Interventions on the Liver

Better hope for patients with liver cancer - Image Guided Liver Surgery

Primary liver cancer claims one million deaths per year worldwide, and secondary liver cancer caused by metastases spreading to the liver adds a significant number of fatalities to that toll.  Despite this high disease burden, only 10-20% of patients with either type of cancer qualify for surgery, the only treatment known to be a chance for cure. 

New forms of chemotherapy are available, but they can only incrementally increase survival and they come at high individual treatment costs.   The use of innovative surgical and interventional therapies would permit clinicians to treat and even cure liver cancer patients that don’t suit surgery and have little or no other treatment options.  These new interventions physically destroy the tumor by “heat treating” (i.e. ablating) it, using a needle/probe that delivers microwave, radiofrequency or […] into the cancer tissue and destroying it on site.  With this approach there is no need for open liver surgery and the stereotactic image guidance akin to “GPS” tracks the position, movement and behavior of the needle on a screen.  The advantage is twofold: much of the healthy tissue lost by removing parts of the liver surgically remains intact and patients that do not qualify for surgery can qualify for this treatment, giving hope to currently “uncurable” patients. 

The group led by the Chair for Image Guided Therapy Prof. Dr. – Ing. Stefan Weber at the ARTORG Center has carried out research at the forefront of imaging, surgical planning and guidance technology to introduce new and efficacious treatment options for liver cancer.  The research effort included multi-center clinical trials to generate clinical data and evidence of better outcomes from interventions using the planning and guidance technology. 

In keeping with the translational mandate of projects at the ARTORG Center, this liver cancer surgical technology has been translated with the help of a spin-off company CAScination AG (CAScination).  CAScination has successfully commercialized the technology into a product: CAS-One IR®.  CAS-One IR® has regulatory approval and is being used in a number of hospitals, benefitting patients every day.

In collaboration with

Prof. Daniel Candinas (Visceral Surgery, Bern)
Prof. Karl Oldhafer (Surgery, Asklepios Hamburg)
Prof. Hauke Lang (Viszeral Surgery, University Mainz)
Prof. E Jonas and J Freedmann (Karolinska, Stockholm)
Prof. Ferraz Neto Ben Hur (Sao Paolo, Brazil)
Prof. Philippe Morel (HUG Genève)
Prof. Nicolas Demartines (CHUV Lausanne)

To increase surgical precision in complex surgical resections of the liver we are aiming at the development of a stereotactic instrument guidance system. Such systems will help the surgical team to orientate and precisely locate critical anatomical structures. In this project we are combining our expertises on registration of medical image data, surgical navigation technology and medical device development.

CT Guided Interventions on the Liver

In collaboration with

Prof. Dr. Joachim Kettenbach (Universitätsklinikum St. Pölten-Lilienfeld, AT)
Prof. Alban Denys (Interventional Radiology, CHUV Lausanne)
Prof. Dr. Reto Bale (Abteilung für Mikroinvasive Therapie - SIP, Universitätsklinik Innsbruck)
Prof. Dr. med. Boris Radeleff (Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg)
PD Dr. Philipp Wiggermann (Institut für Röntgendiagnostik, Universitätsklinikum Regensburg)

Percutaneous needle interventions based on Computed Tomography (CT) have been widely used in medicine as minimally invasive alternatives to open surgical procedures. It not only allows patient treatment and diagnose in less time and with less surgical trauma than open surgery, but also allows patients with poor heart function that cannot undergo conventional surgery to benefit of an alternative treatment. Although the currently used clinical approach is effective, it exposes patient and staff to unnecessary radiation due to the excessive number of CT image acquisitions for needle guidance. In this project, a stereotactic needle guidance system to support percutaneous interventions is being developed. The system aims to aid needle placement on deformable regions of the anatomy (like abdomen and chest) by means of retro-reflective markers placed on the patient skin.

Image Guided Intraoperative Brachytherapy

In collaboration with Radio-Oncology, Inselspital Bern

Prof. Daniel Aebersold
Dr. Jacqueline Vock (Radio-Oncology Clinic, Inselspital Bern)

and Medical Radiation Physics, Inselspital Bern

Dr. Peter Manser
Dr. Dario Terribilini
Dr. Bernhard Isaak 

Current developments in 3D imaging methods, including X-ray computed tomography (CT), have dramatically changed the practices in brachytherapy’s planning. Now, it is feasible to obtain patient-specific, anatomy-related dosimetry estimation as well as highly-accurate applicator position prior to the implantation. However, in order to provide an absolute correlation between clinical output and the pre-planned data, one needs to provide an intraoperative guidance system that fully reproduces planned position of the applicator on the OR. By devising such a system, a large increase in effectiveness of brachytherapy as well as less need for post-operative, verification is expected.