Does preoperative analysis of intrahepatic venous anastomoses improve the surgeon's intraoperative decision making? Pilot data from a case report

<p>Abstract</p> <p>Background</p> <p>Three-dimensional (3D) visualization is thought to improve the anatomical understanding of clinicians, thus improving patient safety.</p> <p>Case presentation</p> <p>A 58-year-old male was admitted to our hospital in April 2007 with a suspected metastasis of a sigmoid cancer in the Couinaud segment (CS) 7. The anatomical situation of this patient was analyzed using both a CT scan and 3D images. The initial CT scan revealed that the proximal part of the middle hepatic vein was completely missing and the metastasis in the CS 7 was closely attached to the right hepatic vein. After analyzing additional 3D images, it became clear that due to the close proximity of metastasis and right hepatic vein, the resection of the right hepatic vein was inevitable. Based on this 3D analysis, it was decided to perform a right-sided hemihepatectomy. In this case report, 3D visualization resulted in a faster and clearer understanding of the unique anatomical situation in a patient with complicated liver anatomy than transversal CT images.</p> <p>Conclusion</p> <p>The here presented data shows for the first time 3D visualization of intravenous anastomoses in the human liver. The information offered by 3D visualization is not redundant but rather serves as a true source of additional information, indicating the potential benefit of 3D visualization in surgical operation planning.</p

Development of a navigation system for endoluminal brachytherapy

The endoluminal brachytherapy of peripherally located bronchial carcinoma is difficult because of the complexity to position an irradiation catheter led by a bronchoscope to a desired spot inside a human lung. Furthermore the size of the bronchoscope permits only rarely the insertion of a catheter into the fine segment bronchi. We are developing an image-guided navigation system which indicates a path for guidance to the desired bronchus. Thereby a thin catheter with an enclosed navigation probe can be led up directly to the target bronchus, either by the use of the video of the bronchoscope or by the use of virtual bronchoscopy. Because of the thin bronchi and their moving soft tissue, the navigation system has to be very precise. This accuracy is reached by a gradually registering navigation component which improves the accuracy in the course of the intervention through mapping the already covered path to the preoperatively generated graph based bronchial tree description. The system includes components for navigation, segmentation, preoperative planning, and intraoperative guidance. Furthermore the visualization of the path can be adapted to the lung specialist’s habits (video of bronchoscope, 2D, 3D, virtual bronchoscopy etc.). Keywords: Image-Guided Radiation Therapy, Enhanced Reality, Image to Physical Space Registration 1