Enhanced ultrasound with navigation leads to improved liver lesion identification and needle placement

• Published in: The Journal of surgical research Vol. 200; no. 2; pp. 420 - 426
• Main Authors: Martin, Robert C.G., MD, PhD, North, Durham Alan, BS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2016
• Subjects: Ablation Techniques - instrumentation; Enhanced ultrasound; Humans; Imaging, Three-Dimensional - methods; Intraoperative imaging; Liver ablation with navigation; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - surgery; Models, Anatomic; Needles; Prospective Studies; Surgery; Three-dimensional ultrasound with navigation; Time Factors; Tomography, X-Ray Computed; Training requirements; Ultrasonography, Interventional - methods; Training requirements; Three-dimensional ultrasound with navigation; Intraoperative imaging; Enhanced ultrasound; Liver ablation with navigation
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2015.09.003

Abstract Background The aim of this study was to evaluate whether enhanced three-dimensional ultrasound (US) could increase the accuracy and efficacy for liver tumor identification and needle placement. Methods In a prospective study, 30 surgeons of various training levels were evaluated for lesion identification success and accuracy of needle placement. All surgeons were evaluated for time (seconds) to identify the liver lesions in an artificial model and placement of needles after review of a 3-phase computed tomography scan of the liver, first using standard B-mode US and then using E-3DUS. Results Participants included 10 hepato-pancreatico-biliary surgeons, 5 surgical fellows, 10 postgraduate years 4 and 5 surgical residents, and 5 postgraduate year-3 residents. Liver lesions were correctly identified in 73% of the cases using B-mode US alone and 100% in E-3DUS. The mean time to identification using B-mode was 51.9 s (standard deviation ±37.1), which was significantly longer than with E-3DUS (time, 17.9 s, standard deviation ±10.7; P  = 0.002). There was significant improvement in time-to-lesion identification using E-3DUS across all training levels ( P ≤ 0.002). There was also a significant reduction in time for accurate needle placement across all training levels (mean reduction of 60%, with enhanced accuracy [ P  = 0.001]) Conclusions E-3DUS significantly enhances lesion identification regardless of size and enhances needle accuracy for all surgeons. This adjunctive system should be considered for both training and for all complex liver tumor ablations.