Mariano E Gimenez, MD, PhD1, Edgardo Serra, MD2, Mariano Palermo, MD2, Alain Garcia, MD1, Amilcar Alzaga, MD3, Eduardo Houghton, MD2, Pablo Acquafresca, MD2, Bernard Dallemagne, MD4, Jacques Marescaux, MD4. 1IHU Strasbourg, Institute of Image-Guided Surgery Strasbourg France. IRCAD, Research Institute against Cancer of the Digestive System Strasbourg France,Docencia Asistencia Investigación en Cirugía Invasiva Mínima (DAICIM) Foundation, Buenos Aires, Argentina., 2Docencia Asistencia Investigación en Cirugía Invasiva Mínima (DAICIM) Foundation, Buenos Aires, Argentina., 3Siemens Healthineers, Advanced Therapies, Surgery., 4IHU Strasbourg, Institute of Image-Guided Surgery Strasbourg France. IRCAD, Research Institute against Cancer of the Digestive System Strasbourg France.
INTRODUCTION: The purpose of this study was to evaluate the feasibility and safety of stereotactic navigation (SN) for percutaneous abdominal procedures beyond tumor ablation.
METHODS AND PROCEDURES: This experimental study, approved by the French National Ethics Committee, included four pigs. All procedures were performed under general anesthesia in an experimental hybrid operating room. Images of the targeted organs/structures were acquired with intraoperative cross-sectional imaging (CT or CBCT, Somatom Confidence, and ARTIS Zeego, Siemens Healthcare, Forchheim, Germany) and loaded in the optical stereotactic navigation system (CAScination, Bern,Switzerland) or worked directly in the workstation from the robotic angiography system. All animals were euthanized at the end of the experiments.
PROCEDURES:
1. Percutaneous drainage of anatomical complex abdominal collections (two animals) of artificial intraabdominal collections, which were created in the subphrenic, peripancreatic and deep pelvic anatomical spaces.
2. Percutaneous cholecystic-gastrostomy (one animal). Dilatation of the biliary system was provoked by a laparoscopic partial ligation of the common bile duct 3 days before the procedure. Percutaneous cholecystostomy was first performed. Then, under SN a needle was inserted through the gallbladder towards the gastric lumen and a transhepatic biliary stent was deployed between the gallbladder and the stomach.
3. Percutaneous Selective Portal vein occlusion before hepatectomy (one animal). SN was used to guide the occlusion of the right portal vein with a percutaneous occluding device ( Amsel Medical Cambridge, Mass.). The efficacy of the procedure was assessedby US Doppler and a laparoscopic exploration with intravenous injection of indocyanine green (ICG).
RESULTS:
All percutaneous procedures were successful without the need for repositioning.
1. All intraabdominal artificial collections were drained successfully. There were no visceral injuries, no bleeding, no thoracic complications (subphrenic collections).
2. An efficient cholecysto-gastrotomy was obtained in 1 animal. Radiological control with contrast confirmed the patency of the anastomosis in the animal. There were no complications.
3. US Doppler and laparoscopic exploration with ICG confirmed the occlusion of one right Glissonian pedicle in the animal liver. There were no complications and laparoscopic right lobectomy was guided by the ICG boundaries.
CONCLUSION: This preliminary experimental study has shown that complex percutaneous procedures can be performed safely under stereotactic navigation guidance. This justifies further studies with the aim of reduction of the exposure of the patients and operators to X-rays during percutaneous procedures which require high precision.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93734
Program Number: P694
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster