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How to operate a liver tumor you cannot see

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Abstract

Backround

As recent chemotherapy regimens for metastatic colorectal cancer become more and more effective in a neoadjuvant setting before liver surgery, a “complete” clinical response is sometimes documented on imaging. Without operation though, metastatic recurrence is likely to commence within 12 months. Surgeons now face the problem to resect non-visualizable and non-palpable lesions.

Methods

Computer-based virtual surgery planning can be used to fuse pre- and postchemotherapy computed tomography data to develop an operative strategy. This information is then intraoperatively transferred to the liver surface using an image-guided stereotactically navigated ultrasound dissector. This enables the surgeon to perform a resection that is otherwise not possible.

Results

During operation, detection of the lesion through palpation or ultrasound was impossible. After registering the virtual operation plan into the navigation system, the planned resection was performed without problems. Histopathologic workup showed vital tumor cells in the specimen.

Conclusion

The new image-guided stereotactic navigation technique combined with virtual surgery planning can solve the surgeon’s dilemma and yield a successful operation.

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Acknowledgment

The work and the results presented in this study are funded by the German Federal Ministry of Education and Research (BMBF) within the SOMIT funding scheme to the FUSION Consortium.

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Authors and Affiliations

  1. Department of General and Visceral Surgery, Celle General Hospital, Siemensplatz 4, 29223, Celle, Germany

    Karl J. Oldhafer & Gregor A. Stavrou

  2. Frauenhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany

    Guido Prause & Heinz-Otto Peitgen

  3. Institute of Micro Technology and Medical Device Technology (MiMed), Technical University Munich, Munich, Germany

    Tim C. Lueth & Stefan Weber

Authors
  1. Karl J. Oldhafer
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  2. Gregor A. Stavrou
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  3. Guido Prause
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  4. Heinz-Otto Peitgen
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  5. Tim C. Lueth
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  6. Stefan Weber
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Corresponding author

Correspondence to Karl J. Oldhafer.

Additional information

“Best of Abstracts—Chirurgisches Forum 2009, Deutsche Gesellschaft für Chirurgie”

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Oldhafer, K.J., Stavrou, G.A., Prause, G. et al. How to operate a liver tumor you cannot see. Langenbecks Arch Surg 394, 489–494 (2009). https://doi.org/10.1007/s00423-009-0469-9

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  • DOI: https://doi.org/10.1007/s00423-009-0469-9

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