Friday, 14 December 2018

Liver surgery


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Laurent MUNDELEER - David WIKLER - Nadine WARZEE - Thierry LELOUP

Project description

Radiofrequency ablation (RFA) is a minimally invasive treatment for either hepatocellular carcinoma (HCC) or metastasis liver carcinoma (MLC).
RFA, as cryogenization or microwave ablation, allows the surgeon to locally destroy tumors using a percutaneous approach and represents a good alternative for treatment of unresectable hepatic malignancies. In most RFA procedures, the surgeon introduces a specific needle-like probe inside the target lesion where the RFA process starts denaturizing the cells with ionic agitation. This probe has an active tip which length can vary; A complete destruction cycle takes 12 minutes.

Op-foie.jpg Suivi-RF-US.jpg
To resect large lesions, the surgeon has to perform multiple time-consuming destruction cycles and reposition the RFA needle for each of them. The critical step in performing a successful ablation and preventing local recurrence is the correct positioning of the needle. For small tumors (i.e. when a single application allows to destroy the entire tumor and a security margin), the surgeon positions the middle of the active needle tip in the center of the tumor under intra-operative ultrasound (US) guidance. When more than one destruction is necessary, US guidance is obstructed by the opacity originating from the first RFA application. In this case the surgeon can only rely on anatomical knowledge and repositioning the RFA needle becomes a subjective task limiting the treatment accuracy. In order to ensure an optimal coverage of the tumoral tissue ablation, we propose the optimization of RFA application procedure to the surgeon using computer assisted image guidance.
Our procedure is a new approach aiming at the optimization of multiple RFA applications. The RFA needle is optically tracked and positioned by the surgeon under US guidance at the center of the lesion. From this point, our system will guide the surgeon’s needle insertions in order to ensure accurate and optimal placement of RFA targets.

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