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Brancadoro M, Dimitri M, Boushaki MN, Staderini F, Sinibaldi E, Capineri L, Cianchi F, Biffi Gentili G, Menciassi A. A novel microwave tool for robotic liver resection in minimally invasive surgery. MINIM INVASIV THER 2020; 31:42-49. [PMID: 32255393 DOI: 10.1080/13645706.2020.1749083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: During the last two decades, many surgical procedures have evolved from open surgery to minimally invasive surgery (MIS). This limited invasiveness has motivated the development of robotic assistance platforms to obtain better surgical outcomes. Nowadays, the da Vinci robot is a commercial tele-robotic platform widely used for different surgical applications.Material and methods: In this work, the da Vinci Research Kit (dVRK), namely the research version of the da Vinci, is used to manipulate a novel microwave device in a teleoperation scenario. The dVRK provides an open source platform, so that the novel microwave tool, dedicated to prevention bleeding during hepatic resection surgery, is mechanically integrated on the slave side, while the software interface is adapted in order to correctly control tool pose. Tool integration is validated through in-vitro and ex-vivo tests performed by expert surgeons, meanwhile the coagulative efficacy of the developed tool in a perfused liver model was proved in in-vivo tests.Results and conclusions: An innovative microwave tool for liver robotic resection has been realized and integrated into a surgical robot. The tool can be easily operated through the dVRK without limiting the intuitive and friendly use, and thus easily reaching the hemostasis of vessels.
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Affiliation(s)
| | - Mattia Dimitri
- Department of Industrial Engineering, University of Florence, Firenze, Italy
| | | | - Fabio Staderini
- Department of Surgery and Translational Medicine, University of Florence, Firenze, Italy
| | - Edoardo Sinibaldi
- Center for Micro-BioRobotics, Istituto Italiano di Tecnologia, Pontedera, Italy
| | - Lorenzo Capineri
- Department of Information Engineering, University of Florence, Firenze, Italy
| | - Fabio Cianchi
- Department of Surgery and Translational Medicine, University of Florence, Firenze, Italy
| | - Guido Biffi Gentili
- Department of Information Engineering, University of Florence, Firenze, Italy
| | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
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Yamada A, Tokuda J, Naka S, Murakami K, Tani T, Morikawa S. Magnetic resonance and ultrasound image-guided navigation system using a needle manipulator. Med Phys 2019; 47:850-858. [PMID: 31829440 DOI: 10.1002/mp.13958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 12/06/2019] [Accepted: 12/06/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Image guidance is crucial for percutaneous tumor ablations, enabling accurate needle-like applicator placement into target tumors while avoiding tissues that are sensitive to injury and/or correcting needle deflection. Although ultrasound (US) is widely used for image guidance, magnetic resonance (MR) is preferable due to its superior soft tissue contrast. The objective of this study was to develop and evaluate an MR and US multi-modal image-guided navigation system with a needle manipulator to enable US-guided applicator placement during MR imaging (MRI)-guided percutaneous tumor ablation. METHODS The MRI-compatible needle manipulator with US probe was installed adjacent to a 3 Tesla MRI scanner patient table. Coordinate systems for the MR image, patient table, manipulator, and US probe were all registered using an optical tracking sensor. The patient was initially scanned in the MRI scanner bore for planning and then moved outside the bore for treatment. Needle insertion was guided by real-time US imaging fused with the reformatted static MR image to enhance soft tissue contrast. Feasibility, targeting accuracy, and MR compatibility of the system were evaluated using a bovine liver and agar phantoms. RESULTS Targeting error for 50 needle insertions was 1.6 ± 0.6 mm (mean ± standard deviation). The experiment confirmed that fused MR and US images provided real-time needle localization against static MR images with soft tissue contrast. CONCLUSIONS The proposed MR and US multi-modal image-guided navigation system using a needle manipulator enabled accurate needle insertion by taking advantage of static MR and real-time US images simultaneously. Real-time visualization helped determine needle depth, tissue monitoring surrounding the needle path, target organ shifts, and needle deviation from the path.
