- Email: [email protected]
Preliminary results from a clinical study evaluating a novel image guidance system for laparoscopic liver surgery
Electronic Poster Abstracts
FP30-08 PREOPERATIVE MEASUREMENT OF THE LEFT HEPATIC VEIN AXIS PREDICTS REMNANT LIVER HYPERTROPHY AFTER A RIGHT HEPATECTOMY V. Drubay1, G. Millet1, S. Truant1, E. Vibert2, F. -R. Pruvot1 and E. Boleslawski1 1 Chirurgie Digestive et Transplantation, CHRU de Lille, and 2Centre Hépato-Biliaire, Paul Brousse Hospital, France Introduction: Adequate remnant-liver hypertrophy (RLH) is a condition for successful major-hepatectomy. RLH is mainly dependent on the remnant-liver to total-liver volume ratio (RLTLV) but other anatomical factors, that may influence the quality of the inflow and outflow, may have an impact on RLH. The aim of this study was to determine the role of preoperative anatomical factors on RLH after a right-hepatectomy. Method: CT-scan (preoperative and Day-30) of 32 noncirrhotic patients undergoing a right-hepatectomy have been reviewed by the same author (V.D.). Measurements of the portal-vein (PV) length and axis, the angle between the left portal vein (LPV) and the PV, as well as the axis (relative to a frontal plan going through the vena cava) of the median hepatic vein (MHV) and of the left hepatic vein (LHV) were performed. Preoperative RLTLV-ratio was calculated. RLH was calculated as: [(remnant-liver at Day30 e preoperative remnant-liver) / preoperative remnantliver]. Quantitative data are expressed as mean (CI95%). Results: Preoperative RLTLV-ratio was 34% (32-37). By contrast to MHV axis, LHV axis did not modify a lot after hepatectomy (MHV: +29.4 ; LHV: +5.1 ). RLH was +100% (82e119) and was negatively-correlated to preoperative RTLV (r = 0.75; p < 0.001) and positivelycorrelated to LHV-axis (r = 0.45; p = 0.01). Other preoperative measurements were not correlated to RLH. Adding LHV axis in a linear-regression model based on RLTLV alone increased its accuracy for the prediction of RLH (adjusted R2: 0.623 vs. 0.542; p = 0.02). Conclusion: For the same preoperative RLTLV-ratio, LHV-axis measurement could be a useful parameter to predict RLH after a right-hepatectomy.
FP30-09 PRELIMINARY RESULTS FROM A CLINICAL STUDY EVALUATING A NOVEL IMAGE GUIDANCE SYSTEM FOR LAPAROSCOPIC LIVER SURGERY C. Schneider1, S. Thompson2, Y. Song2, J. Totz2, A. Desjardins3, K. Gurusamy1, D. Stoyanov2, M. Clarkson2, D. Hawkes2 and B. Davidson1 1 Division of Surgery & Interventional Science, 2Centre for Medical Image Computing, and 3Department of Medical Physics and Bioengineering, University College London, United Kingdom Introduction: Image guidance systems (IGS) may be beneficial during laparoscopic liver resection (LLR), but the use of current systems is limited by concerns about operative delay, complex manual setup and the difficulty of
HPB 2016, 18 (S1), e1ee384
e99
visualising pre-operative data integrated within the laparoscopic view (image overlay). To address these issues, a system employing landmark based alignment was developed. The systems usability and alignment performance were evaluated in a clinical study. Methods: Patients scheduled for staging laparoscopy or LLR were recruited. A 3D liver model was reconstructed from a preoperative CT scan and subsequently overlayed onto the laparoscopic screen (Figure). System setup consisted of software initialisation, hardware component installation and laparoscope calibration. Setup time was recorded and at case conclusion, surgeons completed usability questionnaires. Results: A total of 11 patients were recruited. Setup time was 15 and 6 minutes pre- and intraoperatively, respectively. Subjectively there was a good anatomical alignment between 3D model and in-situ liver (video presentation). Laparoscope movement did not cause any discernible lag to the overlay visualisation. Questionnaire feedback was generally positive but surgeons felt that the setup procedure was too unergonomic and required simplification. Conclusion: The feasibility of using a novel IGS in a surgical setting was demonstrated. Potential advantages over current IGS solutions include: minimal intraoperative disruption of the surgical workflow and an integrated view of 3D anatomical data and operative site. Future development work and clinical evaluation will focus on integrating ultrasound guidance and implementing automatic alignment of 3D model and in-situ liver to improve system ergonomics.
