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Laparoscopic surface scanning and subsurface targeting: implications for image-guided laparoscopic liver surgery
Thomas P Rauth1, Philip Q Bao, Robert L Galloway
1Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. thomas.rauth@vanderbilt.edu
Abstract:
Segmental liver resection and locoregional ablative therapies are dependent upon accurate tumor localization to ensure safety as well as acceptable oncologic results. Because of the liver's limited external landmarks and complex internal anatomy, such tumor localization poses a technical challenge. Image guided therapies (IGT) address this problem by mapping the real-time, intraoperative position of surgical instruments onto preoperative tomographic imaging through a process called registration. Accuracy is critical to IGT and is a function of: 1) the registration technique, 2) the tissue characteristics, and 3) imaging techniques. The purpose of this study is to validate a novel method of registration using an endoscopic Laser Range Scanner (eLRS) and demonstrate its applicability to laparoscopic liver surgery. Six radiopaque targets were inserted into an ex-vivo bovine liver and a computed tomography (CT) scan was obtained. Using the eLRS, the liver surface was scanned and a surface-based registration was constructed to predict the position of the intraparenchymal targets. The target registration error (TRE) achieved using our surface-based registration was 2.4 +/- 1.0 mm. A comparable TRE using traditional fiducial-based registration was 2.6 +/- 1.7 mm. Compared to traditional fiducial-based registration, laparoscopic surface scanning is able to predict the location of intraparenchymal liver targets with similar accuracy and rate of data acquisition.
Insights
Accurate liver tumor localization is crucial for safe and effective cancer treatment. A new endoscopic Laser Range Scanner (eLRS) method for surface-based registration shows similar accuracy to traditional methods in guiding laparoscopic liver surgery.
Area of Science:
- Surgical Navigation
- Medical Imaging
- Hepatobiliary Surgery
Background:
- Accurate tumor localization is essential for segmental liver resection and locoregional therapies.
- The liver's anatomy presents challenges for precise intraoperative tumor identification.
- Image-guided therapies (IGT) improve accuracy by registering real-time instrument positions with preoperative imaging.
Purpose of the Study:
- To validate a novel registration method using an endoscopic Laser Range Scanner (eLRS).
- To assess the applicability of this eLRS method for laparoscopic liver surgery.
- To compare the accuracy of surface-based registration with traditional fiducial-based registration.
Main Methods:
- Six radiopaque targets were placed in an ex-vivo bovine liver.
- A computed tomography (CT) scan was performed for target localization.
- An endoscopic Laser Range Scanner (eLRS) was used to scan the liver surface for surface-based registration.
- Target Registration Error (TRE) was calculated and compared between methods.
Main Results:
- Surface-based registration using eLRS achieved a Target Registration Error (TRE) of 2.4 +/- 1.0 mm.
- Traditional fiducial-based registration resulted in a TRE of 2.6 +/- 1.7 mm.
- The laparoscopic surface scanning method demonstrated comparable accuracy and data acquisition rates to fiducial-based registration.
Conclusions:
- Surface-based registration with an endoscopic Laser Range Scanner (eLRS) is a viable technique for laparoscopic liver surgery.
- This novel method provides accuracy comparable to traditional fiducial-based registration.
- eLRS offers a promising approach for improving intraoperative tumor localization in liver procedures.
