Journal of Surgical Simulation 2019; 6: A: 6 - 6

Published: 06 November 2019


Oral presentation

Special Issue: Using image guidance to transform management of upper GI cancers

Brian Davidson
Corresponding author: Brian Davidson, Department of HPB Surgery, Royal Free and Wellingon Hospitals, London, UK; Centre for Surgical Innovation, Organ Repair and Transplantation, University College London, London, UK. Email:


There has been a rapid development over the last decade in minimally invasive surgery and novel diagnostics for the earlier detection of upper GI cancers. These techniques have been largely led by innovations in imaging and image guidance. Image guidance systems allow augmented reality in which clinicians or surgeons can combine imaging information in real time procedures (surgical resections, diagnostics and targeted biopsies and therapy). The current market for image guided systems is estimated to be worth £2.7 billion annually.

Over the last 10 years we have been developing augmented reality systems for diagnosis and treatment of upper GI cancers. Our aim is to increase the feasibility, safety and accuracy of procedures. The presentation will firstly discuss the development of a novel image guided system for use in laparoscopic liver surgery. The laparoscopic approach to liver surgery is used in only 5-10% of patients because of concerns over risks of bleeding and operative complications in major laparoscopic liver resection. Our system was developed to overlay a 3-dimensional model of an individual patient’s liver on the laparoscopic view of the liver at time of surgery and the major steps will be outlined. Major challenges in system development included image registration, particularly with movement artefact during surgery. Following a 5 year development programme supported by the Department of Health and Wellcome Trust a working system was produced. The system is now being further developed for clinical use supported by NIHR i4i.

Another limitation in laparoscopic liver surgery is the difficult of determining tumour margins without the ability of tumour palpation. Laparoscopic US is limited. We are developing novel mini probes for both laparoscopic and percutaneous tumour therapy which will use multispectral imaging to define tumour margins.

We have also been exploring augmented reality in other GI cancers. Pancreas cancer is cured in only a minority of patients due to late diagnosis and advanced disease at diagnosis. We have been investigating both populations. Pancreas cystic tumours pre-dispose to pancreas cancer. A guidance system is in development to for endoscopic ultrasound (EUS) guided biopsy of premalignant cystic disease to facilitate new therapies, such as EUS guided radio frequency (RF) ablation. In more advanced and unresectable disease irreversible electroporaton (IRE) therapy has been shown to double the median survival of patients undergoing palliative therapy. The main limitation of this novel technique is the difficulty of providing optimal electrode placement for therapy. Whether producing a tumour model which directs needle placement and can predict the likely field of therapy and hence technical success rate is being pursued.


image guidance; upper GI cancer; endoscopic ultrasound; augmented reality

Additional Information

This presentation was given at the 8th Annual Homerton Simulation Conference, Homerton University Hospital, London, UK, on 6 December 2018.

Conflicts of interest: none declared.