Value of 3D printing technology combined with indocyanine green fluorescent navigation in complex laparoscopic hepatectomy

Abstract

Background Laparoscopic hepatectomy (LH) has achieved rapid progress over the last decade. However, it is still challenging to apply laparoscopy to lesions located in segments I, VII, VIII, and IVa and the hepatic hilar region due to difficulty operating around complex anatomical structures. In this study, we applied three-dimensional printing (3DP) and indocyanine green (ICG) fluorescence imaging technology to complex laparoscopic hepatectomy (CLH) to explore the effects and value of the modified procedure. Materials and methods From January 2019 to January 2021, 54 patients with complex hepatobiliary diseases underwent LH at our center. Clinical data were collected from these patients and retrospectively analyzed. Results A total of 30 patients underwent CLH using the conventional approach, whereas 24 cases received CLH with 3DP technology and ICG fluorescent navigation. Preoperative data were compared between the two groups. In the 3DP group, we modified the surgical strategy of four patients (4/24, 16.7%) due to real-time intraoperative navigation with 3DP and ICG fluorescent imaging technology. We did not modify the surgical strategy for any patient in the non-3DP group (P = 0.02). There were no significant differences between the non-3DP and 3DP groups regarding operating time (297.7±104.1 min vs. 328.8±110.9 min, P = 0.15), estimated blood loss (400±263.8 ml vs. 345.8±356.1 ml, P = 0.52), rate of conversion to laparotomy (3/30 vs. 2/24, P = 0.79), or pathological outcomes including the incidence of microscopical R0 margins (28/30 vs. 24/24, P = 0.57). Additionally, there were no significant differences in postoperative complications or recovery conditions between the two groups. No instances of 30- or 90-day mortality were observed. Conclusion The optimal surgical strategy for CLH can be chosen with the help of 3DP technology and ICG fluorescent navigation. This modified procedure is both safe and effective, but without improvement of intraoperative and short-term outcomes.

A clinical assessment of three-dimensional-printed liver model navigation for thrice or more repeated hepatectomy based on a conversation analysis

“…Despite the findings described in the proceedings sheet, we found that conversation analyses before, during, and after utilization of 3D-printed liver models were effective assessments of the clinical value that facilitated fostering common recognition among doctors during surgery and continuing surgery safely [21]. This assessment procedure for navigation surgery is quite different from the previously reported assessments [25][26][27][28][29][30][31][32][33][34]. In the present study, according to our conversation analysis, the clinical value of 3D-printed liver model navigation was shown to have an educational effect for non-expert surgeons under the guidance of an expert surgeon.…”

“…Such an assessment focuses only on topologically navigating accuracy, which should be evaluated using another approach for a clinical assessment. Meanwhile, there have been some reports comparing surgical results between navigation and non-navigation surgery, but such a comparison does not directly demonstrate the clinical utility of navigation surgery [31][32][33][34]. Despite the findings described in the proceedings sheet, we found that conversation analyses before, during, and after utilization of 3D-printed liver models were effective assessments of the clinical value that facilitated fostering common recognition among doctors during surgery and continuing surgery safely [21].…”

Safety and effectiveness of indocyanine green fluorescence imaging-guided laparoscopic hepatectomy for hepatic tumor: a systematic review and meta-analysis

“…Among them, 1,919 studies were excluded due to duplication, and an additional 2,731 studies were removed after reviewing their titles and abstracts. The remaining 39 full-text articles were reviewed, followed by the removal of 28 articles for various reasons, resulting in the inclusion of 11 studies (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) in the meta-analysis (Figure 1). All 11 studies were retrospective cohort studies, with nine conducted in China and the remaining two in Japan.…”

The role of 3D printing, virtual and augmented reality in liver surgery: The technological imperative!

“…Souzaki et al reported the successful use of 3D printing in a 3-year-old patient diagnosed with hepatoblastoma. [33] The tumor was adjacent to the portal hepatis while she had undergone neoadjuvant chemotherapy prior to the resection. [33] Cheng et al used 3D printing for further guidance in laparoscopic hepatectomy, adjusting the surgical strategy in 4 out of 24 patients after real-time navigation of 3D technology and indocyanine green fluoroscopy.…”

“…[33] The tumor was adjacent to the portal hepatis while she had undergone neoadjuvant chemotherapy prior to the resection. [33] Cheng et al used 3D printing for further guidance in laparoscopic hepatectomy, adjusting the surgical strategy in 4 out of 24 patients after real-time navigation of 3D technology and indocyanine green fluoroscopy. [34] All final pathological microscopic R0 margins were negative in 3D group, while two out of 30 were positive in the non-R0 group, yet without reaching statistical significance.…”