Top

Published in:

01-10-2018

Computer tomographic analysis of organ motion caused by respiration and intraoperative pneumoperitoneum in a porcine model for navigated minimally invasive esophagectomy

Authors: Felix Nickel, Hannes G. Kenngott, Jochen Neuhaus, Nathanael Andrews, Carly Garrow, Johannes Kast, Christof M. Sommer, Tobias Gehrig, Carsten N. Gutt, Hans-Peter Meinzer, Beat P. Müller-Stich

Published in: Surgical Endoscopy | Issue 10/2018

Abstract

Background

Navigation systems have the potential to facilitate intraoperative orientation and recognition of anatomical structures. Intraoperative accuracy of navigation in thoracoabdominal surgery depends on soft tissue deformation. We evaluated esophageal motion caused by respiration and pneumoperitoneum in a porcine model for minimally invasive esophagectomy.

Methods

In ten pigs (20–34 kg) under general anesthesia, gastroscopic hemoclips were applied to the cervical (CE), high (T1), middle (T2), and lower thoracic (T3) level, and to the gastroesophageal junction (GEJ) of the esophagus. Furthermore, skin markers were applied. Three-dimensional (3D) and four-dimensional (4D) computed tomography (CT) scans were acquired before and after creation of pneumoperitoneum. Marker positions and lung volumes were analyzed with open source image segmentation software.

Results

Respiratory motion of the esophagus was higher at T3 (7.0 ± 3.3 mm, mean ± SD) and GEJ (6.9 ± 2.8 mm) than on T2 (4.5 ± 1.8 mm), T1 (3.1 ± 1.8 mm), and CE (1.3 ± 1.1 mm). There was significant motion correlation in between the esophageal levels. T1 motion correlated with all other esophagus levels (r = 0.51, p = 0.003). Esophageal motion correlated with ventilation volume (419 ± 148 ml) on T1 (r = 0.29), T2 (r = 0.44), T3 (r = 0.54), and GEJ (r = 0.58) but not on CE (r = − 0.04). Motion correlation of the esophagus with skin markers was moderate to high for T1, T2, T3, GEJ, but not evident for CE. Pneumoperitoneum led to considerable displacement of the esophagus (8.2 ± 3.4 mm) and had a level-specific influence on respiratory motion.

Conclusions

The position and motion of the esophagus was considerably influenced by respiration and creation of pneumoperitoneum. Esophageal motion correlated with respiration and skin motion. Possible compensation mechanisms for soft tissue deformation were successfully identified. The porcine model is similar to humans for respiratory esophageal motion and can thus help to develop navigation systems with compensation for soft tissue deformation.

Perry KA, Enestvedt CK, Pham T, Welker M, Jobe BA, Hunter JG, Sheppard BC (2009) Comparison of laparoscopic inversion esophagectomy and open transhiatal esophagectomy for high-grade dysplasia and stage I esophageal adenocarcinoma. Arch Surg 144:679–684. https://doi.org/10.1001/archsurg.2009.113 CrossRefPubMed

Verhage RJ, Hazebroek EJ, Boone J, Van Hillegersberg R (2009) Minimally invasive surgery compared to open procedures in esophagectomy for cancer: a systematic review of the literature. Minerva Chir 64:135–146PubMed

Bottger T, Terzic A, Muller M, Rodehorst A (2007) Minimally invasive transhiatal and transthoracic esophagectomy. Surg Endosc 21:1695–1700. https://doi.org/10.1007/s00464-006-9178-4 CrossRefPubMed

Smithers BM (2010) Minimally invasive esophagectomy: an overview. Expert Rev Gastroenterol Hepatol 4:91–99. https://doi.org/10.1586/egh.09.62 CrossRefPubMed

Nagpal K, Ahmed K, Vats A, Yakoub D, James D, Ashrafian H, Darzi A, Moorthy K, Athanasiou T (2010) Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc. https://doi.org/10.1007/s00464-009-0822-7 CrossRefPubMed

Gutt CN, Bintintan VV, Koninger J, Muller-Stich BP, Reiter M, Buchler MW (2006) Robotic-assisted transhiatal esophagectomy. Langenbecks Arch Surg 391:428–434. https://doi.org/10.1007/s00423-006-0055-3 CrossRefPubMed

Kenngott HG, Neuhaus J, Muller-Stich BP, Wolf I, Vetter M, Meinzer HP, Koninger J, Buchler MW, Gutt CN (2008) Development of a navigation system for minimally invasive esophagectomy. Surg Endosc 22:1858–1865. https://doi.org/10.1007/s00464-007-9723-9 CrossRefPubMed

Zhang H, Banovac F, Lin R, Glossop N, Wood BJ, Lindisch D, Levy E, Cleary K (2006) Electromagnetic tracking for abdominal interventions in computer aided surgery. Comput Aided Surg 11:127–136. https://doi.org/10.3109/10929080600751399 CrossRefPubMedPubMedCentral

Banovac F, Cheng P, Campos-Nanez E, Kallakury B, Popa T, Wilson E, Abeledo H, Cleary K (2010) Radiofrequency ablation of lung tumors in swine assisted by a navigation device with preprocedural volumetric planning. J Vasc Interv Radiol 21:122–129. https://doi.org/10.1016/j.jvir.2009.09.012 CrossRefPubMed

10.

