A clinical pilot study of Resection Process Map: A novel virtual hepatectomy software to visualize the resection process, case series

3-D reconstruction in liver surgery: a systematic review

BACKGROUND

Three-dimensional reconstruction of the liver offers several advantages to the surgeon before and during liver resection. This review discusses the factors behind the use of liver 3-D reconstruction.

METHODS

Systematic electronic search, according to PRISMA criteria, was performed. A literature search of scientific papers was performed until October 2023. Articles were chosen based on reference to 3-D liver reconstruction and their use in liver surgery. GRADE methodology and the modified Newcastle-Ottawa scale were used to assess the quality of the studies.

RESULTS

The research included 47 articles and 7724 patients were analyzed. Preoperative planning was performed with 3-D liver reconstruction in the 87.2% of the studies. Most of preoperative 3-D liver reconstructions were performed in the planning of complex or major hepatectomies. Complex hepatectomies were performed in 64.3% patients. The 55.3% of the studies reported an improved navigation and accuracy during liver resection. Four studies (8.6%) on living donor liver transplant (LDLT) concluded that 3-D liver reconstruction is useful for graft selection and vascular preservation. Nine papers (19.1%) reported an accurate measurement of future liver remnant.

CONCLUSION

Liver 3-D reconstruction helps surgeons in the planning of liver surgery, especially in liver graft and complex liver resections, increasing the accuracy of the surgical resection.

Application value of mixed reality in hepatectomy for hepatocellular carcinoma

BACKGROUND

As a new digital holographic imaging technology, mixed reality (MR) technology has unique advantages in determining the liver anatomy and location of tumor lesions. With the popularization of 5G communication technology, MR shows great potential in preoperative planning and intraoperative navigation, making hepatectomy more accurate and safer.

AIM

To evaluate the application value of MR technology in hepatectomy for hepatocellular carcinoma (HCC).

METHODS

The clinical data of 95 patients who underwent open hepatectomy surgery for HCC between June 2018 and October 2020 at our hospital were analyzed retrospectively. We selected 95 patients with HCC according to the inclusion criteria and exclusion criteria. In 38 patients, hepatectomy was assisted by MR (Group A), and an additional 57 patients underwent traditional hepatectomy without MR (Group B). The perioperative outcomes of the two groups were collected and compared to evaluate the application value of MR in hepatectomy for patients with HCC.

RESULTS

We summarized the technical process of MR-assisted hepatectomy in the treatment of HCC. Compared to traditional hepatectomy in Group B, MR-assisted hepatectomy in Group A yielded a shorter operation time (202.86 ± 46.02 min vs 229.52 ± 57.13 min, P = 0.003), less volume of bleeding (329.29 ± 97.31 mL vs 398.23 ± 159.61 mL, P = 0.028), and shorter obstructive time of the portal vein (17.71 ± 4.16 min vs 21.58 ± 5.24 min, P = 0.019). Group A had lower alanine aminotransferas and higher albumin values on the third day after the operation (119.74 ± 29.08 U/L vs 135.53 ± 36.68 U/L, P = 0.029 and 33.60 ± 3.21 g/L vs 31.80 ± 3.51 g/L, P = 0.014, respectively). The total postoperative complications and hospitalization days in Group A were significantly less than those in Group B [14 (37.84%) vs 35 (60.34%), P = 0.032 and 12.05 ± 4.04 d vs 13.78 ± 4.13 d, P = 0.049, respectively].

CONCLUSION

MR has some application value in three-dimensional visualization of the liver, surgical planning, and intraoperative navigation during hepatectomy, and it significantly improves the perioperative outcomes of hepatectomy for HCC.

Performance of image guided navigation in laparoscopic liver surgery - A systematic review

BACKGROUND

Compared to open surgery, minimally invasive liver resection has improved short term outcomes. It is however technically more challenging. Navigated image guidance systems (IGS) are being developed to overcome these challenges. The aim of this systematic review is to provide an overview of their current capabilities and limitations.

METHODS

Medline, Embase and Cochrane databases were searched using free text terms and corresponding controlled vocabulary. Titles and abstracts of retrieved articles were screened for inclusion criteria. Due to the heterogeneity of the retrieved data it was not possible to conduct a meta-analysis. Therefore results are presented in tabulated and narrative format.

RESULTS

Out of 2015 articles, 17 pre-clinical and 33 clinical papers met inclusion criteria. Data from 24 articles that reported on accuracy indicates that in recent years navigation accuracy has been in the range of 8-15 mm. Due to discrepancies in evaluation methods it is difficult to compare accuracy metrics between different systems. Surgeon feedback suggests that current state of the art IGS may be useful as a supplementary navigation tool, especially in small liver lesions that are difficult to locate. They are however not able to reliably localise all relevant anatomical structures. Only one article investigated IGS impact on clinical outcomes.

CONCLUSIONS

Further improvements in navigation accuracy are needed to enable reliable visualisation of tumour margins with the precision required for oncological resections. To enhance comparability between different IGS it is crucial to find a consensus on the assessment of navigation accuracy as a minimum reporting standard.

Application of three-dimensional reconstruction and virtual reality technology in liver surgery

After three-dimensional (3D) reconstruction of the two-dimensional information obtained from routine computed tomography or magnetic resonance imaging examinations of the liver using software, surgeons can examine the volume of the liver, anatomical variation, the course of intrahepatic vessels, the location of the tumor, and its relationship with the surrounding vessels more intuitively, vividly, and from multiple angles. Preoperative 3D reconstruction and virtual reality technology can realize the measurement of liver volume and the implementation of simulated hepatectomy, which can further clarify the scope of surgical resection and ensure the residual liver volume and function to meet the needs of patients after operation. The virtual operation and image navigation before and during the operation can also prevent the injury to important blood vessels and bile ducts in the liver during the operation, significantly shorten the operation time, reduce the bleeding during the operation, and reduce the occurrence of complications such as liver dysfunction, bile leakage, and bleeding after the operation.