Project: Computer-Aided Minimally Invasive Liver Surgery

Colorectal cancer (CRC) is the third leading cause of cancer death in the world and a leading cause of tumour-associated deaths in Western countries. Forty to fifty percent of patients with CRC have liver metastases, either detected at the time of diagnosis of the primary tumour (synchronous), or at a later stage (metachronous). Surgery, regarded as the only treatment modality that can achieve cure, can be performed in about 15% of cases, (5-year overall survival: 35% to 58%). A further 15% of patients, initially unresectable may be rendered resectable with downstaging chemotherapy. Approximately 70% of patients are treated palliatively. Indications for surgery have been expanded in recent years: surgery is currently proposed in patients where complete (i.e. R0) resections can be achieved, regardless of the number of metastases, on condition that an adequate future liver remnant (FLR) will reCO. _x000D__x000D_Currently, extensive research efforts are directed towards the 70% of patients currently treated with palliative intent. Innovations attempting to convert to a curative situation with combinations of tumour and liver volume manipulation, staged procedures and combinations of surgery and local ablative therapies have been proposed. _x000D__x000D_These developments have resulted in increased numbers of interventions for CRCLM but also in more complex procedures (non-anatomical resections, anatomical resections with small margins). In a multi-modality treatment management sequence and timing of modalities are inter-dependent. For example, chemotherapy-associated parenchymal damage necessitates a waiting period after completion of neo-adjuvant chemotherapy before surgical intervention; conversely, a certain time has to pass after surgery before adjuvant chemotherapy can be commenced. Thus, a strong case can be made for minimally invasive approaches for both surgery and local ablation to minimize delays between treatment modalities. _x000D__x000D_Minimally-invasive (i.e. laparoscopic) surgery combines the advantages of open surgery (direct visualisation and direct ultrasound) with those of percutaneous procedures (less trauma). To date, all resective procedures can be performed laparoscopically, even with the present shortcomings such as limited view and orientation inside the situs, reduced haptic feedback and freedom in instrument manipulation. High spatial instrument guidance accuracy during resection or ablation is essential in order to achieve a R0 situation without compromising FLR. Stereotactic (i.e. computer-assisted) technology will effectively allow precise tracking and guiding of surgical instruments together with a suitable visualisation of anatomical structures and precise orientation relative to the tumour. This research project proposes the development of a liver-specific stereotactic laparoscopic guidance approach utilizing state-of-the-art ultrasound based patient-to-image registration techniques. _x000D__x000D_CAScination AG (CO applicant) together with the University of Bern (both CH) have codeveloped an image-guidance approach for open liver surgery as part of an Eurostars project (iVisc, E!6201, 2011-2014). The technological developments have reached the anticipated milestones and business development is successfully advancing according to the business plan (2012: 8 installations in EU and BRA). To date, CAScination reCOs the only provider for image-guided technology specific to soft tissue surgery and the liver. Recently, and on top of its business plan, a second product line for stereotactic guidance during percutaneous interventional procedures such as radio frequency (RF) or Microwave (MW) ablations has been introduced by CAScination._x000D__x000D_At the same time, Sectra AB (global vendor within radiology IT solutions and enterprise image management systems) together with the university of Linköping (both SWE) are interested to support complex surgical procedures with their specific expertise in visualization of medical image data both on the hardware (medical visualisation table) as well as on the software level (3D Rendering, Augmented Reality)._x000D__x000D_Consequently, the above-mentioned technical Ps are proposing the joint development of a laparoscopic stereotactic planning and guidance system. Research will be carried out to 1) extend the existing concepts of ultrasound-based referencing of the liver to its pre-operative imagery; 2) to introduce augmented-reality visualisation techniques allowing surgeons to ultimately view preoperative (i.e CT) and intra-operative (i.e. ultrasound) image data in the image coordinate system of the endoscopic video. Additionally, Karolinska Institutet (SWE), acting as a clinical P will carry out extensive preclinical and clinical testing of the developed technology and aims to generate initial data about the efficacy of the proposed approach.

Acronym CAMILIS (Reference Number: 8565)
Duration 01/10/2013 - 30/09/2016
Project Topic An approach and system for image-guided laparoscopic liver surgery will be developed. The project is based on an existing navigation system and includes research in navigation technology, medical image processing and augmented reality. The final goal are clinical trials of a novel navigation system.
Network Eurostars
Call Eurostars Cut-Off 10

Project partner

Number Name Role Country
5 Karolinska Institutet, Danderyds Sjukhus Partner Sweden
5 University of Bern, ARTORG Center for Biomedical Engineering Partner Switzerland
5 CAScination AG Coordinator Switzerland
5 Scientific Visualization Group, Linköpping University Partner Sweden
5 Sectra AB Partner Sweden