Engineering instruments for the open HF-MRI

Liver resection

Subproject 1- Keyhole Technique for Liver Surgery under MRI Guidance

So-called minimally invasive surgery (keyhole surgery) is less traumatic than open surgery and patients recover faster. The minimally invasive approach uses very small cuts in the skin to introduce the surgical instruments, making the large incisions of conventional surgery unnecessary. Minimally invasive surgery of the abdomen, also known as laparoscopy, has already become the standard procedure for operations on the gallbladder and appendix.

The aim of this subproject is to apply the experience with minimally invasive surgery to the liver. Compared with the organs on which minimally invasive surgery has already been performed, liver surgery is far more complex and associated with a higher risk of complications. Much hope is placed on the intraoperative use of MRI, which will provide the surgeon with information on the dense vascular network of the liver without having to open the abdominal wall. The continually updated image information provides the surgeon with a roadmap and helps to make very precise cuts with little damage to normal liver tissue.

Handport MRT Endo

(a) MR image. The magnification shows the surgeon’s hand at the liver.
(b) Corresponding optical view through the laparoscope.

Ãœbersicht nah Monitor Liver Hand

Handport

  • MR-taugliches Kamerasystem HDC905 der Firma World of Medicine AG (W.O.M.)
  • MR-taugliches Laparoskop LAPALUX-Telescope 0° (429-60200MRT) oder 30° (429-61200MRT) mit Trokar-Schaft (455-35200MRT) der Firma MGB Endoskopische Geräte GmbH Berlin (MGB)
  • MR-taugliche W.O.M.-Video-Kameralinse (Adapter) 470-24400MRT der Firma MGB
  • Zwei MR-taugliche Monitore der Firma Philips Healthcare (Hamburg, Germany)
  • MR-tauglicher Trokar (455-31200MRT) der Firma MGB
  • MR-taugliche Handinstrumente (Metzenbaumschere, Maryland-Zange, Babcock-Zange, flexibler Retraktor) der Firma MGB
  • Laparoskopische Ports der Firma Applied Medical (Rancho Santa Margarita, CA, USA)
  • Für optionale Handünterstützung: Gel-Port der Firma Applied Medical (Rancho Santa Margarita, CA, USA)
  • Clip Applikator der Firma Ethicon (Norderstedt, Germany)
  • 1,064-nm Nd:YAG Laser der Firma Dornier (Germany)
  • Titan-Nadel der Firma Somatex (Teltow, Germany)
  • Evaluation of laparoscopic liver resection with two different Nd:YAG lasers for future use in a high-field open MRI. Chopra SS, Wiltberger G, Teichgraeber U, Papanikolaou I, Schwabe M, Schmidt S, Fikatas P, Streitparth F, Philipp C, Wichlas F, Seebauer C, Schumacher G. Photomed Laser Surg. 2009 Apr;27(2):281-6.
  • Imaging sequences for intraoperative MR-guided laparoscopic liver resection in 1.0-T high field open MRI. Chopra SS, Rump J, Schmidt SC, Streitparth F, Seebauer C, Schumacher G, Van der Voort I, Teichgräber U. Eur Radiol. 2009 Apr 7.

Sascha Chopra
Georg Wiltberger
Felix Güttler (Ed.)

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