Department of General-, Visceral- and Transplantation Surgery, Charité Campus Virchow Clinic, University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Surg Endosc. 2010 Oct;24(10):2506-12. doi: 10.1007/s00464-010-0994-1. Epub 2010 Mar 13.
The goal of this study was to evaluate high-field open magnetic resonance imaging (MRI) for intraoperative real-time imaging during hand-assisted laparoscopic liver resection. MR guidance has several advantages compared to ultrasound and may represent a future technique for abdominal surgery. Various MRI-safe and -compatible instruments were developed, tested, and applied to realize minimally invasive liver surgery under MR guidance. As proof of the concept, liver resection was performed in a porcine model.
All procedures were conducted in a 1.0-T open MRI unit. Imaging quality and surgical results were documented during three cadaveric and two live animal procedures. A nonferromagnetic hand port was used for manual access and the liver tissue was dissected using a Nd:YAG laser.
The intervention time ranged from 126 to 145 min, with a dissection time from 11 to 15 min. Both live animals survived the intervention with a blood loss of 250 and 170 ml and a specimen weight of 138 and 177 g. A dynamic T2W fast spin-echo sequence allowed real-time imaging (1.5 s/image) with good delineation of major and small hepatic vessels. The newly developed MR-compatible instruments and camera system caused only minor interferences and artifacts of the MR image.
MR-guided liver resection is feasible and provides additional image information to the surgeon. We conclude that MR-guided laparoscopic liver resection improves the anatomical orientation and may increase the safety of future minimally invasive liver surgery.
本研究旨在评估高磁场开放式磁共振成像（MRI）在手助腹腔镜肝切除术中的实时术中成像。与超声相比，MR 引导具有多项优势，可能代表未来腹部手术的一项技术。已经开发、测试和应用了各种 MRI 安全且兼容的器械，以实现 MR 引导下的微创肝手术。作为概念验证，在猪模型中进行了肝切除术。
所有手术均在 1.0-T 开放式 MRI 单元中进行。在三具尸体和两具活体动物手术过程中记录了成像质量和手术结果。使用非铁磁性手端口进行手动进入，使用 Nd:YAG 激光切割肝组织。
干预时间为 126 至 145 分钟，分离时间为 11 至 15 分钟。两只活体动物均存活，出血量分别为 250 和 170 毫升，标本重量分别为 138 和 177 克。动态 T2W 快速自旋回波序列允许实时成像（1.5 s/图像），可清晰显示大、小肝血管。新开发的 MRI 兼容器械和摄像系统仅对 MRI 图像产生轻微干扰和伪影。
MR 引导下的肝切除术是可行的，并为外科医生提供了额外的图像信息。我们得出结论，MR 引导下的腹腔镜肝切除术改善了解剖定位，并可能提高未来微创肝手术的安全性。
