Deformation Corrected Image Guided Laparoscopic Liver Surgery

摘要 支持这一应用的科学前提是与精确的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，即通常由成像提供的，将使更安全 因此，侵入性更小的肝脏外科手术增加了手术的可能性，并允许更准确地 干预措施。更进一步，本地化方面的改进将有助于分析以下方面的结果 评估疗效、方法的比较、改善的等级和成像的影响 推动治疗决策的生物标记物。在这一应用中，虽然可能会产生广泛的临床影响，但 具体的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 目的：加强腹腔镜肝脏手术中的导航辅助。实现这一点将是一个基本的 程序医学领域的进展。其应用假设是基于生物力学模型 配准与非接触式数字化相结合可以考虑软组织变形和定位 肝脏实质内靶点的平均误差小于3 mm，达到前所未有的误差。此外，我们 将开始探索这项技术对局部治疗的影响。还有什么设置了此应用程序 不同的是，通过我们建议的与On FDA的集成，该技术的强大转换轨迹 清除肝脏引导系统。应用程序的另一个区别是我们采用了一种评估 在斯隆·凯特林纪念馆招募世界上最好的肝胰胆服务机构之一的框架 癌症中心在威廉·R·贾纳金博士的监督下对该技术进行了独立评估。 合作绩效指标之间长达十年的协作关系卓有成效(见多绩效指标计划) 是图像引导肝脏导航领域最具科学性的实质性研究之一。具体目标 该应用包括：(1)将变形校正集成到商业制导系统中，(2) 一种新的非接触式腹腔镜手术适应证的研究 数字化和对模型注气、韧带支撑和模型异质性的新增强，(3) 三项量化表征数字化进步的临床旁观者研究，以及腹腔镜 方法，以及(4)开展探索性研究，调查区域区域合作平台的使用情况 治疗。综上所述，虽然应用的重点是肝癌外科治疗的根本进步， 它还通过在人类系统的上下文中提供一个新的研究框架来提供范式转换 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.