Deformation Corrected Image Guided Laparoscopic Liver Surgery

总结 支持这一应用的科学前提是，与精确物理位置相关的技术， 治疗和共同定位的空间编码的疾病信息，即通常由成像提供，将使得能够更安全地 微创肝脏外科手术，从而增加手术候选人，并允许更准确的 干预措施。更进一步，这种本地化的改进将有助于分析结果， 评价疗效、方法比较、改善评级和成像的影响 生物标志物来推动治疗决策。在该应用中，虽然存在潜在的广泛临床影响， 具体重点是促进和量化基于图像的局部信息的空间准确性和保真度 以增强腹腔镜肝脏手术期间的导航辅助。实现这一目标将是 在程序医学领域取得进展。应用假设是基于生物力学模型的 与非接触式数字化相结合的配准可以解释软组织变形并定位 实质内肝脏靶向到平均小于3mm的前所未有的误差。另外我们 将开始探索这项技术对局部治疗的影响。什么也设置此应用程序 除了通过我们提议的与FDA的整合， 清除肝脏引导系统该应用程序的另一个区别是，我们采用了一种评估方法， 在纪念斯隆-凯特琳医院争取世界上最好的肝胆胰服务的框架 癌症中心的监督下，威廉R。Jarnagin对该技术进行独立评估。 共同PI之间长达十多年的合作关系非常富有成效（参见Multi-PI计划） 并且是图像引导肝脏导航领域中最具科学实质性的。具体目标 的应用涉及：（1）变形校正到商业导向系统的集成，（2） 腹腔镜适应症的新方法的研究，包括非接触式 数字化和新的增强功能，用于建模注气、韧带支撑和模型异质性，（3） 三项临床旁观者研究定量描述了数字化的改善，腹腔镜 方法，以及（4）一项探索性研究，启动对使用该平台进行局部区域研究的调查 治疗总之，虽然应用的重点是肝癌手术护理的根本性进步， 它还提供了一个范式转变，提供了一个新的研究框架，在人类系统的背景下， 程序医学。

Summary The scientific premise underpinning this application is that technologies relating the precise physical location of therapy and co-located spatially-encoded disease information, i.e. usually provided by imaging, will enable safer less invasive liver surgical procedures thus increasing surgical candidacy and allowing for more accurate interventions. Going further, this improvement in localization will facilitate the analysis of outcomes for evaluating efficacy, the comparison of approaches, the rating of improvements, and the impact of imaging biomarkers to drive therapy decisions. In this application, while there is potentially broad clinical impact, the specific focus is facilitating and quantifying the spatial accuracy and fidelity of localized image-based information to enhance navigational assistance during laparoscopic liver surgery. Realization would be a fundamental advance in the domain of procedural medicine. The application hypothesis is that biomechanical model-based registration coupled to non-contact digitization can account for soft-tissue deformations and localize intraparenchymal liver targets to an unprecedented error of less than 3 mm of error on average. In addition, we will begin to explore the impact of this technology on locoregional therapies. What also sets this application apart is the strong translational trajectory of the technology through our proposed integration with the on FDA cleared liver guidance system. Another distinction for the application is that we have employed an assessment framework enlisting one of the best hepatopancreatobiliary services in the world at Memorial Sloan Kettering Cancer Center under the supervision of Dr. William R. Jarnagin for the independent evaluation of the technology. This decade+ long collaborative relationship among the co-PIs has been extremely productive (see Multi-PI plan) and is among the most scientifically substantive in the field of image guided liver navigation. The specific aims of the application involve: (1) the integration of deformation correction into a commercial guidance system, (2) the investigation of a novel approach to the laparoscopic indication which includes advances in a non-contact digitization and novel enhancements for modeling insufflation, ligament support, and model heterogeneity, (3) three clinical bystander studies that quantitatively characterize improvements in digitization, and the laparoscopic approach, and (4) an exploratory study that initiates the investigation of the use of the platform for locoregional therapies. In summary, while the focus of the application is a fundamental advance in liver cancer surgical care, it also offers a paradigm shift by providing a novel investigational framework in human systems within the context of procedural medicine.