Image-guided surgery - Preliminary feasibility studies of frameless stereotactic liver surgery
Image-guided surgery - Preliminary feasibility studies of frameless stereotactic liver surgery
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DOI：
10.1001/archsurg.134.6.644
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发表时间：
1999-06-01
影响因子：
--
通讯作者：
Chapman, WC
中科院分区：
文献类型：
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作者：
Herline, AJ;Stefansic, JD;Chapman, WC
背景：肝脏手术可能很困难，因为定义肝脏解剖的外部标志物很少，而且肝脏有大量的血管。虽然术前断层成像(计算机断层扫描或磁共振成像)为手术计划提供了基本的解剖学信息，但目前它不能积极用于手术中的精确定位。交互式图像引导手术包括在术前图像(计算机或正电子发射断层扫描或磁共振成像)上同时实时显示术中器械的位置。从生物医学工程的角度来看，交互式图像引导手术(IIGS)在肝脏手术中的应用是可行的。方法：我们开发了一种用于肝脏手术的交互式图像引导手术系统，并测试了猪肝脏模型，用于跟踪充气过程中的肝脏运动；在开放手术中肝运动的跟踪；以及普通外科器械，包括腹腔镜和超声探头的跟踪准确性。平均活动度2.5+/-1.4 mm。患者继发于呼吸的平均总肝脏运动为10.8+/-2.5 mm。在27m(3)(3X3X3-m)的空间内，包括腹腔镜在内的不同长度的器械可以追踪到1.4到2.1 mm的精度。结论：交互式图像引导手术似乎适用于开腹和腹腔镜肝脏手术，并可能增强未来的手术定位。
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-m(3) (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.