Advances in image guided conventional and minimal invasive liver surgery

Department of General, Visceral and Transplantation Surgery, Charité Campus Virchw Clinic, University Medicine, Berlin, Germany.
Minerva chirurgica (Impact Factor: 0.68). 08/2010; 65(4):463-78.
Source: PubMed


Technological developments, advances in perioperative medicine and ongoing scientific research have led to reduced rates of mortality and morbidity in patients undergoing major liver surgery. Under these conditions, the frontier of resectability is constantly in movement towards more complex cases with extended tumor spread and potentially minimized remnant liver volume. A promising technique to support oncological correct and safe liver surgery is the introduction of preoperative computer based planning models and intraoperative navigation systems. Whereas three-dimensional (3D) liver models are commercially available and have been clinically implemented, the use of navigation systems is currently under evaluation by different groups using a variety of techniques. This manuscript is meant to give the reader an overview on current developments, difficulties and future aspects of image guided liver surgery.

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    • "The largest LN in an involved region may not always be the involved LN. To compare the preoperative image with the pathological diagnosis in node-by-node manner, data accumulated from imageguided surgery, currently used for gastric or liver cancer [23] [24] are necessary. Although the detection rate of at least one LN in a region was increased when involved LNs existed, the detection rate was still 75%, not 100% (Fig. 1b). "
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    ABSTRACT: Advances in surgical and in imaging technology permit the performance of complex tumour resections in a safe and oncologically correct manner. To date, this has mainly implicated refined preoperative imaging methods, such as three-dimensional computer-assisted planning (3D-CASP). With the advent of modern hybrid operating rooms, intraoperative imaging has spread and various techniques of intraoperative image guidance have been developed. We review recent advances in intraoperative image guidance. We also delineate the role of intraoperative imaging techniques such as intraoperative ultrasound and computed tomography for real-time image guidance in laparoscopic liver surgery. Our review shows that advances in intraoperative imaging accompany the increasing use of laparoscopic approaches in visceral surgery. For the liver surgeon working laparoscopically, the loss of tactile sensation and the complex three-dimensional anatomy of the human liver make 3D-imaging techniques and intraoperative image guidance indispensable. We describe the role of 3D-CASP in preoperative surgical planning in liver surgery. An innovative imaging strategy for identifying liver segments during laparoscopic liver surgery by applying a fluorescent imaging method is proposed.
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