Abstract
Computational support in intervention planning promises to support the subjective interpretation of data with reproducible measurements. Moreover, it is possible to develop and apply models that provide additional information which is not directly visible in the data. Based on computertomography multi-slice images of the liver, the planning software developed by MeVis Research offers tools to evaluate different interventional strategies preoperatively. In identifying patient individual risks, an optimized interventional plan is developed. In radiofrequency ablation of liver tumors, the treatment success highly depends on an effective placement of the radiofrequency applicators into the tumor to achieve sufficient coagulative necrosis. Beside tumor size and shape, the cooling effects of surrounding vessels are taken into account for a numerical estimation of the accessible thermal destruction. Based on this information, an optimized positioning can be obtained. In case of the surgical resection, removing the tumor together with a safety margin from the liver, requires transsection of local vascular structures that are supplying or draining a dedicated liver region. The identification and quantitative assessment of these regions, which are functionally endangered, guides the preoperative evaluation of surgical strategies. Subsequently proper visualizations of the planning data help to identify critical structures, and allow for a better control of the intraoperative situation. The planning data are matched with images from intraoperative ultrasound, and the aligned data are displayed in the operating theatre on monitors, which are placed directly the table. Moreover, an intraoperative adaption of the surgical planning is addressed: In oncologic liver surgery, additional tumors that were not visible in the preoperative images are often found during the intervention. With such findings, the resection strategy must be updated or completely revised. The planning software allows for an automated adaption of the surgical planning. The aim is to provide surgeons with an efficient tool for the quantitative assessment of planning, which is integrated in the workflow of oncologic liver interventions. To provide a meaningful procedural support of the surgical workflow, the cognitive needs of the surgeons have to be taken into account.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Llovet, J.M. (2005) Updated treatment approach to hepatocellular carcinoma. J Gastroenterol 40(3):225–235
Bläker, H., Hofmann, W.J., Theuer, D., Otto, H.F. (2001) Pathohistological findings in liver metastases. Radiologe 41(1):1–7
Bechstein, W. (2007) Which liver metastases are resectable? European Journal of Cancer Supplements 5(5):301–306
Livraghi, T., Meloni, F., Stasi, M.D., Rolle, E., Solbiati, L., Tinelli, C., Rossi, S. (2008) Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice? Hepatology 47(1):82–89
Abdalla, E., Barnett, C., Doherty, D., Curley, S., Vauthey, J. (2002) Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 137(6):675–680
Lang, H., A. Radtke, M. Hindennach, Schroeder, T., Frühauf, N., Malag, M., Bourquain, H., Peitgen, H.O., Oldhafer, K.J., Broelsch, C.E. (2005) Impact of virtual tumor resection and computer-assisted risk analysis on operation planning and intraoperative strategy in major hepatic resection. Arch Surg. 140(7):629–638
Oldhafer, K.J., Hogemann, D., Stamm, G., et al. (1999) [3-dimensional (3-D) visualization of the liver for planning extensive liver resections]. Chirurg, 70(3):233–238.
Hansen, C., Schlichting, S., Markert, M., Zidowitz, S., Hindennach, M., Kleemann, M., and Peitgen, H. O. (2007) Intraoperative adaption of preoperative risk analysis for oncologic liver surgery using navigated 2D ultrasound, Proc. CURAC:155–158.
