Toward integrated image guided liver surgery

While clinical neurosurgery has benefited from the advent of frameless image guidance for over three decades, the translation of image guided technologies to abdominal surgery, and more specifically liver resection, has been far more limited. Fundamentally, the workflow, complexity, and presentation have confounded development. With the first real efforts in translation beginning at the turn of the millennia, the work in developing novel augmented technologies to enhance screening, planning, and surgery has come to realization for the field. In this paper, we will review several examples from our own work that demonstrate the impact of image-guided procedure methods in eight clinical studies that speak to: (1) the accuracy in planning for liver resection, (2) enhanced surgical planning with portal vein embolization impact, (3) linking splenic volume changes to post-hepatectomy complications, (4) enhanced intraoperative localization in surgically occult lesions, (5) validation of deformation correction, and a (6) a novel blinded study focused at the value of deformation correction. All six of these studies were achieved in human systems and show the potential impact image guided methodologies could make on liver tissue resection procedures.