A navigation system for open liver surgery: design, workflow and first clinical applications

Area of Science:

• Hepatobiliary Surgery
• Surgical Navigation Technology
• Medical Imaging and Visualization

Background:

• Precise localization of liver tumors and understanding patient-specific anatomy are crucial for successful surgical treatment.
• Detailed three-dimensional (3D) anatomical information aids in complete tumor removal while preserving functional liver tissue.

Purpose of the Study:

• To present a user-friendly, clinically applicable navigation system for enhanced visualization and tool guidance in liver surgery.
• To validate the system's efficiency, accuracy, and workflow integration in real-world surgical scenarios.

Main Methods:

• Development of a navigation system enabling accurate instrument guidance within 3D surgical plans.
• Implementation of a rapid registration procedure accounting for intraoperative deformations.
• Focus on seamless workflow integration and minimizing procedural time overhead.
• Validation through nine clinical cases of navigated liver surgery.

Main Results:

• Navigated surgeries incurred a median time overhead of 16.5 minutes.
• The navigation technology demonstrated a median accuracy of 6.3 mm.
• Improved anatomical orientation and enhanced detection of critical structures at risk were observed.

Conclusions:

• The navigation technology was successfully applied to open liver surgery, simplifying procedures and integrating well into the surgical environment.
• The assumption of locally rigid patient registration proved valid.
• Clinical evaluation confirmed significant benefits for surgical precision and patient safety.