Three-Dimensional Liver Surgery Simulation: Computer-Assisted Surgical Planning with Three-Dimensional Simulation Software and Three-Dimensional Printing

Abstract

To perform accurate hepatectomy without injury, it is necessary to understand the anatomical relationship among the branches of Glisson's sheath, hepatic veins, and tumor. In Japan, three-dimensional (3D) preoperative simulation for liver surgery is becoming increasingly common, and liver 3D modeling and 3D hepatectomy simulation by 3D analysis software for liver surgery have been covered by universal healthcare insurance since 2012. Herein, we review the history of virtual hepatectomy using computer-assisted surgery (CAS) and our research to date, and we discuss the future prospects of CAS. We have used the SYNAPSE VINCENT medical imaging system (Fujifilm Medical, Tokyo, Japan) for 3D visualization and virtual resection of the liver since 2010. We developed a novel fusion imaging technique combining 3D computed tomography (CT) with magnetic resonance imaging (MRI). The fusion image enables us to easily visualize anatomic relationships among the hepatic arteries, portal veins, bile duct, and tumor in the hepatic hilum. In 2013, we developed an original software, called Liversim, which enables real-time deformation of the liver using physical simulation, and a randomized control trial has recently been conducted to evaluate the use of Liversim and SYNAPSE VINCENT for preoperative simulation and planning. Furthermore, we developed a novel hollow 3D-printed liver model whose surface is covered with frames. This model is useful for safe liver resection, has better visibility, and the production cost is reduced to one-third of a previous model. Preoperative simulation and navigation with CAS in liver resection are expected to help planning and conducting a surgery and surgical education. Thus, a novel CAS system will contribute to not only the performance of reliable hepatectomy but also to surgical education.

An Integrated Suture Simulation System with Deformation Constraint Under A Suture Control Strategy

“…The closer the virtual curve to the real one, the better the simulation method is. Virtual tissues are simulated with our system, and three other suture simulation systems: a skin suture system based on works of Choi et al [Choi, Chan and Pang (2012)], a liver suture system based on works of Oshiro et al [Oshiro and Ohkohchi (2017)], and a vessel suture system based on works of Wang et al [Wang, Guo, Tamiya et al (2014)]. The deformation and force data of real soft tissue from the First Affiliated Hospital of Nanjing Medical University in Nanjing are recorded as the reference substance to show the deformation accuracy of our method.…”

“…The interns are arranged into two groups. The first group will carry out the suture training with our suture surgery system, and the second group will carry out the suture training with three other suture simulation systems: a skin suture system based on works of Choi et al [Choi, Chan and Pang (2012)], a liver suture system based on works of Oshiro et al [Oshiro and Ohkohchi (2017)], and a vessel suture system based on works of Wang et al [Wang, Guo, Tamiya et al (2014)] for a comparison with our system. The training process will last for 30 minutes.…”

Low-field magnetic resonance imaging for 3D volume rendering of canine stifle joint pathologies: a case report

“…High-field MRI data were also used in a stereo 3D reconstruction of the anatomical structures of a normal human ankle and knee, which supported accurate evaluations of tendons, muscles, bones and cartilages (Anastasi et al 2007;Anastasi et al 2009). Three-dimensional reconstruction has evolved into 3D geometrical modelling as an accurate method for simulating and planning or training for computer-aided surgery (Krupa et al 2007;Loke et al 2017;Oshiro and Ohkohchi 2017). For a better understanding or for analysis, the obtained model could be rotated, and the superimposed objects could be switched on and off and cropped.…”

Modeling the hepatic arterial flow in living liver donor after left hepatectomy and postoperative boundary condition exploration

“…Currently, the widely adopted method for hepatic surgery planning is to analyze liver anatomy and predict postoperative remnant liver volume, which should be more than 30% to be considered safe for the donor. In the literature, extensive studies were performed concerning the donor safety in living liver donation, mainly monitoring the postoperative changes in liver function, ie, total bilirubin, aspartate aminotransferase, and alanine aminotransferase .…”