Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 10/2010

01-10-2010

Initial results of MR-guided liver resection in a high-field open MRI

Authors: Sascha Santosh Chopra, Sven Christian Schmidt, Robert Eisele, Ulf Teichgräber, Ivo Van der Voort, Christian Seebauer, Florian Streitparth, Guido Schumacher

Published in: Surgical Endoscopy | Issue 10/2010

Login to get access

Abstract

Background

The goal of this study was to evaluate high-field open magnetic resonance imaging (MRI) for intraoperative real-time imaging during hand-assisted laparoscopic liver resection. MR guidance has several advantages compared to ultrasound and may represent a future technique for abdominal surgery. Various MRI-safe and -compatible instruments were developed, tested, and applied to realize minimally invasive liver surgery under MR guidance. As proof of the concept, liver resection was performed in a porcine model.

Methods

All procedures were conducted in a 1.0-T open MRI unit. Imaging quality and surgical results were documented during three cadaveric and two live animal procedures. A nonferromagnetic hand port was used for manual access and the liver tissue was dissected using a Nd:YAG laser.

Results

The intervention time ranged from 126 to 145 min, with a dissection time from 11 to 15 min. Both live animals survived the intervention with a blood loss of 250 and 170 ml and a specimen weight of 138 and 177 g. A dynamic T2W fast spin-echo sequence allowed real-time imaging (1.5 s/image) with good delineation of major and small hepatic vessels. The newly developed MR-compatible instruments and camera system caused only minor interferences and artifacts of the MR image.

