Laparoscopic surgery in a 0.5-t interventional magnetic resonance unit

Area of Science:

• Minimally invasive surgery
• Medical imaging technology
• Interventional radiology

Background:

• Interventional MR (IMR) units enable intraoperative magnetic resonance imaging (MRI).
• MRI offers advantages in visualizing deep structures and clarifying surgical anatomy compared to other methods.
• This study explores the feasibility of laparoscopic surgery within an IMR unit.

Purpose of the Study:

• To investigate the feasibility of performing laparoscopic surgery with intraoperative imaging in an interventional MR (IMR) unit.
• To evaluate the utility of intraoperative MR cholangiography (MRC) techniques for guiding laparoscopic procedures.

Main Methods:

• Procedures conducted in a 0.5-T General Electric IMR scanner.
• Simulated laparoscopic cholecystectomies on porcine livers using magnet-safe instruments and ultrasonic dissection.
• Intraoperative MRC utilizing T2-weighted fast-spin-echo (FSE) and single-shot fast-spin-echo (ssFSE) with maximal intensity projection (MIP).
• Two human patient laparoscopic cholecystectomies with intraoperative MRC.

Main Results:

• Simulated procedures facilitated the development of surgical techniques for the IMR environment.
• Both FSE and ssFSE techniques yielded reasonable intraoperative image quality.
• ssFSE provided intraoperative gallbladder images with partial visualization of the extrahepatic biliary tree; FSE imaging quality was poor.

Conclusions:

• Laparoscopic surgery within an IMR unit is technically achievable.
• Intraoperative MRC presents challenges, with FSE imaging susceptible to motion artifacts.
• The faster ssFSE technique shows promise for intraoperative biliary tree imaging in MR-guided surgery with further development.