Publications

CAS One IR

Year Purpose Results/Conclusions Reference
2017 Case report on the navigated treatment of lymph node metastases from gastric cancer with a combination of irreversible electroporation and electrochemotherapy Treatment was well tolerated with no major adverse effects.  At 6-week and 8-month follow-up there was no indication of tumor recurrence N. Klein, S. Zapf, E. Gunther, and M. Stehling, “Treatment of lymph node metastases from gastric cancer with a combination of Irreversible Electroporation and Electrochemotherapy: a case report,” Clin. Case Reports, vol. 5, no. 8, pp. 1389–1394, Aug. 2017.
2017 Discussion on 3D navigation in liver ablation Stereotactic thermal ablation procedures are reliable and reproducible and challenge surgical resection as the first line treatment in primary and secondary liver tumors R. Bale, “3D Navigation: do we need it?,” CIRSE, 2017.
2017 Case report on the use of CAS-One IR in a procedure on an inoperable lung metastasis of a Wilms tumor The paediatric patient was successfully treated with percutaneous navigated microwave ablation under high- frequency jet ventilation. The case demonstrates the clinical applicability of new-generation targeting technologies  J. Freedman and P. Harbut, “Navigated Percutaneous Lung Ablation under High-Frequency Jet Ventilation of a Metastasis from a Wilms’ Tumour: A Paediatric Case Report.,” Case Rep. Oncol., vol. 9, no. 2, pp. 400–404, 2016.
2017 Evaluation of the accuracy and safety of antenna placement with the use of a CT-guided stereotactic navigation system for percutaneous ablation Percutaneous microwave ablation performed with CT-guide stereotactic navigation provides sufficient accuracy and requires almost no repositioning of the needle. Therefore, it is technically feasible for safe treatments Engstrand J, Toporek G, Harbut P, Jonas E, Nilsson H, Freedman J. Stereotactic CT-Guided Percutaneous Microwave Ablation of Liver Tumors With the Use of High-Frequency Jet Ventilation: An Accuracy and Procedural Safety Study. Am J Roentgenol. 2017 Jan;208(1):193–200. 
2016 Comparison of needle placement between CT-navigated stereotactic IRE (SIRE) and non-navigated conventional IRE (CIRE) for percutaneous ablation of liver malignancies CT-navigated stereotactic IRE (SIRE) showed a significant reduction in procedure length and higher accuracy vs the conventional (CIRE) approach.  Radiation dose as measured by DLP was significantly lower in the SIRE group Beyer LP, Pregler B, Nießen C, Schicho A, Haimerl M, Jung EM, et al. Stereotactically-navigated percutaneous Irreversible Electroporation (IRE) compared to conventional IRE: a prospective trial. PeerJ. PeerJ, Inc; 2016;4:e2277. 
2016 Case report on navigated IRE as a non-thermic method to perform ablation on malignant liver tumors Procedure was successful. Set-up of navigation device and planning was 23 minutes, and needles (5 electrodes) were placed within 18 minutes, no repositioning was necessary L. Beyer, P. Wiggermann, and C. Stroszczynski, “Stereotaktisch gestützte perkutane irreversible Elektroporation einer malignen Leberläsion unter Verwendung eines computergestützten Navigationssystems,” IROS Poster Present., 2016.
2015 Evaluation of the targeting accuracy of a stereotactic navigation system for CT-guided interventions using an intra-interventional image fusion and needle placement verification module Navigated percutaneous microwave ablation (MWA) has a sufficient level of lateral targeting accuracy (4.1 ± 2.6 mm),suggesting that navigated percutaneous application of MWA is accurate and efficacious. Target positioning error reported by intra-interventional image fusion and treatment verification module might be beneficial for the interventionalist for correcting the depth (longitudinal component) or before making a decision of repositioning the needle (lateral component) Toporek G, Engstrand J, Nilsson H, Michos A, Harbut P, Freedman J, et al. Intra-interventional image fusion and needle placement verification for percutaneous CT-guided interventions. Int J Comput Assist Radiol Surg,. 2015;10(Suppl. 1):37–8.
2015 Overview of ablation modalities used for treatment of hepato­ cellular carcinoma (HCC) and the indications for ablative treatment in common practice Ablative therapies for HCC are becoming more efficient with advances in energy delivery and targeting, and are poised to become first line treatment for tumors < 30 mm in diameter with the benefits of sparing of liver parenchyma, shorter hospitalization time, fewer complications and shorter recovery times for patients Freedman J, Nilsson H, Jonas E. New horizons in ablation therapy for hepatocellular carcinoma. Hepatic Oncol. 2015 Oct;2(4):349–58. 
2014 Safety and feasibility assessment of a multiple microwave ablation strategy in patients with initially unresectable colorectal cancer liver metastases The MWA group showed a 4-year overall survival of 41%, compared to 70% for a historic cohort of primarily resected patients and 4% for patients with palliative treatment, therefore suggesting a survival benefit compared to chemotherapy in the multiple ablation strategy J. Engstrand, H. Nilsson, A. Jansson, B. Isaksson, J. Freedman, L. Lundell, and E. Jonas, “A multiple microwave ablation strategy in patients with initially unresectable colorectal cancer liver metastases - A safety and feasibility study of a new concept.,” Eur. J. Surg. Oncol., vol. 40, no. 11, pp. 1488–93, Nov. 2014.
2013 Comparison of three guiding methods of needle placement for an optical-based navigation system: : freehand, using a stereotactic aiming device and active depth control, and using a stereotactic aiming device and passive depth control Using an aiming device may increase the lateral accuracy of navigated needle insertion. Time requirements were reduced using the aiming device and passive depth control. The lateral component was significantly lower when an aiming device was used (2.31.3–2.81.6mm with an aiming device vs 4.22.0mm without)
 
