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

Tobias Huber; Verena Tripke; Janine Baumgart; Fabian Bartsch; Alicia Schulze; Stefan Weber; Stefan Heinrich; Hauke Lang

doi:10.21037/atm-22-5489

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

Ann Transl Med. 2023 Aug 30;11(10):346. doi: 10.21037/atm-22-5489. Epub 2023 Jun 28.

Authors

Affiliations

¹ Department of General, Visceral and Transplantation Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
² Institute of Medical Biometry, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
³ ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.

^# Contributed equally.

Abstract

Background: Liver surgery is the standard of care for primary and many secondary liver tumors. Due to variability and complexity in liver anatomy preoperative imaging is necessary to determine resectability and for planning the surgical strategy. In the last few years, computer-assisted resection planning has been introduced in liver surgery. Aim of this trial was the evaluation of computer-assisted three-dimensional (3D)-navigation for liver surgery.

Methods: This study was a prospective randomized-controlled pilot trial and patients were randomized in navigated or non-navigated group. Primary end point was the quotient of intraoperative resected volume and planned resection volume. Secondary end points included operation time, resection margin and postoperative complications. 3D reconstructions were performed with MeVis Distant Services (MeVis AG, Bremen, Germany). The navigation system CAS-One Liver (CAScination AG, Bern, Switzerland) was used for intraoperative computer-assisted 3D-navigation.

Results: The data of 16 patients with 20 liver tumors were used in this analysis. Of these, 8 liver tumors were resected with the utilization of intraoperative navigation. Two postoperative complications were classified grade IIIa or higher. There was no difference in duration of operation (189 vs. 180 min, P=0.970), rate of postoperative complications (n=1 vs. n=1, P=0.696) and length of hospital stay (9 vs. 7 days, P=0.368) between the two groups. Minimal resection margin (0.15 vs. 0.40 cm, P=0.384) and quotient of planned to intraoperative resection volume (0.94 vs. 1.11, P=0.305) were also similar.

Conclusions: Intraoperative navigation is a technology that can be safely used during liver resection. Surgical accuracy is not yet superior to the current standard of intraoperative orientation. Further technological advances with suitable deformation algorithms and augmented reality systems will enable a further improvement of the technical feasibility.

Keywords: 3D navigation; Liver surgery; liver tumors; surgical planning; three-dimensional liver reconstruction (3D liver reconstruction).