This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Citing articles on Web of Science (23)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Gastrointestinal/ Upper Foregut  • Magnetic Resonance Imaging  • Alert me on articles by topic  Social Bookmarking   What's this?

Preliminary Feasibility Studies of Frameless Stereotactic Liver Surgery

Alan J. Herline, MD; James D. Stefansic, MS; Jacob P. Debelak, MS; Steven L. Hartmann, BS; C. Wright Pinson, MD; Robert L. Galloway, PhD; William C. Chapman, MD

Arch Surg. 1999;134:644-650.

Background  Liver surgery can be difficult because there are few external landmarks defining hepatic anatomy and because the liver has significant vascularity. Although preoperative tomographic imaging (computed tomography or magnetic resonance imaging) provides essential anatomical information for operative planning, at present it cannot be used actively for precise localization during surgery. Interactive image-guided surgery involves the simultaneous real-time display of intraoperative instrument location on preoperative images (computed or positron-emission tomography or magnetic resonance imaging). Interactive image-guided surgery has been described for tumor localization in the brain (frameless stereotactic surgery) and allows for interactive use of preoperative images during resections or biopsies.

Hypothesis  The application of interactive image-guided surgery (IIGS) is feasible for hepatic procedures from a biomedical engineering standpoint.

Methods  We developed an interactive image-guided surgery system for liver surgery and tested a porcine liver model for tracking liver motion during insufflation; liver motion during respiration in open procedures in patients undergoing hepatic resection; and tracking accuracy of general surgical instruments, including a laparoscope and an ultrasound probe.

Results  Liver motion due to insufflation can be quantified; average motion was 2.5 ± 1.4 mm. Average total liver motion secondary to respiration in patients was 10.8 ± 2.5 mm. Instruments of varying lengths, including a laparoscope, can be tracked to accuracies ranging from 1.4 to 2.1 mm within a 27-m³ (3 x 3 x 3-m) space.

Conclusion  Interactive image-guided surgery appears to be feasible for open and laparoscopic hepatic procedures and may enhance future operative localization.

From the Departments of Hepatobiliary Surgery and Liver Transplantation (Drs Herline, Pinson, and Chapman and Mr Debelak) and Biomedical Engineering (Drs Herline and Galloway and Messrs Stefansic and Hartmann), Vanderbilt University, Nashville, Tenn.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Augmented Reality in Surgery
Shuhaiber
Arch Surg 2004;139:170-174.
ABSTRACT | FULL TEXT