Computer-assisted intraoperative 3D-navigation for liver surgery: a prospective randomized-controlled pilot study.

Area of Science:

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

Background:

• Liver surgery is crucial for treating primary and secondary liver tumors.
• Complex liver anatomy necessitates precise preoperative imaging for surgical planning and resectability assessment.
• Computer-assisted resection planning is an emerging technology in liver surgery.

Purpose of the Study:

• To evaluate the efficacy of computer-assisted three-dimensional (3D)-navigation in liver surgery.
• To compare navigated versus non-navigated liver resections in a pilot trial.

Main Methods:

• Prospective randomized-controlled pilot trial comparing navigated and non-navigated liver resection groups.
• Primary endpoint: ratio of intraoperative resected volume to planned resection volume.
• Secondary endpoints: operation time, resection margin, and postoperative complications. Utilized MeVis Distant Services for 3D reconstructions and CAS-One Liver system for navigation.

Main Results:

• Analysis included 16 patients with 20 liver tumors (8 navigated resections).
• No significant differences observed in operation time (189 vs. 180 min), postoperative complications (1 vs. 1), or hospital stay (9 vs. 7 days).
• Similar minimal resection margins (0.15 vs. 0.40 cm) and planned-to-resected volume ratios (0.94 vs. 1.11) were found between groups.

Conclusions:

• Intraoperative navigation is a safe technology for liver resection.
• Current surgical accuracy with navigation is not superior to standard intraoperative orientation methods.
• Future advancements in deformation algorithms and augmented reality systems are expected to enhance technical feasibility.