Intra-operative navigation of a 3-dimensional needle localization system for precision of irreversible electroporation needles in locally advanced pancreatic cancer

Abstract Introduction Irreversible electroporation (IRE) uses multiple needles and a series of electrical pulses to create pores in cell membranes and cause cell apoptosis. One of the demands of IRE is the precise needle spacing required. Two-dimensional intraoperative ultrasound (2-D iUS) is curren...

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Bibliographic Details
Published in:European journal of surgical oncology 2017-02, Vol.43 (2), p.337-343
Main Authors: Bond, Logan, BS, Schulz, Brittany, MD, VanMeter, Tracy, MD, Martin, Robert CG., MD, PhD
Format: Article
Language:English
Subjects:
Adenocarcinoma - pathology
Adenocarcinoma - therapy
Adult
Electroporation
Electroporation - instrumentation
Female
Hematology, Oncology and Palliative Medicine
Humans
Imaging, Three-Dimensional
Intraoperative Period
Male
Needles
Pancreatic carcinoma
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - therapy
Prospective Studies
Surgery
Surveys and Questionnaires
Tomography, X-Ray Computed
Treatment Outcome
X-ray computed tomography
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Summary:Abstract Introduction Irreversible electroporation (IRE) uses multiple needles and a series of electrical pulses to create pores in cell membranes and cause cell apoptosis. One of the demands of IRE is the precise needle spacing required. Two-dimensional intraoperative ultrasound (2-D iUS) is currently used to measure inter-needle distances but requires significant expertise. This study evaluates the potential of three-dimensional (3-D) image guidance for placing IRE needles and calculating needle spacing. Patients and Methods A prospective clinical evaluation of a 3-D needle localization system (ExplorerTM ) was evaluated in consecutive patients from April 2012 through June 2013 for unresectable pancreatic adenocarcinoma. 3-D reconstructions of patients’ anatomy were generated from preoperative CT images, which were aligned to the intraoperative space. Results Thirty consecutive patients with locally advanced pancreatic cancer were treated with IRE. The needle localization system setup added an average of 6.5 minutes to each procedure. The 3-D needle localization system increased surgeon confidence and ultimately reduced needle placement time. Conclusion IRE treatment efficacy is highly dependent on accurate needle spacing. The needle localization system evaluated in this study aims to mitigate these issues by providing the surgeon with additional visualization and data in 3-D. The ExplorerTM system provides valuable guidance information and inter-needle distance calculations.
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2016.09.009