William Chapman, MD, monitors his surgical instrument's position on corresponding CT scans during liver surgery. This is performed using image-guided techniques that track location, including infrared-emitting diodes located on the instrument handle.
Image-guided surgery — a technology that continues to grow in the fields of neurosurgery and breast cancer treatment — now is available to treat liver cancer.
An image-guided system for liver surgery — recently approved by the FDA — is the result of about 10 years of research by William Chapman, MD, chief of the Section of Transplant Surgery at Washington University School of Medicine, and a team of bioengineers at Vanderbilt University in Nashville, TN.
Starting with preoperative imaging studies (computed tomography [CT] and magnetic resonance imaging [MRI]), Chapman and his team developed a system to scan the liver surface in the OR and perform a registration, matching the actual liver to its appearance on the pre-operative scan. Once this is accomplished, surgical team members can visualize the liver, including all internal structures, in three dimensions on a monitor. Surgical instruments also are tracked, and the surgeon can see the locations of instrument tips throughout the procedure.
Image-guided surgery has found widespread acceptance in the treatment of brain tumors and other neurological disorders and more recently has been used in the diagnosis and treatment of breast cancer. As with other applications, image-guided liver surgery holds the promise of more accurate navigation and excision through three-dimensional imaging. It also can be used for guidance in liver ablation surgery and in living donor liver resections.
The work of Chapman and the bioengineering team is supported by the National Institutes of Health and the National Science Foundation. Thus far, the group has focused on developing the technology and proving that an imaging system can accurately portray the liver and track instruments during a procedure. The next step is a clinical trial now underway at Memorial Sloan-Kettering Cancer Center in New York City, the University of Pittsburgh and the University of Florida in Gainesville. Researchers at these institutions will evaluate the usefulness of the image-guided system in treating patients with liver disease.