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World Journal of Surgery

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01-02-2016 | Original Scientific Report with Video

Augmented Reality Guidance for the Resection of Missing Colorectal Liver Metastases: An Initial Experience

Authors: Dimitrios Ntourakis, Ricardo Memeo, Luc Soler, Jacques Marescaux, Didier Mutter, Patrick Pessaux

Published in: World Journal of Surgery | Issue 2/2016

Abstract

Background

Modern chemotherapy achieves the shrinking of colorectal cancer liver metastases (CRLM) to such extent that they may disappear from radiological imaging. Disappearing CRLM rarely represents a complete pathological remission and have an important risk of recurrence. Augmented reality (AR) consists in the fusion of real-time patient images with a computer-generated 3D virtual patient model created from pre-operative medical imaging. The aim of this prospective pilot study is to investigate the potential of AR navigation as a tool to help locate and surgically resect missing CRLM.

Methods

A 3D virtual anatomical model was created from thoracoabdominal CT-scans using customary software (VR RENDER^®, IRCAD). The virtual model was superimposed to the operative field using an Exoscope (VITOM^®, Karl Storz, Tüttlingen, Germany). Virtual and real images were manually registered in real-time using a video mixer, based on external anatomical landmarks with an estimated accuracy of 5 mm. This modality was tested in three patients, with four missing CRLM that had sizes from 12 to 24 mm, undergoing laparotomy after receiving pre-operative oxaliplatin-based chemotherapy.

Results

AR display and fine registration was performed within 6 min. AR helped detect all four missing CRLM, and guided their resection. In all cases the planned security margin of 1 cm was clear and resections were confirmed to be R0 by pathology. There was no postoperative major morbidity or mortality. No local recurrence occurred in the follow-up period of 6–22 months.

Conclusions

This initial experience suggests that AR may be a helpful navigation tool for the resection of missing CRLM.

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Title: Augmented Reality Guidance for the Resection of Missing Colorectal Liver Metastases: An Initial Experience
Authors: Dimitrios Ntourakis
Ricardo Memeo
Luc Soler
Jacques Marescaux
Didier Mutter
Patrick Pessaux
Publication date: 01-02-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 2/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-3229-8

At a glance: The STEP trials

Springer Medicine

Augmented Reality Guidance for the Resection of Missing Colorectal Liver Metastases: An Initial Experience

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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