Oldhafer K J, Peterhans M, Kantas A, Schenk A, Makridis G, Pelzl S, Wagner K C, Weber S, Stavrou G A, Donati M
Klinik für Allgemein- und Viszeralchirurgie, Asklepios Klinik Barmbek, Hamburg, Deutschland.
Semmelweis Universität Budapest, Campus Hamburg, Hamburg, Deutschland.
Chirurg. 2018 Oct;89(10):769-776. doi: 10.1007/s00104-018-0713-3.
The preoperative computer-assisted resection planning is the basis for every navigation. Thanks to modern algorithms, the prerequisites have been created to carry out a virtual resection planning and a risk analysis. Thus, individual segment resections can be precisely planned in any conceivable combination. The transfer of planning information and resection suggestions to the operating theater is still problematic. The so-called stereotactic liver navigation supports the exact intraoperative implementation of the planned resection strategy and provides the surgeon with real-time three-dimensional information on resection margins and critical structures during the resection. This is made possible by a surgical navigation system that measures the position of surgical instruments and then presents them together with the preoperative surgical planning data. Although surgical navigation systems have been indispensable in neurosurgery and spinal surgery for many years, these procedures have not yet become established as standard in liver surgery. This is mainly due to the technical challenge of navigating a moving organ. As the liver is constantly moving and deforming during surgery due to respiration and surgical manipulation, the surgical navigation system must be able to measure these alterations in order to adapt the preoperative navigation data to the current situation. Despite these advances, further developments are required until navigated liver resection enters clinical routine; however, it is already clear that laparoscopic liver surgery and robotic surgery will benefit most from navigation technology.
术前计算机辅助切除规划是所有导航的基础。借助现代算法，已具备进行虚拟切除规划和风险分析的前提条件。因此，可以精确规划任何可想象组合的个体节段切除。将规划信息和切除建议传输到手术室仍然存在问题。所谓的立体定向肝脏导航支持计划切除策略在术中的精确实施，并在切除过程中为外科医生提供关于切除边缘和关键结构的实时三维信息。这通过一个手术导航系统得以实现，该系统测量手术器械的位置，然后将其与术前手术规划数据一起呈现。尽管手术导航系统多年来在神经外科和脊柱外科中不可或缺，但这些程序尚未在肝脏手术中成为标准做法。这主要是由于对移动器官进行导航的技术挑战。由于肝脏在手术过程中因呼吸和手术操作而不断移动和变形，则手术导航系统必须能够测量这些变化，以便使术前导航数据适应当前情况。尽管有这些进展，但在导航肝脏切除进入临床常规之前仍需要进一步发展；然而，已经很清楚的是，腹腔镜肝脏手术和机器人手术将从导航技术中受益最大。