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Affiliation(s)
- Atsushi Yamada
- Department of Research and Development for Innovative Medical Devices and Systems, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Junichi Tokuda
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Shigeyuki Naka
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Koichiro Murakami
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Tohru Tani
- Department of Research and Development for Innovative Medical Devices and Systems, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Shigehiro Morikawa
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
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Murakami K, Naka S, Shiomi H, Akabori H, Kurumi Y, Morikawa S, Tani T. Initial experiences with MR Image-guided laparoscopic microwave coagulation therapy for hepatic tumors. Surg Today 2014; 45:1173-8. [DOI: 10.1007/s00595-014-1042-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/15/2014] [Indexed: 02/06/2023]
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Minimally invasive surgery using the open magnetic resonance imaging system combined with video-assisted thoracoscopic surgery for synchronous hepatic and pulmonary metastases from colorectal cancer: report of four cases. Surg Today 2014; 45:652-8. [PMID: 25096001 DOI: 10.1007/s00595-014-1002-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 04/01/2014] [Indexed: 01/17/2023]
Abstract
Simultaneous resection of hepatic and pulmonary metastases (HPM) from colorectal cancer (CRC) has been reported to be effective, but it is also considered invasive. We report the preliminary results of performing minimally invasive surgery using the open magnetic resonance (MR) imaging system to resect synchronous HPM from CRC in four patients. All four patients were referred for thoracoscopy-assisted interventional MR-guided microwave coagulation therapy (T-IVMR-MCT) combined with video-assisted thoracoscopic surgery (VATS). The median diameters of the HPM were 18.2 and 23.2 mm, respectively. The median duration of VATS and T-IVMR-MCT was 82.5 and 139 min, respectively. All patients were discharged without any major postoperative complications. One patient was still free of disease at 24 months and the others died of disease progression 13, 36, and 47 months without evidence of recurrence in the treated area. Thus, simultaneous VATS + T-IVMR-MCT appears to be an effective option as a minimally invasive treatment for synchronous HPM from CRC.
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Real-time magnetic resonance-guided microwave coagulation therapy for pelvic recurrence of rectal cancer: initial clinical experience using a 0.5 T open magnetic resonance system. Dis Colon Rectum 2010; 53:1555-62. [PMID: 20940606 DOI: 10.1007/dcr.0b013e3181e8f4b6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study aims to evaluate consecutive cases of recurrent rectal cancer in the pelvic cavity treated with microwave coagulation therapy using real-time navigation by an open magnetic resonance system. METHODS Nine recurrent pelvic lesions in 8 patients after curative resection of rectal cancer were treated with real-time magnetic resonance-guided microwave coagulation therapy as a palliative local therapy to reduce tumor volume and/or local pain. Clinical and pathological data were collected retrospectively by reviewing medical records and clinical imaging results. RESULTS Seven patients received other treatments before real-time magnetic resonance-guided microwave coagulation. Six patients had distant synchronous metastases. Three patients underwent surgery under lumbar anesthesia. Microwave coagulation was performed percutaneously in 5 lesions and under laparotomy in 4 lesions. Although adverse events related to microwave coagulation (skin necrosis and nerve injury) were observed, no fatal complications occurred. Local re-recurrence was observed in 2 of 9 ablated lesions. Except for 1 patient who died of chronic renal failure, the remaining 7 patients died of cancer. Median overall survival after microwave coagulation for all patients was 10 months (range, 4-37 mo). Median overall survival after discovery of pelvic recurrence in all patients was 22 months (range, 9-42 mo). CONCLUSIONS The benefits of using an open magnetic resonance system in the pelvic cavity include the abilities to treat tumors that cannot be visualized by other modalities, to demonstrate internal architectural changes during treatment, to differentiate treated vs untreated areas, and to allow adjustments to the treatment plan during the procedure. Additional studies are required to clarify the efficacy of tumor coagulation for local control.
