Surgeons can now practise keyhole surgery to remove tumors on a "virtual 3D liver" before doing it in real patients; the new system, developed
under the pan-European EUREKA Odysseus project, will help to reduce risks to patients and also enable surgeons to take expert advice before doing
Over 44 months and at a cost of more than 7 million Euros, German, French and Norwegian teams working on the the Odysseus project, also known as EUREKA project E! 3184, have developed systems that allow an expert to see 3D images of the liver of an individual patient.
The Odysseus images are created using information from MRI and CT scans and show the liver and its tumors or other pathologies.
Surgeons can send the reconstructions electronically to other experts, allowing them to consult in real time just before carrying out the procedure, get diagnostic support and make collaborative decisions about the best way to plan and do the operation.
According to a statement released earlier this month from the EUREKA secretariat, the system simulates "laparoscopic and robotic surgery, with tissue resistance", allowing surgeons to "practise the exact surgery proposed for an individual patient". The system can also be used to train several surgeons at the same time.
Until now, surgeons have relied on 2D images of organs and tissues, and these have contributed significantly to diagnosis and planning of therapy, especially in the treatment of cancer, the major cause of deaths worldwide.
But 2D scanned images are difficult to interpret for surgical purposes, and the way they are currently produced does not allow the surgeon to show them easily, in real time, to colleagues and other experts who are not physically present.
With the 3D images that the Odysseus software produces, surgeons can see the blood vessels in the patient's liver which helps them understand how the liver is segmented.
Until now, liver surgeons have relied on a classical description of the structure of the human liver that dates back to Couinaud in 1957. But the 3D models have shown that up to 50 per cent of patients have livers that are structured quite differently to that described in the Couinaud model.
Professor Luc Soler of the Institut de Recherche pour les Cancers de l'Appareil Digestif (IRCAD), of the University Hospitals in Strasbourg, France, told the media that:
"Thanks to the 3D modelling, the future of liver surgery has gained more precision through accurate definition of the liver's blood vessels."
IRCAD is one of the French partners in the Odysseus project.
The Odysseus software integrates not only expertise in how to reconstruct a 3D image and relay it remotely in real time, but also specialist knowledge in tumour detection, endoscopy, and virtual simulation.
Some of the key parts of the system are:
- Virtual Patient Modelling (VR-Anat, formerly known as 3D-VPM), which with patient-specific data enables pre-operative assessment.
- Diagnosis and Virtual Planning (VR Planning, formerly 3D DVP), which enables navigation and tool positioning within 3D images that can be reconstructed from any multimedia-equipped computer.
- Argonaute, a communication system that allows several practitioners in different places to interact and advise on the images simultaneously.
- The unlimited laparoscopic simulator (ULIS) and the robotic surgery simulator (SEP Robot): these lend the 3D model characteristic texture and tissue resistance, giving surgeons a realistic feel of what to expect when they operate on the patient.
France Telecom, also a partner in the Odysseus project, developed the Argonaute communication system, while the ULIS and SEP Robot were developed by the German endoscope manufacturer Karl Storz and SimSurgery of Norway.
Soler said the simulator images are hard to distinguish from photos of real surgery.
Once the various products of the system have been tested and validated in trials, the developers expect that doctors will be able to carry out more accurate diagnoses of secondary tumors.
Soler said more lives will be saved because using Odysseus:
"Will reduce secondary tumours in the liver, and it will reduce the segments we have to remove."
Also, because the success of liver surgery depends on the volume of liver that can safely remain, more accurate information about the topology of an individual patient's liver should significantly increase the number of patients eligible for surgery, said the developers.
However, there is still work to be done before the system can be available for general use, said Soler, explaining that:
"Everyone says it is vital to use this system, but we have to wait five years after surgery to prove the benefit of the software on survival rates. So it is too soon to see all the benefits yet."
Created as an intergovernmental Initiative in 1985, EUREKA promotes European competitiveness by supporting pan-European development of innovative products, processes and services through a combination of public and private funding. The organization now comprises some 40 member countries.
-- more info on EUREKA, including how to start a project.
Source: EUREKA Secretariat.
Written by: Catharine Paddock, PhD