Conclusion

MR-guided liver resection is feasible and provides additional image information to the surgeon. We conclude that MR-guided laparoscopic liver resection improves the anatomical orientation and may increase the safety of future minimally invasive liver surgery.
Literature
1.
Santambrogio R, Opocher E, Ceretti AP, Barabino M, Costa M, Leone S, Montorsi M (2007) Impact of intraoperative ultrasonography in laparoscopic liver surgery. Surg Endosc 21(2):181–188CrossRefPubMed
2.
Bao P, Warmath J, Galloway R Jr, Herline A (2005) Ultrasound-to-computer-tomography registration for image-guided laparoscopic liver surgery. Surg Endosc 19(3):424–429CrossRefPubMed
3.
Beller S, Hunerbein M, Eulenstein S, Lange T, Schlag PM (2007) Feasibility of navigated resection of liver tumors using multiplanar visualization of intraoperative 3-dimensional ultrasound data. Ann Surg 246(2):288–294CrossRefPubMed
4.
Cash DM, Miga MI, Glasgow SC, Dawant BM, Clements LW, Cao Z, Galloway RL, Chapman WC (2007) Concepts and preliminary data toward the realization of image-guided liver surgery. J Gastrointest Surg 11(7):844–859CrossRefPubMed
5.
Beller S, Hunerbein M, Lange T, Eulenstein S, Gebauer B, Schlag PM (2007) Image-guided surgery of liver metastases by three-dimensional ultrasound-based optoelectronic navigation. Br J Surg 94(7):866–875CrossRefPubMed
6.
Hall WA, Truwit CL (2008) Intraoperative MR-guided neurosurgery. J Magn Reson Imaging 27(2):368–375CrossRefPubMed
7.
Clasen S, Pereira PL (2008) Magnetic resonance guidance for radiofrequency ablation of liver tumors. J Magn Reson Imaging 27(2):421–433CrossRefPubMed
8.
Mahnken AH, Buecker A, Spuentrup E, Krombach GA, Henzler D, Gunther RW, Tacke J (2004) MR-guided radiofrequency ablation of hepatic malignancies at 1.5 T: initial results. J Magn Reson Imaging 19(3):342–348CrossRefPubMed
9.
Gould SW, Gedroyc W, Darzi A (1999) Laparoscopic surgery in a 0 5-t interventional magnetic resonance unit. Surg Endosc 13(6):604–610CrossRefPubMed
10.
Chopra SS, Rump J, Schmidt SC, Streitparth F, Seebauer C, Schumacher G, Van der Voort I, Teichgraber U (2009) Imaging sequences for intraoperative MR-guided laparoscopic liver resection in 1.0-T high field open MRI. Eur Radiol 19(9):2191–2196CrossRefPubMed
11.
Chopra SS, Wiltberger G, Teichgraeber U, Papanikolaou I, Schwabe M, Schmidt S, Fikatas P, Streitparth F, Philipp C, Wichlas F, Seebauer C, Schumacher G (2009) Evaluation of laparoscopic liver resection with two different Nd:YAG lasers for future use in a high-field open MRI. Photomed Laser Surg 27(2):281–286CrossRefPubMed
12.
Boll DT, Lewin JS, Duerk JL, Aschoff AJ, Merkle EM (2004) Comparison of MR imaging sequences for liver and head and neck interventions: is there a single optimal sequence for all purposes? Acad Radiol 11(5):506–515CrossRefPubMed
13.
Jersenius U, Fors D, Rubertsson S, Arvidsson D (2007) Laparoscopic parenchymal division of the liver in a porcine model: comparison of the efficacy and safety of three different techniques. Surg Endosc 21(2):315–320CrossRefPubMed
14.
Rau HG, Schardey HM, Buttler E, Reuter C, Cohnert TU, Schildberg FW (1995) A comparison of different techniques for liver resection: blunt dissection, ultrasonic aspirator and jet-cutter. Eur J Surg Oncol 21(2):183–187CrossRefPubMed
15.
Joffe SN, Brackett KA, Sankar MY, Daikuzono N (1986) Resection of the liver with the Nd:YAG laser. Surg Gynecol Obstet 163(5):437–442PubMed
16.
Vogl TJ, Straub R, Zangos S, Mack MG, Eichler K (2004) MR-guided laser-induced thermotherapy (LITT) of liver tumours: experimental and clinical data. Int J Hyperth 20(7):713–724CrossRef
17.
Vogl TJ, Eichler K, Zangos S, Mack MG (2005) Interstitial laser therapy of liver tumors. Med Laser Appl 20(2):115–118CrossRef
18.
Kariniemi J, Sequeiros RB, Ojala R, Tervonen O (2006) Feasibility of MR imaging-guided percutaneous drainage of pancreatic fluid collections. J Vasc Interv Radiol 17(8):1321–1326CrossRefPubMed
19.
Feng L, Dumoulin CL, Dashnaw S, Darrow RD, Delapaz RL, Bishop PL, Pile-Spellman J (2005) Feasibility of stent placement in carotid arteries with real-time MR imaging guidance in pigs. Radiology 234(2):558–562CrossRefPubMed
Metadata
Title
Initial results of MR-guided liver resection in a high-field open MRI
Authors
Sascha Santosh Chopra
Sven Christian Schmidt
Robert Eisele
Ulf Teichgräber
Ivo Van der Voort
Christian Seebauer
Florian Streitparth
Guido Schumacher
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 10/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-0994-1

Other articles of this Issue 10/2010

Surgical Endoscopy 10/2010 Go to the issue

Editorial

Laparoscopic biliary surgery: will we ever learn?

OriginalPaper

Vacuum grasping as a manipulation technique for minimally invasive surgery

Video

Laparoscopic splenic-preserving distal pancreatectomy for trauma in a child

Letter-Reply

Fetoscopic surgery for spina bifida: surgically important differences between the ovine model and the clinical situation encountered with humans

OriginalPaper

Proficiency-based Fundamentals of Laparoscopic Surgery skills training results in durable performance improvement and a uniform certification pass rate

OriginalPaper

Advantages of endoscopic submucosal dissection with needle-knife over endoscopic mucosal resection for small rectal carcinoid tumors: a retrospective study