Nickel F (2014) Accuracy assessment of a navigation system and analysis of soft tissue deformation in an experimental model for minimally invasive esophagectomy. Doctoral thesis, Heidelberg University

11.

Nickel F, Kenngott HG, Neuhaus J, Sommer CM, Gehrig T, Kolb A, Gondan M, Radeleff BA, Schaible A, Meinzer HP, Gutt CN, Muller-Stich BP (2013) Navigation system for minimally invasive esophagectomy: experimental study in a porcine model. Surg Endosc 27:3663–3670. https://doi.org/10.1007/s00464-013-2941-4 CrossRefPubMed

12.

Troidl H, Bäcker B, Langer B, Winkler-Wilfurth A (1993) Fehleranalyse — Evaluierung und Verhütung von Komplikationen; ihre juristische Implikation. In: Hartel W (eds) Wandel der Chirurgie in unserer Zeit. Langenbecks Archiv für Chirurgie (Gegründet 1860, Kongreßorgan der Deutschen Gesellschaft für Chirurgie), vol 1993. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-78145-2_12 CrossRef

13.

Boselova L, Meitner ER (1977) Comparative morphology of the esophagus in various vertebrates II. Mammals. Gegenbaurs Morphol Jahrb 123:311–326PubMed

14.

Bower AL, Ponsky JL, Brody FJ (2001) Physiology of intra-abdominal and intrathoracic Nissen fundoplications in a porcine model. J Laparoendosc Adv Surg Tech A 11:5–8. https://doi.org/10.1089/10926420150502869 CrossRefPubMed

15.

Green EM, Forrest LJ, Adams WM (2003) A vacuum-formable mattress for veterinary radiotherapy positioning: comparison with conventional methods. Vet Radiol Ultrasound 44:476–479CrossRef

16.

Mallmann C, Wolf KJ, Wacker FK, Meyer BC (2012) Assessment of patient movement in interventional procedures using electromagnetic detection: comparison between conventional fixation and vacuum mattress. Rofo 184:37–41. https://doi.org/10.1055/s-0031-1281633 CrossRefPubMed

17.

Wolf I, Vetter M, Wegner I, Bottger T, Nolden M, Schobinger M, Hastenteufel M, Kunert T, Meinzer HP (2005) The medical imaging interaction toolkit. Med Image Anal 9:594–604. https://doi.org/10.1016/j.media.2005.04.005 CrossRefPubMed

18.

Bitter I, Van Uitert R, Wolf I, Ibanez L, Kuhnigk JM (2007) Comparison of four freely available frameworks for image processing and visualization that use ITK. IEEE Trans Vis Comput Graph 13:483–493. https://doi.org/10.1109/TVCG.2007.1001 CrossRefPubMed

19.

Maleike D, Nolden M, Meinzer HP, Wolf I (2009) Interactive segmentation framework of the Medical Imaging Interaction Toolkit. Comput Methods Progr Biomed 96:72–83. https://doi.org/10.1016/j.cmpb.2009.04.004 CrossRef

20.

Seitel A, Yung K, Mersmann S, Kilgus T, Groch A, Dos Santos TR, Franz AM, Nolden M, Meinzer HP, Maier-Hein L (2011) MITK-ToF-range data within MITK. Int J Comput Assist Radiol Surg. https://doi.org/10.1007/s11548-011-0617-x CrossRefPubMed

21.

Wang ZY (1991) The length of the esophagus measured by SND-1 esophagus detector. Report of 197 cases. Zhonghua Wai Ke Za Zhi 29:566, 590PubMed

22.

Wei XH (1989) Measurement of the length of the adult esophagus using a fiberogastroscope: 104 cases. Zhonghua Wai Ke Za Zhi 27:407–408, 444–405PubMed

23.

Li Q, Castell JA, Castell DO (1994) Manometric determination of esophageal length. Am J Gastroenterol 89:722–725PubMed

24.

Zhao KL, Liao Z, Bucci MK, Komaki R, Cox JD, Yu ZH, Zhang L, Mohan R, Dong L (2007) Evaluation of respiratory-induced target motion for esophageal tumors at the gastroesophageal junction. Radiother Oncol 84:283–289. https://doi.org/10.1016/j.radonc.2007.07.008 CrossRefPubMed

25.

Maier-Hein L, Muller SA, Pianka F, Worz S, Muller-Stich BP, Seitel A, Rohr K, Meinzer HP, Schmied BM, Wolf I (2008) Respiratory motion compensation for CT-guided interventions in the liver. Comput Aided Surg 13:125–138. https://doi.org/10.3109/10929080802091099 CrossRefPubMed

26.

Banovac F, Tang J, Xu S, Lindisch D, Chung HY, Levy EB, Chang T, McCullough MF, Yaniv Z, Wood BJ, Cleary K (2005) Precision targeting of liver lesions using a novel electromagnetic navigation device in physiologic phantom and swine. Med Phys 32:2698–2705CrossRef

27.