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Morikawa S, Naka S, Murakami K, Kurumi Y, Shiomi H, Tani T, Haque HA, Tokuda J, Hata N, Inubushi T. Preliminary clinical experiences of a motorized manipulator for magnetic resonance image–guided microwave coagulation therapy of liver tumors. Am J Surg 2009; 198:340-7. [DOI: 10.1016/j.amjsurg.2009.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Revised: 02/13/2009] [Accepted: 02/16/2009] [Indexed: 11/29/2022]
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Suzuki M, Sakurai H, Seno S, Kitanishi T, Shimizu T, Nishida Y, Morikawa H, Inubushi T, Kitano H. Use of real‐time magnetic resonance image guidance in endoscopic sinus surgery. MINIM INVASIV THER 2009; 14:376-84. [PMID: 16754185 DOI: 10.1080/13645700500381511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We evaluated the effectiveness of magnetic resonance image (MRI) guidance using an optical tracking system (MRI-guided therapy: MRT) in performing endoscopic sinus surgery (ESS). The profiles of the fourteen patients in the present study were as follows: eleven with mucocele in the paranasal sinus, one with recurrent chronic sinusitis, one with maxillary cancer, and one with Graves' ophthalmopathy. Preparation of the MRT system required an additional 54 min in cases involving general anesthesia, and an additional 17 min in cases involving local anesthesia, in comparison with corresponding control groups undergoing ESS in a traditional operating room. We developed nonmetal probes that were visualized in a real-time mode and assistive devices for the optical tracking system that were equipped to avoid obstruction caused by surgical instruments as well as by the hands of surgeons. Using these unique devices, anatomic landmarks were visualized using the present MRT system. The prognosis of patients was favorable, and in particular, no patients with sinus mucocele showed a recurrence of their lesions. We concluded that the MRT system used here for performing ESS was beneficial, especially in terms of the intranasal marsupialization of sinus mucoceles and for the verification of orbital contents.
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Affiliation(s)
- M Suzuki
- Department of Otolaryngology, Shiga University of Medical Science, Seta, Otsu, Japan
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Hata N, Tokuda J, Hurwitz S, Morikawa S. MRI-compatible manipulator with remote-center-of-motion control. J Magn Reson Imaging 2008; 27:1130-8. [PMID: 18407542 DOI: 10.1002/jmri.21314] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To develop and assess a needle-guiding manipulator for MRI-guided therapy that allows a physician to freely select the needle insertion path while maintaining remote center of motion (RCM) at the tumor site. MATERIALS AND METHODS The manipulator consists of a three-degrees-of-freedom (DOF) base stage and passive needle holder with unconstrained two-DOF rotation. The synergistic control keeps the Virtual RCM at the preplanned target using encoder outputs from the needle holder as input to motorize the base stage. RESULTS The manipulator assists in searching for an optimal needle insertion path which is a complex and time-consuming task in MRI-guided ablation therapy for liver tumors. The assessment study showed that accuracy of keeping the virtual RCM to predefined position is 3.0 mm. In a phantom test, the physicians found the needle insertion path faster with than without the manipulator (number of physicians = 3, P = 0.001). However, the alignment time with the virtual RCM was not shorter when imaging time for planning were considered. CONCLUSION The study indicated that the robot holds promise as a tool for accurately and interactively selecting the optimal needle insertion path in liver ablation therapy guided by open-configuration MRI.
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Affiliation(s)
- Nobuhiko Hata
- Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02115, USA.
