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Surg Endosc (2010) 24:25062512 DOI 10.1007/s00464-010-0994-1
Initial results of MR-guided liver resection in a high-eld open MRI
Sascha Santosh Chopra Sven Christian Schmidt
Robert Eisele Ulf Teichgraber Ivo Van der Voort
Christian Seebauer Florian Streitparth Guido Schumacher
Received: 10 November 2009 / Accepted: 25 February 2010 / Published online: 13 March 2010 Springer Science+Business Media, LLC 2010
AbstractBackground The goal of this study was to evaluate high-eld open magnetic resonance imaging (MRI) for intraoperative real-time imaging during hand-assisted laparoscopic liver resection. MR guidance has several advantages compared to ultrasound and may represent a future technique for abdominal surgery. Various MRI-safe and -compatible instruments were developed, tested, and applied to realize minimally invasive liver surgery under MR guidance. As proof of the concept, liver resection was performed in a porcine model.
Methods All procedures were conducted in a 1.0-T open MRI unit. Imaging quality and surgical results were documented during three cadaveric and two live animal procedures. A nonferromagnetic hand port was used for
manual access and the liver tissue was dissected using a Nd:YAG laser.
Results The intervention time ranged from 126 to 145 min, with a dissection time from 11 to 15 min. Both live animals survived the intervention with a blood loss of 250 and 170 ml and a specimen weight of 138 and 177 g. A dynamic T2W fast spin-echo sequence allowed real-time imaging (1.5 s/image) with good delineation of major and small hepatic vessels. The newly developed MR-compatible instruments and camera system caused only minor interferences and artifacts of the MR image.
Conclusion MR-guided liver resection is feasible and provides additional image information to the surgeon. We conclude that MR-guided laparoscopic liver resection improves the anatomical orientation and may increase the safety of future minimally invasive liver surgery.
Keywords MR guidance Open MR Liver resection
Nd:YAG laser Laparoscopy
The increasing quantity and complexity of laparoscopic liver resections point out the need for improved intraoperative imaging tools. Especially in difcult cases with complex tumor localization, intraoperative visualization of liver vessels and tumor margins is essential for an adequate resection and reduction of surgery-associated risks [13]. Various groups have worked on navigation techniques for open liver resection. One promising technique is the use of optical tracking systems attached to the dissection instruments...