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28.04.2016 | ORIGINAL ARTICLE | Ausgabe 4/2016

Langenbeck's Archives of Surgery 4/2016

Intraoperative image-guided navigation system: development and applicability in 65 patients undergoing liver surgery

Zeitschrift:
Langenbeck's Archives of Surgery > Ausgabe 4/2016
Autoren:
Vanessa M. Banz, Philip C. Müller, Pascale Tinguely, Daniel Inderbitzin, Delphine Ribes, Matthias Peterhans, Daniel Candinas, Stefan Weber
Wichtige Hinweise
Vanessa M. Banz and Philip C. Müller contributed equally to the publication.

Abstract

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.

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