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Shiomi H, Naka S, Sato K, Demura K, Murakami K, Shimizu T, Morikawa S, Kurumi Y, Tani T. Thoracoscopy-assisted magnetic resonance guided microwave coagulation therapy for hepatic tumors. Am J Surg 2008; 195:854-60. [DOI: 10.1016/j.amjsurg.2007.08.056] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2007] [Revised: 08/22/2007] [Accepted: 08/27/2007] [Indexed: 01/14/2023]
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Baumhauer M, Feuerstein M, Meinzer HP, Rassweiler J. Navigation in Endoscopic Soft Tissue Surgery: Perspectives and Limitations. J Endourol 2008; 22:751-66. [PMID: 18366319 DOI: 10.1089/end.2007.9827] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Matthias Baumhauer
- Division of Medical and Biological Informatics, German Cancer Research Center, Heidelberg, Germany
| | - Marco Feuerstein
- Computer Aided Medical Procedures (CAMP), Technical University Munich (TUM), Munich, Germany
| | - Hans-Peter Meinzer
- Division of Medical and Biological Informatics, German Cancer Research Center, Heidelberg, Germany
| | - J. Rassweiler
- Department of Urology, Clinic Heilbronn, University of Heidelberg, Heilbronn, Germany
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MR-compatible laparoscope with a distally mounted CCD for MR image-guided surgery. Int J Comput Assist Radiol Surg 2007. [DOI: 10.1007/s11548-007-0076-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kurumi Y, Tani T, Naka S, Shiomi H, Shimizu T, Abe H, Endo Y, Morikawa S. MR-guided microwave ablation for malignancies. Int J Clin Oncol 2007; 12:85-93. [PMID: 17443275 DOI: 10.1007/s10147-006-0653-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Indexed: 11/24/2022]
Abstract
Since we first successfully performed magnetic resonance (MR)-guided microwave coagulation therapy for liver tumors in January 2000, we have developed new MR-compatible instruments, laparoscopy and thoracoscopy, which have enabled us to approach liver tumors located just below the diaphragm and in contact with other organs. We have customized software for an MR gradient-based tracking system for the easy detection of the location and orientation of treatment area and for the real-time display of MR temperature maps with a scale bar. Navigation software was customized to enable real-time image navigation. The reformatted images in the two perpendicular planes complemented the limitations of real-time MR imaging. Evaluation software, "FootPrint," was useful for distinguishing treated areas from untreated areas and improved the evaluation of treatment accuracy. These newly developed MR-guided systems that utilize microwave have played important roles in more accurate, safer, and easier treatment for liver tumors. We have treated 184 patients using these new techniques without major complications.
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Affiliation(s)
- Yoshimasa Kurumi
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
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Busse H, Schmitgen A, Trantakis C, Schober R, Kahn T, Moche M. Advanced approach for intraoperative MRI guidance and potential benefit for neurosurgical applications. J Magn Reson Imaging 2006; 24:140-51. [PMID: 16739122 DOI: 10.1002/jmri.20597] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To present an advanced approach for intraoperative image guidance in an open 0.5 T MRI and to evaluate its effectiveness for neurosurgical interventions by comparison with a dynamic scan-guided localization technique. MATERIALS AND METHODS The built-in scan guidance mode relied on successive interactive MRI scans. The additional advanced mode provided real-time navigation based on reformatted high-quality, intraoperatively acquired MR reference data, allowed multimodal image fusion, and used the successive scans of the built-in mode for quick verification of the position only. Analysis involved tumor resections and biopsies in either scan guidance (N = 36) or advanced mode (N = 59) by the same three neurosurgeons. Technical, surgical, and workflow aspects were compared. RESULTS The image quality and hand-eye coordination of the advanced approach were improved. While the average extent of resection, neurologic outcome after functional MRI (fMRI) integration, and diagnostic yield appeared to be slightly better under advanced guidance, particularly for the main surgeon, statistical analysis revealed no significant differences. Resection times were comparable, while biopsies took around 30 minutes longer. CONCLUSION The presented approach is safe and provides more detailed images and higher navigation speed at the expense of actuality. The surgical outcome achieved with advanced guidance is (at least) as good as that obtained with dynamic scan guidance.
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Affiliation(s)
- Harald Busse
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany.