Clifford MA, Banovac F, Levy E, Cleary K (2002) Assessment of hepatic motion secondary to respiration for computer assisted interventions. Comput Aided Surg 7:291–299. https://doi.org/10.1002/igs.10049 CrossRefPubMed

28.

Levy EB, Tang J, Lindisch D, Glossop N, Banovac F, Cleary K (2007) Implementation of an electromagnetic tracking system for accurate intrahepatic puncture needle guidance: accuracy results in an in vitro model. Acad Radiol 14:344–354. https://doi.org/10.1016/j.acra.2006.12.004 CrossRefPubMed

29.

Yaniv Z, Cheng P, Wilson E, Popa T, Lindisch D, Campos-Nanez E, Abeledo H, Watson V, Cleary K, Banovac F (2010) Needle-based interventions with the image-guided surgery toolkit (IGSTK): from phantoms to clinical trials. IEEE Trans Biomed Eng 57:922–933. https://doi.org/10.1109/tbme.2009.2035688 CrossRefPubMed

30.

Koch N, Liu HH, Starkschall G, Jacobson M, Forster K, Liao Z, Komaki R, Stevens CW (2004) Evaluation of internal lung motion for respiratory-gated radiotherapy using MRI: part I–correlating internal lung motion with skin fiducial motion. Int J Radiat Oncol Biol Phys 60:1459–1472CrossRef

31.

Sra J, Krum D, Malloy A, Bhatia A, Cooley R, Blanck Z, Dhala A, Anderson AJ, Akhtar M (2006) Posterior left atrial-esophageal relationship throughout the cardiac cycle. J Interv Card Electrophysiol 16:73–80CrossRef

32.

Plathow C, Zimmermann H, Fink C, Umathum R, Schobinger M, Huber P, Zuna I, Debus J, Schlegel W, Meinzer HP, Semmler W, Kauczor HU, Bock M (2005) Influence of different breathing maneuvers on internal and external organ motion: use of fiducial markers in dynamic MRI. Int J Radiat Oncol Biol Phys 62:238–245CrossRef

33.

Birkfellner W, Watzinger F, Wanschitz F, Ewers R, Bergmann H (1998) Calibration of tracking systems in a surgical environment. IEEE Trans Med Imaging 17:737–742CrossRef

34.

Muench RK, Blattmann H, Kaser-Hotz B, Bley CR, Seiler PG, Sumova A, Verwey J (2004) Combining magnetic and optical tracking for computer aided therapy. Z Med Phys 14:189–194CrossRef

35.

Bintintan V, Gutt CN, Mehrabi A, Yazdi SF, Kashfi A, Funariu G, Ciuce C (2009) Gas-chamber mediastinoscopy for dissection of the upper esophagus. Chirurgia (Bucur) 104:67–72

36.

Bintintan VV, Mehrabi A, Fonouni H, Esmaeilzadeh M, Muller-Stich BP, Funariu G, Ciuce C, Gutt CN (2009) Feasibility of a high intrathoracic esophagogastric anastomosis without thoracic access after laparoscopic-assisted transhiatal esophagectomy: a pilot experimental study. Surg Innov 16:228–236. https://doi.org/10.1177/1553350609345852 CrossRefPubMed

37.

Bintintan VV, Mehrabi A, Fonouni H, Golriz M, Koninger J, Kashfi A, Funariu G, Buechler MW, Ciuce C, Gutt CN (2009) Evaluation of the combined laparoscopic and mediastinoscopic esophagectomy technique. Chirurgia (Bucur) 104:187–194

Title: Computer tomographic analysis of organ motion caused by respiration and intraoperative pneumoperitoneum in a porcine model for navigated minimally invasive esophagectomy
Authors: Felix Nickel
Hannes G. Kenngott
Jochen Neuhaus
Nathanael Andrews
Carly Garrow
Johannes Kast
Christof M. Sommer
Tobias Gehrig
Carsten N. Gutt
Hans-Peter Meinzer
Beat P. Müller-Stich
Publication date: 01-10-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 10/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6168-2

At a glance: The STEP trials

Springer Medicine

Computer tomographic analysis of organ motion caused by respiration and intraoperative pneumoperitoneum in a porcine model for navigated minimally invasive esophagectomy

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2018

Rendezvous endoscopic recanalization for complete esophageal obstruction

Prospective histological evaluation of a 20G core trap with a forward-cutting bevel needle for EUS-FNA of pancreatic lesions

An in vivo analysis of safe laparoscopic grasping thresholds for colorectal surgery

Operative technique in robotic pancreaticoduodenectomy (RPD) at University of Illinois at Chicago (UIC): 17 steps standardized technique

Intracorporeal delta-shaped gastroduodenostomy in reduced-port robotic distal subtotal gastrectomy: technical aspects and short-term outcomes

A novel method of intracorporeal end-to-end gastrogastrostomy in laparoscopic pylorus-preserving gastrectomy for early gastric cancer, including a unique anastomotic technique: piercing the stomach with a linear stapler