Rationale and Objectives
The aim of this prospective, randomized animal study was to compare a new computer guided needle–based navigation system for liver biopsy with conventional computed tomography (CT)-guided liver biopsy. Computer-navigated interventions provide continuous needle tracking during motion and deformation from patient respiration and movement.
Materials and Methods
Twenty artificial tumors of about 5 mm in diameter were injected into the livers of five pigs, each at a different site. Each tumor was targeted by conventional CT-guided and computer navigated intervention. Intervention was considered complete after successful tumor biopsy. Data on procedure time, number of CT scans performed, accuracy, and success rate were recorded.
Results
All tumors (100%) were biopsied successfully. Mean procedural time was comparable between the two techniques (20 ± 9 minutes conventional versus 20 ± 8 minutes navigation). Mean number of CT scans were 1.2 ± 0.4 with navigation and 6.1 ± 3.8 with the conventional technique ( P < .01). The dose-length product in the conventional group was significantly higher (212 ± 116 mGy × cm) than in the navigated group (78 ± 22 mGy × cm; P < .001). Mean number of capsule penetrations was 4 ± 1 with navigation versus 2 ± 1 with the conventional technique ( P < .001).
Conclusion
Computer-navigated liver biopsy may provide a promising and innovative device for easy, rapid, and successful liver biopsies with low morbidity. Further technical improvements and clinical studies in humans are required.
Convergent developments in radiology, teletransmission, computer science, and surgical innovations have allowed for the development of image-guided surgery and navigation. These techniques are well-established in the daily routine in orthopedic, neuro-, and head and neck surgery for improving precision and minimizing radiation exposure . However, the use of computer navigation systems for interventions in soft organs with motion and deformation, such as the liver is not yet established and constitutes an area of current research .
In cooperation with the German Cancer Research Center (Heidelberg, Germany), an image-guided navigation system was developed using optical tracking including fiducial needles in combination with preprocedural computer tomography (CT) imaging. After promising results with in vitro studies , we examined common clinical procedures in the liver to select a clinical relevant standardized procedure to evaluate technical aspects of computer navigation and allow comparison to current clinical practice . Based on this examination, we chose to evaluate CT-guided liver biopsy with and without the use of our novel soft-tissue navigation system.
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Materials and methods
Experimental Setting, Artificial Tumor Placement, and Parameters
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Conventional CT-guided Liver Biopsy
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Navigated Liver Biopsy
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Statistical Analysis
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Results
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Table 1
Comparative Data of Both the Conventional and the Navigated Group
Parameter Conventional Liver Biopsy Navigated Liver Biopsy_P_ Overall procedure time (minutes) 20 ± 9 20 ± 8 .8 Mean number of computed tomography scans 6.1 ± 3.8 1.2 ± 0.4 <.01 Dose length product (mGy × cm) 212 ± 116 78 ± 22 <.001 Extracted tumor tissue (%) 53 ± 31 51 ± 29 .87 First pass accuracy (%) 94 ± 18 74 ± 32 <.05 Mean number of trials 2.3 ± 2.9 1.2 ± 0.5 <.05 Number of attempts to target tumor 3.0 ± 3.0 1.0 ± 0 <.001 Needle repositioning 3.2 ± 3.8 0.2 ± 0.5 <.001 Liver capsule penetration 2.0 ± 1.0 4.0 ± 1.0 <.001 Angle of the needle 70.1 ± 17.3 69 ± 12.7 >.5
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Discussion
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Conclusion
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Acknowledgment
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