Navigated laparoscopic microwave ablation of tumour mimics in pig livers - a randomized ex-vivo trial

Background In order to efficiently and safely perform laparoscopic ablation procedures precise positioning of the ablation probe is mandatory. This study evaluates the precision and ablation accuracy using the innovative laparoscopic stereotactic navigation system CAS-One-SPOT in comparison to 2d ultrasound guided laparoscopic ablation procedures in a experimental ex vivo porcine model.

Methods In a pig liver tumor-mimic ablation model a total of four surgeons, experienced (n=2) and inexperienced (n=2) in laparoscopic ablation procedures, were randomized for 2d ultrasound guided laparoscopic or stereotactic navigated laparoscopic ablation procedures. Each surgeon performed a total of 20 ablations. Total attempts of needle placements, time from tumor localization till beginning of ablation and ablation accuracy were analyzed.

Results With the use of the laparoscopic stereotactic navigation system experienced and inexperienced surgeons were able to significantly reduce the total amount of needle placements from a mean of 2.75±2.291 respectively 2.5 ±1.50 attempts in the 2d ultrasound guided ablation group to 1.45 ±1.191 respectively 1.15 ±0.489 attempts in the stereotactic navigation group. This was accompanied by a significant time saving of 43%, from identification of the tumor mimic until beginning of ablation. The accuracy of the ablation process was hereby not impaired as postinterventional sectioning of the ablation zone revealed.

Conclusion The use of an electromagnetic stereotactic navigation system for laparoscopic ablation procedures leads to a significant reduction in necessary attempts of predicted correct needle placement with a significant intraoperative time saving while not impairing the accuracy of the ablation procedure.

Publication History

Article published online:
08 September 2020