Augmented environments for the targeting of hepatic lesions during robotic liver surgery

Nicolas C Buchs, MD, Francesco Volonte, MD, Francois Pugin, MD, Christian Toso, MD, PhD, Matteo Fusaglia, Kate Ghavagan, Pietro Majno, MD, Matthias Peterhans, Stefan Weber, Philippe Morel, MD

Department of Surgery, University Hospital of Geneva

Background: Stereotactic navigation technology can enhance guidance during surgery and enables the precise reproduction of planned surgical strategies. Currently, specific systems are available specifically for instrument guidance in open liver surgery. This study aims to evaluate the implementation of such a system for the targeting of hepatic tumors during robotic liver surgery.

Material and methods: Optical tracking references were attached to one of the robot’s instruments and to the robot’s endoscopic camera. After instrument and video calibration and patient-to-image registration, a virtual model of the tracked instrument and the available 3D images of the liver, were displayed directly within the robotic console, superimposed onto the endoscopic video image. An additional superimposed targeting viewer allowed for the visualization of the target tumor, relative to the tip of the instrument for an assessment of the distance between the tumor and the tool for the realization of safe resection margins.

Results: Two cirrhotic patients underwent robotic navigated atypical hepatic resections for hepatocellular carcinoma (HCC). The augmented endoscopic view allowed for the definition of an accurate 1cm resection margin around the tumor. The overlay of reconstructed 3D models was also used during parenchymal transection for the identification of vascular and biliary structures. Operative times were 240 and 300 min respectively. There were no intra-operative complications.

Conclusions: The da Vinci Surgical System provides an excellent platform for image guided liver surgery with a stable optic and instrumentation. Robotic image guidance improves the surgeon’s orientation during the operation and increases accuracy in tumor resection. Further developments of this technology combination are needed to improve accuracy and to cope with organ deformation during surgery.

Session: Poster Presentation

Program Number: ETP028