Preoperative Diagnosis
The patient, a male born in 1969, was 173cm tall and weighed 77kg. In the left lobe of the liver, there is a sort of circular, slightly low-density shadow that is roughly 23mm by 20mm in size, has indistinct borders, considerably uneven enhancement in the arterial phase, weak enhancement in the venous and delayed phases, and is slightly lower density.The doctor suggests percutaneous radiofrequency ablation treatment for cancer.
Preoperative CT scan shows the lesion site, which is 2 cm in diameter and situated in the left lobe of the liver, behind the sternum and 2 cm from the heart. According to the patient's preoperative CT scans, the lesion lies behind the sternum, and the intestines and diaphragm will be punctured on either side, respectively. The penetration path from the foot side to the head side over several levels is what we intend to plan.
Treatment:
● At 15:00, the subject entered the operating room. After combining ultrasound images, the physician discovered that the lesion was difficult to see since the sternum was obstructing it during a typical breathing state. Even though the lesion was clearly visible upon breathing, the foot to head side puncture angle was still necessary. As a result, the patient was instructed on how to practice breathing and inhalation.
● At 15:03, the preoperative CT scan was finished, with the patient holding their breath as instructed by the doctor. Through PACS, the CT scans are sent to SGNIO's surgical planning software, where SGNIO aligns patient surface aseptic operation and coordinates location. The doctor's initial effort at needle insertion involved starting the needle 2cm below the xiphoid process on the body's surface and moving it 3cm across the layer that separates the foot from the head.
Ultrasound probe blocked by sternum during first needle insertion plan
● At 15:20, manipulator arrived at the intended needle insertion location after performing a terminal landing on the sick human body. The sternum was obstructing the ultrasound probe, preventing the clinician from getting a clean ultrasound image. Thus, a second injection schedule was implemented. The second needle is placed around 4 cm below the right side of the xiphoid process, with the intention of crossing a layer that is roughly 6 cm from the foot side to the head side. For the purpose of fitting the ultrasonic probe into the patient's belly and avoiding obstruction from the xiphoid process, the execution end is spun clockwise along the needle insertion path to a specific angle using SGNIO planning software.
To better suit the ultrasound probe for imaging, rotate the execution end and increase the needle insertion angle in the second needle insertion plan.
● At 15:24, by the time the procedure was completed, the ultrasound probe was properly placed and the intended position had been reached. The participant held their breath in accordance with the preoperative breathing training under the supervision of a physician. Located on the intended insertion path, the liver target lesion was visible in the ultrasonography field. The doctor decided to start the injection.
The operator inserted the needle under the guidance of ultrasound.
● During the process of needle insertion guided by ultrasound, doctors can clearly see the target point, puncture needle, and beating heart in the ultrasound image.
The ultrasound image of the needle insertion process is shown in the figure
● At 15:35, the doctor completed the needle insertion, the manipulator returned to the initial position, and the patient scanned CT to confirm the placement of the ablation needle in the body. After CT confirmation, the ablation needle was inserted into the target site in one go, and the insertion route was consistent with the preoperative planned path.
Verification of the ablation needle's condition on a postoperative plain CT scan and comparison with the intended route
● At this stage, the ablation needle is in place and the puncture needle is completed with the help of SGNIO. The following ablation procedure is started by the physician. Following surgery, the patient had an enhanced CT scan, which revealed decreased echo within the lesion, hazy borders, no enhancement in the lesion's third phase, and no discernible fluid buildup surrounding the liver. After the procedure, the patient recovered well, no unusual discomfort was recorded, and all vital signs were normal three days later.
Comparison image before and after ablation (right image before ablation, left image after ablation)
Result:
SGNIO helped surgeons precisely place and plan suitable cross-level needle insertion routes. SGNIO's ultrasound module simultaneously ensures the safety of the needle insertion procedure by giving doctors clear, real-time surveillance of the procedure. Ultimately, from the initial CT scan until the ablation needle reached the intended target, the procedure only took roughly thirty minutes. The patient's radiation exposure was significantly decreased because they only had two CT scans. The surgery was successfully completed.