Hansen, C., Schlichting, S., Zidowitz, S., Köhn, A., Hindennach, M., Kleemann, M., and Peitgen, H. O. (2008) Intraoperative adaptation and visualization of preoperative risk analyses for oncologic liver surgery, SPIE Medical Imaging, in print
Hansen, C., Köhn, A., Schlichting, S., Weiler, F., Konrad, O., Zidowitz, S. and Peitgen, H. O. (2008) Intraoperative modification of resection plans for liver surgery, IJCARS, DOI: 10.1007/s11548-008-0161-5
Endo, I., Shimada, H., Takeda, K., Fujii, Y., Yoshida, K., Morioka, D., Sadatoshi, S., Togo, S., Bourquain, H. and Peitgen, H. O. (2007) Successful duct-to-duct biliary reconstruction after right hemihepatectomy. Operative planning using virtual 3D reconstructed images, J Gastrointest.Surg 11:666–670
Endo, I., Shimada, H., Sugita, M., Fujii, Y., Morioka, D., Takeda, K., Sugae, S., Tanaka, K., Togo, S., Bourquain, H. and Peitgen, H. O. (2007) Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma, Surgery 142(5):666–675
M. Markert, S. N., S. Weber, C. Hansen, S. Zidowitz, H. Bourquain, G. A. Stavrou, K. J. Oldhafer, H.-O. Peitgen, T. C. Lueth. (2008). Navigated resection of residual liver tumors that are no longer visible after presurgical chemotherapy. IJCARS, in print
Fuchs, J., Warmann, S. W., Szavay, P., Kirschner, H. J., Schäfer, J. F., Hennemuth, A., Scheel-Walter, H.G., Bourquain, H., Peitgen, H. O. (2005) Three-dimensional visualization and virtual simulation of resections in pediatric solid tumors. Journal of Pediatric Surgery 40(2):364–370
Lang, H., Radtke, A., Liu, C., Frühauf, N. R., Peitgen, H. O. and Broelsch, C. E. (2004) Extended left hepatectomy modified operation planning based on three-dimensional visualization of liver anatomy. Arch Surg 389(4):306–310
Lang, H., Radtke, A., Liu, C., Sotiropoulos, G. C., Hindennach, M., Schroeder, T., Peitgen, HO. and Broelsch, C. E. (2005) Improved Assessment of Functional Resectability in Repeated Hepatectomy by Computer-assisted Operation Planning. Hepatogastroenterology 52:1645–1648
Lang, H., Radtke, A., Hindennach, M., Schroeder, T., Bourquain, H., Schenk, A., Oldhafer, K. J., Prause, G., Peitgen, H. O. and Broelsch. C. E. (2007) Virtual hepatic surgery-computer-assisted operation planning on the 3-dimensional reconstructed liver. Z Gastroenterol 45(9):965–970
Lang, H., Broelsch, C. E., Bertona, C. and Bourquain, H. (2007) Extended left hepatectomy with an inferior right liver vein: improved operation planning by 3-D reconstruction and computer-assisted imaging. J Am Coll Surg 205(4):626–627
van Ooijen, P. M. A., Wolf, R., Schenk, A., Rouw, D. B., Slooff, M., Peitgen, H. O. and Oudkerk, M. (2003) Recent Developments in Organ-Selective Reconstruction and Analysis of Multiphase Liver CT, Imaging Decisions 7(1):37–43
Kuhnigk, J. M., Dicken, V., Bornemann, L., Wormanns, D., Krass, S., and Peitgen, H.O. (2004) Fast Automated Segmentation and Reproducible Volumetry of Pulmonary Metastases in CT-Scans for Therapy Monitoring. In MICCAI LNCS 3217:933–941
Kröger, T., Altrogge, I., Preusser, T., Pereira, P., Schmidt, D., Weihusen, A., and Peitgen, H.O. (2006) Numerical simulation of radio frequency ablation with state dependent material parameters in three space dimensions. Proc. MICCAI 4191:380–388
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Zidowitz, S. et al. (2009). Software Assistance for Planning of RF-Ablation and Oncological Resection in Liver Surgery. In: Vander Sloten, J., Verdonck, P., Nyssen, M., Haueisen, J. (eds) 4th European Conference of the International Federation for Medical and Biological Engineering. IFMBE Proceedings, vol 22. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-89208-3_29
Download citation
DOI: https://doi.org/10.1007/978-3-540-89208-3_29
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-89207-6
Online ISBN: 978-3-540-89208-3
eBook Packages: EngineeringEngineering (R0)