Commentary on 'navigation systems in liver surgery: The new challenge for surgical research'

摘要

Computer-assisted navigation systems are used in various surgical specialties like orthopedic surgery, ear, nose, and throat surgery, and neurosurgery, for rigid anatomical regions. Navigation systems involve real-time movies of the anatomy and instruments of the surgical field displayed on a computer monitor. The three-dimensional virtual anatomy is constructed from computed tomography, magnetic resonance imaging, or ultrasound images, and tracking systems are used to translate the position of surgical instruments into coordinates on the preoperative images of the anatomy. In neurosurgery, navigation systems have achieved accuracy rates of 0.5-1 mm in correspondence between real anatomy and virtual anatomy and even include functional magnetic resonance imaging data. Since these advances, strong efforts have been made to transfer this technology to soft-tissue surgeries; however, navigation has harder to adapt in soft-tissue surgeries such as liver surgery. As advances in research and technology continue to reduce rates of morbidity and mortality in patients undergoing major liver surgery, there is a strong interest in moving toward more complex cases with extended tumor spread that would otherwise be considered nonpperable. This endeavor shows promise with the advent of in-traoperative navigation systems. Currently, selection of patients and surgical planning for hepatic resections are based in large part on computed tomography or sometimes magnetic resonance imaging. Based on these images and the additional information gained by the palpating hand and intraoperative ultrasound, the operative resection plans are made. With the increasing use of ablative procedures and laparoscopy, intraoperative imaging and navigation will hold increasing significance for the hepatobiliary-pancreatic surgeon.