Joseph Broucek, MD, Aaron Wiegmann, BS, Minh Luu, MD, FACS, Daniel J Deziel, MD, FACS, Jonathan A Myers, MD, FACS. Rush University Medical Center
Introduction: We report utility of an improved, reproducible, and simplified image-guided modality to assist in laparoscopy. As we are often consulted for surgical biopsy of intra-abdominal lesions located in areas of critical structures inaccessible to the interventional radiology service, we sought to modify and perfect a modality that would more easily and safely guide our dissections and subsequent biopsies. Image-guided surgery has been established in neurosurgery, spine surgery, thoracic and otolaryngology utilizing real-time imaging synced to preoperative imaging via infrared camera and image-guided platform/programming to create a 2-D model to aid in localization. To an extent, general surgical fields have used 3-D reconstruction models to assist in liver resections and localizing intra-abdominal lesions, but are not widely used. Several companies exist that supply the navigational platform and software. We set out to describe and validate our modified technique.
Methods: An infrared image-guidance platform and associated tools were utilized to modify laparoscopic instruments and establish a 2-D real-time model to direct localization and subsequent dissection of intra-abdominal lesions. We uploaded and synced our patients’ preoperative imaging (CT, CT-PET, or MRI) to at least four fixed patient landmarks (sternal notch, clavicular heads, xyphoid process, costal margins, pubic symphysis, and/or ASIS) to create the 2-D interactive images. Using navigation-modified laparoscopic instruments, we guided our localization and dissections. We enlisted patients with retroperitoneal or fixed abdominal lesions that required surgical biopsy in which we could apply this technique.
Results: We have produced a video submission to describe our technique and showcase examples of its utility. All cases described have resulted in successful biopsy utilizing our method.
Conclusion: By utilizing our modified image-guided laparoscopic technique, we believe we can more accurately and safely localize lesions improving operative time, time under anesthesia, unnecessary dissection, conversion to open procedure, and re-operation for tissue volume and diagnosis. Further, we find this technique particularly useful in the morbidly obese, instances of limited foci of disease, PET-active lesions, or to identify areas of highest PET-avidity in larger target lesions.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79163
Program Number: V026
Presentation Session: Thursday Exhibit Hall Video Presentations Session 1 (Non CME)
Presentation Type: EHVideo