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Demura K, Morikawa S, Murakami K, Sato K, Shiomi H, Naka S, Kurumi Y, Inubushi T, Tani T. An Easy-to-Use Microwave Hyperthermia System Combined with Spatially Resolved MR Temperature Maps: Phantom and Animal Studies. J Surg Res 2006; 135:179-86. [PMID: 16580694 DOI: 10.1016/j.jss.2006.02.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Revised: 01/13/2006] [Accepted: 02/07/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hyperthermia has been used in multimodal cancer treatments, and in randomized, controlled studies, hyperthermia is an effective cancer therapy. For clinical accuracy and safety, however, temperature monitoring during treatment is essential. We aimed to develop a convenient microwave hyperthermia system combined with spatially resolved real-time temperature monitoring to improve its efficacy and safety. MATERIALS AND METHODS Using an MR-compatible irradiation-type microwave applicator, agar phantoms, thigh muscles of rabbit, and subcutaneous VX2 tumors of rabbit were heated in combination with noninvasive MR temperature maps. For MR temperature calculation, a proton resonance frequency method was used. After determination of temperature coefficients and evaluation of the precision in MR thermometry, distribution of microwave heating over time was examined for each substance. RESULTS The temperature coefficients of phantoms, rabbit muscles, and VX2 tumors were -0.00977, -0.00976, and -0.01027 ppm/ degrees C, respectively. The 95% limits of agreement of MR and fluoroptic thermometry in the three subjects were +0.318/-0.339 degrees C, +0.693/-0.661 degrees C, and +0.564/-0.526 degrees C, respectively. Concerning VX2 tumor, the average tumor temperature was 42.60 +/- 0.14 degrees C and the surface of skin was 43.27 +/- 0.45 degrees C in the 60-min experimental period. CONCLUSIONS With this easy-to-use microwave hyperthermia system, effective hyperthermia was accomplished in phantoms and living animals in combination with MR temperature maps.
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Affiliation(s)
- Koichi Demura
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan.
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Yamaguchi T, Mukaisho KI, Yamamoto H, Shiomi H, Kurumi Y, Sugihara H, Tani T. Disruption of erythrocytes distinguishes fixed cells/tissues from viable cells/tissues following microwave coagulation therapy. Dig Dis Sci 2005; 50:1347-55. [PMID: 16047486 DOI: 10.1007/s10620-005-2786-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Microwave coagulation therapy (MCT) has recently been applied to treat hepatic tumors. However, the histological changes in the liver following MCT have not been fully elucidated. A type of cell death known as microwave fixation has been reported in areas adjacent to the microwave irradiator electrodes, and these areas are without acid phosphatase (AcP) activity. Diagnosis of microwave-fixed tissue by hematoxylin and eosin (HE) staining is very difficult because morphology is well maintained for months. In an effort to clarify the histological changes and the mechanisms of microwave fixation, we performed HE staining, enzyme histochemistry for AcP, and electron microscopy in both rat and human liver samples after MCT. Although the microwave-fixed tissues maintained their structure on HE staining, membranes of microwave-fixed cells were seriously damaged and there were no apparent organelle structures in these cells on electron microscopy. Erythrocytes were also damaged in these tissues on both light and electron microscopy. The cause of microwave fixation is thought to be injury of the membrane, which is similar to coagulative necrosis. In conclusion, microwave fixation can be considered a type of coagulative necrosis without enzyme digestion. Disruption of erythrocytes on HE staining is an interesting and important diagnostic clue in distinguishing nonviable fixed tissues from viable tissues following MCT.
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Affiliation(s)
- Tsuyoshi Yamaguchi
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowa-cho, Ohtsu, Shiga, 520-2192, Japan.
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Sato K, Morikawa S, Inubushi T, Kurumi Y, Naka S, Haque HA, Demura K, Tani T. Alternate Biplanar MR Navigation for Microwave Ablation of Liver Tumors. Magn Reson Med Sci 2005; 4:89-94. [PMID: 16340163 DOI: 10.2463/mrms.4.89] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Real-time MR (magnetic resonance) images in two perpendicular planes, both of which included the path of the needle, were utilized for MR-guided microwave ablation of liver tumors. The two image planes were automatically and alternately switched by new MR scanner control software installed on an external PC. This technique is possible only with MRI (magnetic resonance imaging) units with multiplanar and multisection capabilities. Reformatted images in the corresponding two planes were also constructed from preoperative three-dimensional volume data. These four images (two real-time and two reformatted) were continuously visible to the surgeons. These images enabled the needle position in the three-dimensional space to be accurately and clearly recognized, in contrast to the difficulty encountered with two-dimensional MR images in a single image plane. This technique was also applied to MR temperature mapping during microwave ablation, as it allowed monitoring of the spread of the heat in a three-dimensional space. This type of computer-integrated image navigation was demonstrated to be feasible for MR-guided microwave ablation of liver tumors.
