Feasibility of navigated resection of liver tumors using multiplanar visualization of intraoperative 3-dimensional ultrasound data

Background: Intraoperative ultrasound is widely used in liver surgery, but primarily for diagnostic purposes. We have developed and evaluated a system for navigated liver resections using on intraoperatively acquired 3-dimensional (3D) ultrasound data. Methods: Navigation technique based on 3D ultrasound and an optical tracking system. Accuracy of the system was validated experimentally in a tumor model. Subsequently, clinical application was evaluated in 54 patients for resection of central liver tumors. Clinical feasibility and accuracy of the navigation technique were assessed with respect to practicability, adequacy of visualization, and precision of navigated resection (free margin). Results: Evaluation of the system in the tumor model showed a significant increase of the accuracy of navigated resections compared with conventional resection (P < 0.05). Clinical application of 3D ultrasound-based navigation was feasible in 52 of 54 patients. Sufficient visualization was obtained with 2 orthogonal section planes. This navigation strategy provided complete anatomic orientation and accurate position control of surgical instruments. Mean histologic resection margin was 9 mm with a maximum deviation of 8 mm from the planned virtual resection margins. Conclusions: Optoelectronic navigation with section mode visualization in 2 orthogonal planes does sufficiently display intraoperative 3D data and enables accurate ultrasound-based navigation of liver resections.