Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Division of Medical and Biological Informatics, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
Surg Endosc. 2018 Oct;32(10):4216-4227. doi: 10.1007/s00464-018-6168-2. Epub 2018 Mar 30.
Navigation systems have the potential to facilitate intraoperative orientation and recognition of anatomical structures. Intraoperative accuracy of navigation in thoracoabdominal surgery depends on soft tissue deformation. We evaluated esophageal motion caused by respiration and pneumoperitoneum in a porcine model for minimally invasive esophagectomy.
In ten pigs (20-34 kg) under general anesthesia, gastroscopic hemoclips were applied to the cervical (CE), high (T1), middle (T2), and lower thoracic (T3) level, and to the gastroesophageal junction (GEJ) of the esophagus. Furthermore, skin markers were applied. Three-dimensional (3D) and four-dimensional (4D) computed tomography (CT) scans were acquired before and after creation of pneumoperitoneum. Marker positions and lung volumes were analyzed with open source image segmentation software.
Respiratory motion of the esophagus was higher at T3 (7.0 ± 3.3 mm, mean ± SD) and GEJ (6.9 ± 2.8 mm) than on T2 (4.5 ± 1.8 mm), T1 (3.1 ± 1.8 mm), and CE (1.3 ± 1.1 mm). There was significant motion correlation in between the esophageal levels. T1 motion correlated with all other esophagus levels (r = 0.51, p = 0.003). Esophageal motion correlated with ventilation volume (419 ± 148 ml) on T1 (r = 0.29), T2 (r = 0.44), T3 (r = 0.54), and GEJ (r = 0.58) but not on CE (r = - 0.04). Motion correlation of the esophagus with skin markers was moderate to high for T1, T2, T3, GEJ, but not evident for CE. Pneumoperitoneum led to considerable displacement of the esophagus (8.2 ± 3.4 mm) and had a level-specific influence on respiratory motion.
The position and motion of the esophagus was considerably influenced by respiration and creation of pneumoperitoneum. Esophageal motion correlated with respiration and skin motion. Possible compensation mechanisms for soft tissue deformation were successfully identified. The porcine model is similar to humans for respiratory esophageal motion and can thus help to develop navigation systems with compensation for soft tissue deformation.
导航系统具有辅助术中定位和识别解剖结构的潜力。胸腹部手术中导航的术中准确性取决于软组织变形。我们在微创食管切除术的猪模型中评估了呼吸和人工气腹引起的食管运动。
在全身麻醉下的 10 头猪（20-34 公斤）中，胃内应用血管夹夹于食管的颈段（CE）、高段（T1）、中段（T2）和下段（T3），以及食管胃连接部（GEJ）。此外，还应用了皮肤标记物。在创建人工气腹前后，进行三维（3D）和四维（4D）计算机断层扫描（CT）扫描。使用开源图像分割软件分析标记物位置和肺容量。
T3（7.0 ± 3.3 毫米，均值 ± 标准差）和 GEJ（6.9 ± 2.8 毫米）的食管呼吸运动高于 T2（4.5 ± 1.8 毫米）、T1（3.1 ± 1.8 毫米）和 CE（1.3 ± 1.1 毫米）。食管各水平之间存在显著的运动相关性。T1 运动与所有其他食管水平相关（r = 0.51，p = 0.003）。T1、T2、T3 和 GEJ 的食管运动与通气量（419 ± 148 毫升）相关（r = 0.29、r = 0.44、r = 0.54 和 r = 0.58），但 CE 无相关性（r = -0.04）。T1、T2、T3、GEJ 的食管与皮肤标记物的运动相关性为中度至高度，但 CE 不明显。人工气腹导致食管明显移位（8.2 ± 3.4 毫米），并对呼吸运动产生特定的影响。
呼吸和创建人工气腹对食管的位置和运动有显著影响。食管运动与呼吸和皮肤运动相关。成功识别了软组织变形的可能补偿机制。猪模型在呼吸性食管运动方面与人类相似，因此有助于开发具有软组织变形补偿功能的导航系统。
