Development and in vivo application of real-time intrahepatic flow display to guide liver dissection in minimally invasive surgery (Conference Presentation)

The primary liver cancer including intrahepatic bile duct cancer pose significant global burden of illness with increasing incidence and mortality in US and around the world. Surgery remains the most effective form of treatment. However, surgical complication rates for medium to high complexity hepatectomies persist in 30-40% range even in highly skilled hands and at high volume centers. The critical challenges appear to be attributable to navigating liver parenchymal dissection, where size of resection surface, associated with blood loss and missed bile leaks from the liver parenchyma, and prolonged operative time during dissection pose significant obstacle. In this work, we present a new laparoscopic real-time liver flow display of subsurface liver structures (e.g., intrahepatic artery, portal vein, and bile duct) by creating a ‘Surgical Map’ to guide liver parenchymal dissection in hepatobiliary surgery. The intelligent display of intrahepatic critical structures and functional physiology in real-time can make the hepatic dissection safer and more efficient for any liver surgery. We integrated multimodal optical imaging technologies into a single laparoscopic vision tool, created a continuously evolving quantitative surgical map based on Bayesian framework, and finally validated the usefulness of Surgical Map through preclinical porcine studies.