitzin, Daniel; Ribes, Delphine; Peterhans, Matthias; Candinas, Daniel; Weber, Stefan (2016). Intraoperative image-guided navigation system: development and applicability in 65 patients undergoing liver surgery. Langenbeck's archives of surgery, 401(4), pp. 495-502. Springer 10.1007/s00423-016-1417-0
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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.
Method 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).
Conclusion 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.