D. Wallach, G. Toporek, S. Weber, R. Bale, and G. Widmann, “Comparison of freehand-navigated and aiming device-navigated targeting of liver lesions,” Int. J. Med. Robot. Comput. Assist. Surg., vol. 10, no. 1, pp. 35–43, Mar. 2014.
2013 Evaluation of the accuracy of navigated Cone Beam CT (CBCT)-guided needle punctures, controlled with CT scans Stereotactic needle punctures might be planned and performed on volumetric CBCT images and controlled with multidetector CT with positioning accuracy higher or similar to those performed using CT scanners
 
G. Toporek, D. Wallach, S. Weber, R. Bale, and G. Widmann, “Cone-beam Computed Tomography-guided Stereotactic Liver Punctures: A Phantom Study,” Cardiovasc. Intervent. Radiol., vol. 36, no. 6, pp. 1629–1637, Dec. 2013.
Ongoing      
Year Purpose Results/Conclusions Reference
2017 Evaluation of MWA and CAS-One IR navigation versus resection in patients with 1-5 resectable metastases ≤ 30mm where both resection and ablation is possible 50 patients included so far from Groningen, Bern and Stockholm.  Two deaths - one from tumor progression, one from myocardial infarction unrelated to the ablation J. Freedman, H. Nilsson, E. Jonas, K. de Jong, D. Candinas, and P. Tinguely, Microwave Ablation VErsus Resection for Resectable Colorectal liver metastases (MAVERRIC). 2017.