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Affiliation(s)
- Koichiro Sato
- Department of Surgery, Shiga University of Medical Science, Ohtsu, Shiga 520-2192, Japan.
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Hoffmann J, Westendorff C, Troitzsch D, Ernemann U, Reinert S. Bilddatengestützte Navigation zur Steuerung der interstitiellen Lasertherapie von vaskulären Malformationen im Kopf- und Halsbereich / Image-guided Interstitial Laser Treatment of Vascular Malformations in the Head and Neck. BIOMED ENG-BIOMED TE 2004; 49:199-201. [PMID: 15481407 DOI: 10.1515/bmt.2004.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laser-induced interstitial thermal therapy (LITT) is a proven minimally invasive surgical technique for the treatment of haemangiomas and vascular malformations, and various tumours. The intra-lesion application of thermal energy destroys regional tissue. The percutaneous placement of the laser fibre for photocoagulation is done without the benefit of direct visual control. Image-data-based LITT was performed in patients (five procedures) with extensive venous malformations in the maxillofacial area. The system comprised a specially developed Nd:YAG laser fibre introducer set used in conjunction with fused high-resolution computed tomography, and magnetic resonance image-data--based surgical navigation. In all cases, follow-up examination clearly showed a diminishment in tumour volume, and all patients reported significant subjective improvement. The results suggest that navigation-guided LITT can be performed safely, preserving vital structures from collateral thermal damage.
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Affiliation(s)
- J Hoffmann
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Tübingen.
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Morikawa S, Inubushi T, Kurumi Y, Naka S, Sato K, Demura K, Tani T, Haque HA, Tokuda J, Hata N. Advanced computer assistance for magnetic resonance-guided microwave thermocoagulation of liver tumors. Acad Radiol 2003; 10:1442-9. [PMID: 14697012 DOI: 10.1016/s1076-6332(03)00508-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to utilize computer assistance effectively for both easy and accurate magnetic resonance (MR) image-guided microwave thermocoagulation therapy of liver tumors. MATERIALS AND METHODS An open configuration MR scanner and a microwave coagulator at 2.45 GHz were used. Navigation software, a 3D Slicer, was customized to combine fluoroscopic MR images and preoperative MR images for the navigation. New functions to display MR temperature maps with simple parameter setting, and to record and display the coagulated areas by multiple microwave ablations in the 3-dimensional space (footprinting), were also introduced into the software. The VGA signal of the computer display was directly transferred to the surgeon's monitor. RESULTS The customized software could be used for both accurate image navigation and convenient and easy temperature monitoring. Because repeated punctures and ablations are usually required in this procedure, the footprinting function made targeting of the tumors both easy and accurate and was quite effective in achieving the necessary and sufficient treatment. Furthermore, clear display on the surgeon's monitor, which was obtained by direct transfer of the VGA signal, enabled precise image navigation. CONCLUSION The newly developed computer assistance was quite useful and helpful for this MR-guided procedure.
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Affiliation(s)
- Shigehiro Morikawa
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Seta Tsukinowa-cho, Ohtsu, Shiga 520-2192, Japan
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Abstract
Parallel with current applications in minimally invasive surgery, the introduction of new imaging modalities, and the availability of high-performance computing, new image-guided therapies are being developed at an impressive rate. Indeed, across a broad front of imaging technologies, rapid advances are being realized. Vastly refined technology for processing and using images, as well as improved therapeutic end-effectors, have no doubt hastened this remarkable progress. At the same time, advances in clinical evaluation and complementary technologies will provide the necessary infrastructure through which IGT can be applied in diverse therapeutic settings--from the already well-established neurosurgical applications to the thermal ablation of tumors in organs other than the brain. That IGT is more efficient and effective and less expensive than conventional surgery has been confirmed both in extensive, long-term studies and in ongoing, revolutionary applications in the operating room. We have laid critical groundwork with this extraordinary technology and have now begun to realize quantifiable benefits in terms of improved surgical and patient outcomes.
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Affiliation(s)
- Kirby G Vosburgh
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
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