Virtual liver resection: computer‐assisted operation planning using a three‐dimensional liver representation

Mise, Yoshihiro; Tani, Kazuhide; Aoki, Taku; Sakamoto, Yoshihiro; Hasegawa, Kiyoshi; Sugawara, Yasuhiko

doi:10.1007/s00534-012-0574-y

Cited by 82 publications

(62 citation statements)

References 52 publications

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“…The 3D reconstruction system allows surgeons to perform virtual surgery on the 3D model of a liver, which maximizes the human-computer interaction in the course of medical treatment [24,25] . The process is helpful for surgeons to understand fully the specific details about key parts [26,27] . The occurrence of intraoperative incidents, such as biliary and vascular injuries, bleeding, and bile leakage, can be effectively prevented by designing different resection planes and optimizing surgical strategies [28,29] .…”

Section: Discussionmentioning

confidence: 99%

Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis

He¹,

Bai²,

Aji³

et al. 2015

WJG

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AIM:To evaluate the reliability and accuracy of threedimensional (3D) reconstruction for liver resection in patients with hepatic alveolar echinococcosis (HAE). METHODS:One-hundred and six consecutive patients with HAE underwent hepatectomy at our hospital between May 2011 and January 2015. Fifty-nine patients underwent preoperative 3D reconstruction and "virtual" 3D liver resection before surgery (Group A). Another 47 patients used conventional imaging methods for preoperative assessment (Group B). Outcomes of hepatectomy were compared between the two groups. RESULTS:There was no significant difference in preoperative data between the two groups. groups had good correlation with actual graft weight (Group A: r = 0.978; Group B: r = 0.960). There was a significant higher serum level of albumin in Group A (26.3 ± 5.9 vs 22.6 ± 4.3 g/L, P < 0.05). Other postoperative laboratory parameters (serum levels of aminotransferase and bilirubin; prothrombin time) and duration of postoperative hospital stay were similar. Sixteen complications occurred in Group A and 19 in Group B. All patients were followed for 3-46 (mean, 17.3) mo. There was no recurrence of lesions in Group A, but two recurrences in Group B. There were three deaths: two from cerebrovascular accident, and one from car accident. CONCLUSION:3D reconstruction provides comprehensive and precise anatomical information for the liver. It also improves the chance of success and reduces the risk of hepatectomy in HAE. Core tip: With the rapid development of digital medicine, three-dimensional (3D) reconstruction software has become a new tool in surgery, and it is a quantitative imaging analysis system that provides real-time interactive tools for presurgical evaluation and planning. We compared the clinical results of hepatectomy for hepatic alveolar echinococcosis based on 3D software with traditional assessment. We found that liver resection based on 3D reconstruction was more effective in the diagnosis and treatment of HAE than techniques without 3D reconstruction. Such 3D reconstruction software for preoperative evaluation and surgical planning could increase the chance of success of surgery and reduce operative risk.

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Section: Discussionmentioning

confidence: 99%

Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis

He¹,

Bai²,

Aji³

et al. 2015

WJG

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“…Current advances in 3D imaging techniques have facilitated clear visualization of the hepatic veins as well as simulation of the perfused region. 21 Consideration of the perfused region in the estimation of the residual liver volume corresponding to the hepatic functional reserve is important for safe liver surgery. Resection was performed after identifying the route of IRHV distribution and the perfused region by 3D imaging in our patients, and the 3D images were considered useful for IRHV-conserving surgery.…”

Section: Discussionmentioning

confidence: 99%

Verification of Inferior Right Hepatic Vein–Conserving Segments 7 to 8 Resection of the Liver