CAS-One Surgery

Completed    
CAS-One Surgery    
Year Purpose Results/Conclusions Reference
2017 Description of a minimally invasive
approach to IRE of pancreatic
tumors using computer-assisted navigation, laparoscopy
and laparoscopic ultrasound
Minimally invasive irreversible electroporation of pancreatic tumors through computer-assisted navigation of needles during laparoscopy is a feasible and accurate approach D. Stillström, H. Nilsson, M. Jesse, M. Peterhans, E. Jonas, and J. Freedman, “A new technique for minimally invasive irreversible electroporation of tumors in the head and body of the pancreas.,” Surg. Endosc., vol. 31, no. 4, pp. 1982–1985, Apr. 2017.
2017 Retrospective
study to evaluate accuracy, efficacy, and safety when using
laparoscopic image-guided microwave ablation for
malignant liver tumors (LIMA)
LIMA does not interfere with the intraoperative workflow and results in low complication and early local recurrence rates, even when simultaneously targeting multiple lesions. LIMA may represent a valid therapy option for patients with extensive hepatic disease within a multimodal treatment approach P. Tinguely, M. Fusaglia, J. Freedman, V. Banz, S. Weber, D. Candinas, and H. Nilsson, “Laparoscopic image-based navigation for microwave ablation of liver tumors—A multi-center study,” Surg. Endosc., Mar. 2017.
2016 Identification and proposal of suitable indications for image-guided navigation systems in open oncologic liver surgery, in particular in liver resection with and without MWA Technological advancements in image guidance are resulting in increased accuracy, so that an increasing number of hitherto untreatable scenarios such as multiple small, bilobar lesions and vanishing lesions are becoming feasible for treatment V. M. Banz, P. C. Müller, P. Tinguely, D. Inderbitzin, D. Ribes, M. Peterhans, D. Candinas, and S. Weber, “Intraoperative image-guided navigation system: development and applicability in 65 patients undergoing liver surgery,” Langenbeck’s Arch. Surg., vol. 401, no. 4, pp. 495–502, Jun. 2016.
2016 Desription of the first use of a new augmented reality navigation system during the laparoscopic rescue of failed portal
vein embolization (PVE)
Surgeon controlled AR has the potential to overcome challenges intrinsic to advanced laparoscopy C. Conrad, M. Fusaglia, M. Peterhans, H. Lu, S. Weber, and B. Gayet, “Augmented Reality Navigation Surgery Facilitates Laparoscopic Rescue of Failed Portal Vein Embolization.,” J. Am. Coll. Surg., vol. 223, no. 4, pp. e31-4, Oct. 2016.
2016 Presentation of a novel registration approach in laparoscopic liver surgery, which reconstructs in real-time an intraoperative volume of the underlying intrahepatic vessels through an ultrasound sweep process The registration accuracy of the proposed method is adequate for laparoscopic intrahepatic tumor targeting. The presented approach is feasible and fast and may, therefore, not be disruptive to the current surgical work flow M. Fusaglia, P. Tinguely, V. Banz, S. Weber, and H. Lu, “A Novel Ultrasound-Based Registration for Image-Guided Laparoscopic Liver Ablation,” Surg. Innov., vol. 23, no. 4, pp. 397–406, Aug. 2016.
2015 A case report on navigated liver surgery for a complex hydatid cyst with biliary tree communication The procedure was easily performed, suggesting that navigation-assisted surgery may guide the surgeon in patients with severe and complicated hydatid cysts F. Panaro, H. Habibeh, P. Pessaux, and F. Navarro, “Navigation liver surgery for complex hydatid cyst with biliary tree communication.,” Int. J. Surg. Case Rep., vol. 12, pp. 112–6, 2015.
2015 Evaluation of whether enhanced three-dimensional
ultrasound (US) could increase the accuracy and efficacy for liver tumor identification
and needle placement
Navigated ultrasound significantly enhances lesion identification regardless of size and enhances needle accuracy for all surgeons, and significantly improves time-to-lesion identification.  This adjunctive system should be considered for both training and for all complex liver tumor ablations R. C. G. Martin and D. A. North, “Enhanced ultrasound with navigation leads to improved liver lesion identification and needle placement.,” J. Surg. Res., vol. 200, no. 2, pp. 420–6, Feb. 2016.
2015 Monograph of the history of stereotactic neurosurgery  Tremendous advances have been made in image-guided liver surgery over the past decade, and further development is needed.  Current systems, including CAS-ONE, provide excellent computer-assisted operation planning with 3D volumetry in addition to basic registration and tracking D. E. Azagury, M. M. Dua, J. C. Barrese, J. M. Henderson, N. C. Buchs, F. Ris, J. M. Cloyd, J. B. Martinie, S. Razzaque, S. Nicolau, L. Soler, J. Marescaux, and B. C. Visser, “Image-guided surgery,” Curr. Probl. Surg., vol. 52, no. 12, pp. 476–520, Dec. 2015.
2015 Description of the first laparoscopic computer-assisted 3D-navigated resection of a vanishing liver metastasis Computer-assisted 3D-navigation enabled a safe oncologic resection of a vanished liver metastasis after chemotherapy, and the post-operative course was uneventful T. Huber, J. Baumgart, M. Peterhans, S. Weber, S. Heinrich, and H. Lang, “Die verschwundene Lebermetastase – Neues Einsatzgebiet für die computerassistierte 3D-navigierte laparoskopische Leberesektion?,” Z. Gastroenterol., vol. 54, no. 1, pp. 40–43, Jan. 2016.
2014 Report on preliminary experience with multiple MWA with computer-assisted liver navigation in advanced neuroendocrine liver metastasis (NLM) Targeting of multiple NLM using navigated MWA can be achieved safely according to this preliminary experience, in particular without infectious complications. This might serve as adjunct to other therapies for the control of advanced NLM P. Tinguely, D. Ribes, M. Worni, M. Peterhans, S. Weber, and D. Candinas, “Preliminary experience with multiple microwave ablation facilitated by computer-assisted liver navigation in advanced neuroendocrine liver metastasis,” IHPBA, 2014.
2014 Investigation of the use of intraoperative navigation systems to improve the accuracy of ablation and surgical resection of so-called “vanishing lesions” For patients with extensive hard-to-treat CRLM, navigated MWA/resection may provide excellent tumor control, improving longer-term survival. Intraoperative navigation systems provide precise, real-time information to the surgeon, aiding the decision-making process and substantially
improving the accuracy of both ablation and resection
V. M. Banz, M. Baechtold, S. Weber, M. Peterhans, D. Inderbitzin, and D. Candinas, “Computer planned, image-guided combined resection and ablation for bilobar colorectal liver metastases,” World J. Gastroenterol., vol. 20, no. 40, p. 14992, Oct. 2014.
2011 Discussion on the use of computer-assisted navigation during liver surgery Stereotactic percutaneous interventions are highly accurate compared with open and laparoscopic surgery.  Low complication rates and similar local recurrence and survival rates as compared to conventional surgery make stereotactic radiofrequency ablation an attractive option for the treatment for primary and secondary liver tumors R. Bale, G. Widmann, and W. Jaschke, “Navigated Open, Laparoscopic, and Percutaneous Liver Surgery - Journals - NCBI,” Minerva Chir., vol. 66, no. 5, pp. 435–453, 2011.