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, Karin Olthof Department of Surgical Oncology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek , Amsterdam , The Netherlands Correspondence to: Karin Olthof, Department of Surgical Oncology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands (e-mail: ka.olthof@nki.nl) Search for other works by this author on: Oxford Academic Jasper Smit Department of Surgical Oncology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek , Amsterdam , The Netherlands Search for other works by this author on: Oxford Academic Matteo Fusaglia Department of Surgical Oncology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek , Amsterdam , The Netherlands Search for other works by this author on: Oxford Academic Niels Kok Department of Surgical Oncology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek , Amsterdam , The Netherlands Search for other works by this author on: Oxford Academic Theo Ruers Department of Surgical Oncology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek , Amsterdam , The Netherlands Faculty of Science and Technology (TNW), Nanobiophysics Group (NBP), University of Twente , Enschede , The Netherlands Search for other works by this author on: Oxford Academic Koert Kuhlmann Department of Surgical Oncology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek , Amsterdam , The Netherlands Search for other works by this author on: Oxford Academic
British Journal of Surgery, Volume 111, Issue 5, May 2024, znae110, https://doi.org/10.1093/bjs/znae110
Published:
03 May 2024
Article history
Received:
26 January 2024
Revision received:
05 April 2024
Accepted:
07 April 2024
Published:
03 May 2024
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Karin Olthof, Jasper Smit, Matteo Fusaglia, Niels Kok, Theo Ruers, Koert Kuhlmann, A surgical navigation system to aid the ablation of vanished colorectal liver metastases, British Journal of Surgery, Volume 111, Issue 5, May 2024, znae110, https://doi.org/10.1093/bjs/znae110
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Introduction
Systemic chemotherapy can result in considerable reduction of the size of colorectal liver metastases (CRLMs) to the point where they sometimes decrease even below the resolution of imaging modalities. These ‘vanishing lesions’ are observed in approximately 20% of patients, even with state-of-the-art imaging1. Nonetheless, microscopic residual disease is frequently present2,3 and tumour regrowth occurs in approximately one-third after ‘watch and wait’1. The current recommendation is to resect or ablate all original disease sites whenever feasible4. However, intraoperative localization of vanishing lesions is challenging5,6.
Surgical navigation provides a live, virtual representation of the surgical scene, using a three-dimensional (3D) model of the organ that includes tumours and critical structures. The model is generated by delineating preoperative diagnostic imaging. When an accurate registration (that is, preoperative alignment of the patient’s liver and 3D model) is achieved, surgical navigation can help to localize vanished lesions7,8.
In previous work, the advantages of ultrasonography-based navigation in open liver surgery combined with electromagnetic (EM) liver tracking were presented9. This approach resulted in a registration accuracy of 8.5 ± 4.2 mm while compensating for liver movement. In this study, the advantages of this method were applied for localization and treatment of vanished CRLMs.
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Hepato-Pancreato-Biliary Surgery
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