Nakayama

Takayama

Higaki

et al. 2015

International Surgery

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This study aims to investigate the safety of inferior right hepatic vein (IRHV)-conserving surgery by comparing the surgical data and postoperative complications between IRHVconserving segments 7 to 8 (S7 to S8) resection and conventional right hemihepatectomy (RH). Five patients who underwent IRHV-conserving S7 to S8 segmentectomy between 2007 and 2011 (IRHV group) and 25 liver cancer patients who underwent RH without biliary tract reconstruction during the same period (RH group) were investigated. The surgical data, postoperative complications, and duration of hospital stay were compared. The IRHV and RH groups included 2 (40%) and 13 (52%) hepatocellular carcinoma patients, respectively. There were no significant differences in liver function before surgery between the groups. The presence of the IRHV did not adversely affect the processing of the short hepatic vein or frontal dissection of the inferior vena cava. The operative time was shorter (median, 366 minutes versus 501 minutes; P ¼ 0.0001), the postoperative bilirubin level was lower (12 mg/dL versus 1.8 mg/dL; P ¼ 0.037), and the duration of hospital stay was shorter (10 days versus 14 days; P ¼ 0.002) in the IRHV group. No significant differences were noted in the intraoperative blood loss, postoperative transaminase levels, or the incidence of severe complications (Clavien grade IIIb or higher) between the groups. IRHV-conserving resection of the liver is a safe surgical procedure that is useful in preventing postoperative elevation of bilirubin level and in shortening the duration of hospital stay. 1,2 When performing radical and safe liver resection, it is necessary to secure a sufficient surgical margin 3 and set the resection range in consideration of the residual liver volume to preserve liver function. 4,5 In order to ensure the liver volume remains sufficient to prevent postoperative liver failure, the surgical procedure is frequently selected based on evaluation of liver function through assessment of the retention of indocyanine green after 15 minutes (ICGR15 test). 6For cancer with hepatocaval confluence involving the right hepatic vein, although right hemihepatectomy [RH; resection of liver segments 5 þ 6 þ 7 þ 8 (S5þ S6 þ S7 þ S8)] or vascular reconstruction is generally selected, 7,8 liver resection conserving the caudal region of the right lobe (S5 and S6) is considered an option for patients with an inferior right hepatic vein (IRHV).9 Makuuchi et al 10 proposed 4 surgical procedures for IRHV-conserving liver resection. Various researchers have described IRHV-conserving surgery, in which they reported that the technique to expose blood vessels around the inferior vena cava is complex and may have an associated risk.11-14 However, in our experience, the blood vessels may be exposed safely-similar to the exposure applied in the series of liver mobilization techniques accompanying conventional RH-by securing a visual field in which the right wall of the inferior vena cava is observed directly by applying thoracolaparotomy. 15 In addition...

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“…7 Furthermore, it is now possible to perform a preoperative virtual liver resection to aid in planning the surgical procedure. 8 A volumetric CT scan can be used to estimate precisely liver volume before transplant. 9 There are several software programs commercially available to aid in volumetric analyses, which include manual, semiautomated (interactive), or automated segmentation analyses.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Sonnemans

Hol²,

Monshouwer³

et al. 2016

Exp Clin Transplant

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Objectives: Before liver transplant, it is necessary to know the size of the organ in advance of the procedure. We studied the correlation between liver volumetric computed tomography results and liver weight. Materials and Methods: Postmortem volumetric computed tomography was conducted on cadavers before autopsy, and 3-dimensional liver volume was estimated with semiautomated software. Liver weight was then determined at autopsy. Linear regression and univariate analysis of variance results were used to determine the accuracy of volumetric 3-dimensional computed tomography in estimating liver weight. We also used 2-dimensional liver sizes to design a 2-dimensional formula to estimate liver volume. Results: We found that 3-dimensional volumetric computed tomography was able to accurately estimate liver weight (standard error = 157 g) with a liver density of 0.99 g/mL. Intraobserver and interobserver variabilities were small. The 2-dimensional formula estimated liver weight slightly less accurately (standard error = 212 g). Conclusions: We conclude that liver weight can be estimated accurately with 3-dimensional volumetric computed tomography; estimates were more precise than with the 2-dimensional formula-based liver volume estimation. Volumetric computed tomography can be an important tool during preoperative workup before transplant surgery. Key words: Density, Formula, VolumeIntroduction Liver transplant requires a precise workup of both the donor's and recipient's liver, including evaluation of liver anatomy, parenchyma, vascular supply, and volume. The preoperative assessment of liver volume can be crucial for transplant success. The recipient needs a future liver remnant volume of at least about 30% of the standard liver size. 1,2 In addition, a liver size of about 30% must be preserved in a healthy living donor for survival. Several studies have investigated the estimation of liver size using mathematical formulas to estimate liver volume. [3][4][5][6] However, these formulas were based on the patient's body surface area, body weight, body length, sex, age, and/or race. Standard errors (SE) in the range of 275 to 328 mL were found. Because liver size and shape vary widely between individuals, it may be difficult, if not impossible, to apply estimation formulas with parameters that are based on the body versus the liver.State-of-the-art transplant surgery necessitates imaging of the liver and its vascular supply, which is usually performed with contrast-enhanced computed tomography (CT) or magnetic resonance imaging. Therefore, most donors and recipients of liver transplant have a preoperative CT or magnetic resonance imaging scan. During the past decade, hepatic volumetry and 3-dimensional imaging techniques with CT have been introduced to increase the precision and safety of liver surgery. 7

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Virtual liver resection: computer‐assisted operation planning using a three‐dimensional liver representation

Cited by 82 publications

References 52 publications

Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis

Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis

Verification of Inferior Right Hepatic Vein–Conserving Segments 7 to 8 Resection of the Liver

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