使用术中超声成像导航引导的肝肿瘤切除术
Navigated hepatic tumor resection using intraoperative ultrasound imaging
AI总结：
本研究评估了一种基于术中超声生成3D模型进行导航引导的免配准肝肿瘤切除系统，在16例可评估患者中实现了3.2 mm的中位导航精度和93.8%的R0切除率，证明了其在开腹肝手术中的可行性和准确性。
摘要：
目的：本概念验证研究评估了基于超声的导航系统在开腹肝手术中的可行性和准确性。与大多数依赖术前图像配准的传统系统不同，该系统利用术中超声生成的3D模型提供导航引导的切除。方法：在25例接受肝转移瘤切除的患者中进行了初步研究。前5例用于优化工作流程。术中，使用电磁传感器补偿器官运动，随后获取超声体积。血管采用自动分割，肿瘤采用区域生长法（n=15）或深度学习算法（n=5）进行半自动分割。生成的3D模型与被跟踪的手术器械一起可视化。通过比较导航软件中手术夹与肿瘤之间的距离与切除标本术后CT上的相同距离来评估准确性。结果：所有20例患者均成功建立导航。然而，由于术中传感器脱落（n=3）或数据记录错误（n=1），4例被排除在准确性评估之外。完整的导航工作流程在5-10分钟内完成。在16例可评估患者中，分析了78个夹到肿瘤的距离。中位导航精度为3.2 mm [IQR: 2.8-4.8 mm]，15/16（93.8%）患者实现了R0切除，1例患者实现了R1血管切除。结论：仅基于术中超声的导航在肝手术中是可行且准确的。这种免配准方法为更简单、更准确的图像引导系统铺平了道路。
英文摘要：
Purpose: This proof-of-concept study evaluates feasibility and accuracy of an ultrasound-based navigation system for open liver surgery. Unlike most conventional systems that rely on registration to preoperative imaging, the proposed system provides navigation-guided resection using 3D models generated from intraoperative ultrasound. Methods: A pilot study was conducted in 25 patients undergoing resection of liver metastases. The first five cases served to optimize the workflow. Intraoperatively, an electromagnetic sensor compensated for organ motion, after which an ultrasound volume was acquired. Vasculature was segmented automatically and tumors semi-automatically using region-growing (n=15) or a deep learning algorithm (n=5). The resulting 3D model was visualized alongside tracked surgical instruments. Accuracy was assessed by comparing the distance between surgical clips and tumors in the navigation software with the same distance on a postoperative CT of the resected specimen. Results: Navigation was successfully established in all 20 patients. However, four cases were excluded from accuracy assessment due to intraoperative sensor detachment (n=3) or incorrect data recording (n=1). The complete navigation workflow was operational within 5-10 minutes. In 16 evaluable patients, 78 clip-to-tumor distances were analyzed. The median navigation accuracy was 3.2 mm [IQR: 2.8-4.8 mm], and an R0 resection was achieved in 15/16 (93.8%) patients and one patient had an R1 vascular resection. Conclusion: Navigation based solely on intra-operative ultrasound is feasible and accurate for liver surgery. This registration-free approach paves the way for simpler and more accurate image guidance systems.
机构、总结、中文摘要均由AI分析而来，可能存在错误，请以论文正文为准。
