Operativ-chirurgisch orientierte Forschungsvorhaben: Innovative und patientenspezifische Visualisierungstechniken für die perioperative Optimierung der onkologischen Chirurgie von perihilären Cholangiokarzinomen

Preoperative planning in oncologic surgery of perihilar cholangiocarcininoma (pCCA) is essential due to a significant morbidity and mortality of these complex procedures and the very high individual variability of the liver anatomy.

The proposed project aims to optimize treatment of patients with biliary tumors using different technological approaches that all yield in the increase of resectability due to better preoperative planning, surgical preparation and intraoperative orientation, the reduction of complications and an overall improvement of patient care.

One goal is to enable a more precise preoperative visualization by optimized imaging using latest photon-coutning detector computed tomography (PCD-CT) for lilar and especially biliary structures. Furthermore a preoperative planning support for surgeons using artificial intelligence will be developed.

The standard of care for intraoperative orientation in hepatobiliary surgery is the intraoperative ultrasound (IOUS). However, this technique is only partly useful in pCCA. Therefore, the project also aims to improve intraoperative orientation through virtual (VR) and augmented reality (AR) and 3D printing, which has been shown to the beneficial for the treatment of intrahepatic tumors and should also be explored for pCCA. Additionally, the IOUS has recently been fused with preoperative 3D reconstructions as commercially available Real Time Virtual Sonography (RVS). The technique has only been described for intrahepatic tumors regarding the liver. The combination of optimized preoperative visualization for pCCA with RVS IOUS may also enable an improved intraoperative orientation during these procedures.

All four work packages influence and build on one another to improve outcomes in these hightly complex oncologic surgeries for pCCA by optimizing current patient care and, with a consistent and lasting contribution, surgical treatment and training.
The unique advantage of the consortium is the established and successful research cooperation between clinicians and engineers as well as the high experience in the field of liver surgery, liver imaging and computer-aided evaluation and analysis.