Chopra S S, Hünerbein M, Eulenstein S, Lange T, Schlag P M, Beller S
Department of Surgery and Surgical Oncology, Charité Campus Buch, Universitätsmedizin Berlin, 13125 Berlin, Germany.
Eur J Surg Oncol. 2008 Apr;34(4):456-61. doi: 10.1016/j.ejso.2007.07.011. Epub 2007 Sep 4.
Intraoperative navigation is a rapidly emerging procedure in orthopaedic surgery and neurosurgery. For abdominal tumors (e.g. liver metastasis) and soft tissue tumors there is only limited experience with navigation techniques due to problems of organ shift and tissue deformation. We have developed a navigation system for tumor resection in soft tissue based on 3D ultrasound imaging and optical tracking.
Two different modes of navigation were evaluated and compared with conventional surgery in an experimental soft tissue model. Both techniques were based on 3D ultrasound and an optical tracking system for intraoperative real time registration of surgical instruments. These two techniques were used: a) Indirect navigation with ultrasound guided insertion of a tracked hook needle into the tumor; and b) Direct navigation using a 3D image which was obtained with an optically tracked 3D ultrasound probe. It was the aim of both techniques to achieve a circumferential resection margin of 2cm around the tumor.
A total of 23 resections were performed consisting of indirect (n=7) and direct (n=10) navigation and conventional surgery (n=6) as gold standard. For indirect navigation a median deviation from the ideal resection margin (accuracy) of 0.32cm was measured. Direct navigation showed an accuracy of 0.16cm compared to 0.42cm with conventional surgery. Navigated surgery showed for both techniques a significant increase of resection accuracy compared to conventional resection (p<0.05).
3D ultrasound based indirect and direct optoelectronic navigation for resection of soft tissue tumors is feasible and may improve intraoperative orientation with increased surgical precision.
术中导航是骨科手术和神经外科中迅速兴起的一种手术方式。对于腹部肿瘤（如肝转移瘤）和软组织肿瘤，由于器官移位和组织变形问题，导航技术的经验有限。我们基于三维超声成像和光学跟踪技术开发了一种用于软组织肿瘤切除的导航系统。
在一个实验性软组织模型中，对两种不同的导航模式进行了评估，并与传统手术进行了比较。这两种技术均基于三维超声和一个用于手术器械术中实时配准的光学跟踪系统。使用了以下两种技术：a）间接导航，通过超声引导将带跟踪的钩针插入肿瘤；b）直接导航，使用通过光学跟踪的三维超声探头获得的三维图像。两种技术的目标都是在肿瘤周围获得2厘米的环周切除边缘。
共进行了23例切除手术，包括间接导航（n = 7）、直接导航（n = 10）和作为金标准的传统手术（n = 6）。对于间接导航，测量得到的与理想切除边缘的中位偏差（准确性）为0.32厘米。直接导航的准确性为0.16厘米，而传统手术为0.42厘米。与传统切除相比，两种导航技术的手术切除准确性均显著提高（p < 0.05）。
基于三维超声的间接和直接光电导航用于软组织肿瘤切除是可行的，并且可以提高术中定位并增加手术精度。