[Figure]
FP30-10 SURFACE OF THE WHOLE ABDOMINAL MUSCLES BETTER PREDICT OVERALL AND DISEASEFREE SURVIVAL THAN SURFACE OF PSOAS MUSCLES T. Voron1, L. Tselikas2, D. Petrasz1, F. Pigneur2, C. Salloum1, P. Compagnon1, A. Luciani2 and D. Azoulay1 1 HPB Surgery and Liver Transplantation Unit, and 2 Radiology, Henri Mondor Hospital, France Introduction: Sarcopenia estimated by CT scan imaging has been shown to be an independent prognostic factor for long-term survival. Sarcopenia may be evaluated by the surface of the whole abdominal muscles (AbdoSarco) or the surface of the psoas only (PsoasSarco). The purposes of this study were to evaluate the prevalence of sarcopenia
FP30-08 PREOPERATIVE MEASUREMENT OF THE LEFT HEPATIC VEIN AXIS PREDICTS REMNANT LIVER HYPERTROPHY AFTER A RIGHT HEPATECTOMY V. Drubay1, G. Millet1, S. Truant1, E. Vibert2, F. -R. Pruvot1 and E. Boleslawski1 1 Chirurgie Digestive et Transplantation, CHRU de Lille, and 2Centre Hépato-Biliaire, Paul Brousse Hospital, France Introduction: Adequate remnant-liver hypertrophy (RLH) is a condition for successful major-hepatectomy. RLH is mainly dependent on the remnant-liver to total-liver volume ratio (RLTLV) but other anatomical factors, that may influence the quality of the inflow and outflow, may have an impact on RLH. The aim of this study was to determine the role of preoperative anatomical factors on RLH after a right-hepatectomy. Method: CT-scan (preoperative and Day-30) of 32 noncirrhotic patients undergoing a right-hepatectomy have been reviewed by the same author (V.D.). Measurements of the portal-vein (PV) length and axis, the angle between the left portal vein (LPV) and the PV, as well as the axis (relative to a frontal plan going through the vena cava) of the median hepatic vein (MHV) and of the left hepatic vein (LHV) were performed. Preoperative RLTLV-ratio was calculated. RLH was calculated as: [(remnant-liver at Day30 e preoperative remnant-liver) / preoperative remnantliver]. Quantitative data are expressed as mean (CI95%). Results: Preoperative RLTLV-ratio was 34% (32-37). By contrast to MHV axis, LHV axis did not modify a lot after hepatectomy (MHV: +29.4 ; LHV: +5.1 ). RLH was +100% (82e119) and was negatively-correlated to preoperative RTLV (r = 0.75; p < 0.001) and positivelycorrelated to LHV-axis (r = 0.45; p = 0.01). Other preoperative measurements were not correlated to RLH. Adding LHV axis in a linear-regression model based on RLTLV alone increased its accuracy for the prediction of RLH (adjusted R2: 0.623 vs. 0.542; p = 0.02). Conclusion: For the same preoperative RLTLV-ratio, LHV-axis measurement could be a useful parameter to predict RLH after a right-hepatectomy.
FP30-09 PRELIMINARY RESULTS FROM A CLINICAL STUDY EVALUATING A NOVEL IMAGE GUIDANCE SYSTEM FOR LAPAROSCOPIC LIVER SURGERY C. Schneider1, S. Thompson2, Y. Song2, J. Totz2, A. Desjardins3, K. Gurusamy1, D. Stoyanov2, M. Clarkson2, D. Hawkes2 and B. Davidson1 1 Division of Surgery & Interventional Science, 2Centre for Medical Image Computing, and 3Department of Medical Physics and Bioengineering, University College London, United Kingdom Introduction: Image guidance systems (IGS) may be beneficial during laparoscopic liver resection (LLR), but the use of current systems is limited by concerns about operative delay, complex manual setup and the difficulty of
HPB 2016, 18 (S1), e1ee384
e99
visualising pre-operative data integrated within the laparoscopic view (image overlay). To address these issues, a system employing landmark based alignment was developed. The systems usability and alignment performance were evaluated in a clinical study. Methods: Patients scheduled for staging laparoscopy or LLR were recruited. A 3D liver model was reconstructed from a preoperative CT scan and subsequently overlayed onto the laparoscopic screen (Figure). System setup consisted of software initialisation, hardware component installation and laparoscope calibration. Setup time was recorded and at case conclusion, surgeons completed usability questionnaires. Results: A total of 11 patients were recruited. Setup time was 15 and 6 minutes pre- and intraoperatively, respectively. Subjectively there was a good anatomical alignment between 3D model and in-situ liver (video presentation). Laparoscope movement did not cause any discernible lag to the overlay visualisation. Questionnaire feedback was generally positive but surgeons felt that the setup procedure was too unergonomic and required simplification. Conclusion: The feasibility of using a novel IGS in a surgical setting was demonstrated. Potential advantages over current IGS solutions include: minimal intraoperative disruption of the surgical workflow and an integrated view of 3D anatomical data and operative site. Future development work and clinical evaluation will focus on integrating ultrasound guidance and implementing automatic alignment of 3D model and in-situ liver to improve system ergonomics.
[Figure]
FP30-10 SURFACE OF THE WHOLE ABDOMINAL MUSCLES BETTER PREDICT OVERALL AND DISEASEFREE SURVIVAL THAN SURFACE OF PSOAS MUSCLES T. Voron1, L. Tselikas2, D. Petrasz1, F. Pigneur2, C. Salloum1, P. Compagnon1, A. Luciani2 and D. Azoulay1 1 HPB Surgery and Liver Transplantation Unit, and 2 Radiology, Henri Mondor Hospital, France Introduction: Sarcopenia estimated by CT scan imaging has been shown to be an independent prognostic factor for long-term survival. Sarcopenia may be evaluated by the surface of the whole abdominal muscles (AbdoSarco) or the surface of the psoas only (PsoasSarco). The purposes of this study were to evaluate the prevalence of sarcopenia