B Krasnick1, D Sindram2, K Simo3, R Goss4, J Bharadwaj4, K Howk4, K Herdina4, C Hammill1. 1Washington University, St. Louis, MO, Department of Surgery, 2Novant Health, Winston-Salem, NC, Department of Surgery, 3Pro Medica Physicians, Toledo, OH, Department of Surgery, 4Medtronic, Boulder, CO
Objective: The objective of this study was to compare the placement of ablation needles using 3-dimensional electromagnetic guided ultrasound to standard ultrasound guidance in both laparoscopic and open surgery. Endpoints for this study included targeting accuracy and number of required needle withdrawals and reorientations.
Methods: Using a porcine model, 1.2 x 5 mm fiducial markers were placed approximately 2.0 cm (± 1.0 cm) into the kidney and liver to represent tumors. Navigation and identification of target sites was achieved using standard ultrasound (standard) or with guided ultrasound (guided). Intra-procedural observations during each needle placement and ablation procedure as well as the number of needle placement attempts per target were recorded. Three board certified general surgeons (2 animals per physician) performed the navigation and ablation procedures. After completion of the navigation and ablation procedures, necropsy was performed. The liver and kidneys were removed in toto for gross examination. The position of the ablation zones relative to the fiducial markers was recorded.
Results: A total of 48 navigation and ablation procedures were performed across the 6 animals (24 standard and 24 guided). Each animal received 4 laparoscopic (2 liver and 2 kidney), followed by 4 open (2 liver and 2 kidney) navigation and ablation procedures.The guided ablations required 50% fewer attempts to successfully target the marker (Table). The standard ablations required an average of 2.4 attempts to successfully place the needle while the guided required only 1.2 attempts. There was not a significant difference between the groups accuracy with respect to finding the marker (95.8% guided vs. 91.7% standard) or targeting accuracy, determined by locating the marker within the ablation zone, (91.3% guided vs. 95.4% standard).
Conclusion: The number of attempts needed to accurately target the lesion was significantly less with guided than with standard ultrasound, with equivalent targeting results. These findings suggest the guided ultrasound can potentially reduce complications during ablation procedures.
| Method | Location | Average Number of Passes to Target Ablation Site | ||
| Guided US | Standard US | Ratio: Standard/Guided | ||
| Lap | Kidney | 1.5 | 4.5 | 3.0 |
| Liver | 1.2 | 2.5 | 2.1 | |
| Method Average | 1.3 | 3.5 | 2.6 | |
| Open | Liver | 1.0 | 1.2 | 1.2 |
| Kidney | 1.2 | 1.3 | 1.1 | |
| Method Average | 1.1 | 1.3 | 1.2 | |
| Procedural Average | 1.2 | 2.4 | 2.0 | |
| US= Ultrasound | ||||
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91024
Program Number: ET010
Presentation Session: Emerging Technology Session (Non CME)
Presentation Type: Podium