PDF(Pubmed)
Abstract：
(1) Introduction: The laparoscopic approach to low pelvic tumors is challenging and hindered by suboptimal tumor visualization and dissection, with possible oncological failure. Stereotactic navigation provides real-time image guidance that may optimize safety, accuracy, and precision when dissecting challenging low pelvic tumors. (2) Methods: Preoperative CT images were acquired with eight skin-fixed fiducials and loaded into a navigation system. A patient tracker was mounted on the bed side. Patient-to-image paired point registration was performed, and an instrument tracker was mounted on a laparoscopic instrument and calibrated for instrument tracking. Surgical operations were performed with real-time stereotactic navigation assistance. (3) Results: Three patients underwent stereotactic navigation surgery. Fiducial registration errors were good to optimal (±1.9, ±3.4, and ±3.4 mm). Lesions were easily identified and targeted with real-time navigation. Surgeries were uneventful. Histopathology examinations identified one retro-rectal schwannoma, one lateral pelvic recurrence from rectal adenocarcinoma, and one advanced anal canal carcinoma. No navigation-related complications, readmissions, or postoperative mortalities were observed. (4) Conclusions: The application of laparoscopic stereotactic navigation surgery to complex low pelvic tumors is feasible and could impact oncological surgical quality by enabling tumor targeting and ensuring resection margins. Further wider series are needed to confirm stereotactic navigation\'s impact on challenging low pelvic tumors.
摘要：
（1）简介：腹腔镜下盆腔肿瘤的方法是具有挑战性的，并受到次优的肿瘤可视化和解剖的阻碍，可能的肿瘤失败。立体定向导航提供实时图像指导，可以优化安全性，准确度,解剖具有挑战性的低骨盆肿瘤时的精确度。（2）方法：使用八个皮肤固定基准采集术前CT图像，并将其加载到导航系统中。患者跟踪器安装在床侧。进行患者-图像配对点配准,和仪器跟踪器安装在腹腔镜仪器上并校准仪器跟踪。在实时立体定向导航辅助下进行外科手术。(3)结果:3例患者行立体定向导航手术。基准配准误差良好至最佳(±1.9、±3.4和±3.4mm)。通过实时导航很容易识别和定位病变。手术很顺利。组织病理学检查发现1例直肠后神经鞘瘤，1例直肠腺癌盆腔外侧复发，和一个晚期肛管癌.无导航相关并发症,再入院,或术后死亡率观察。(4)结论:腹腔镜立体定向导航手术治疗复杂低位盆腔肿瘤是可行的,并能使肿瘤靶向性和保证切缘,影响肿瘤手术质量。需要进一步更广泛的系列来确认立体定向导航对具有挑战性的低骨盆肿瘤的影响。
