[Application of indocyanine green-fluorescent imaging technique in planning resection line and real-time surgical navigation in small hepatocellular carcinoma]

[Clinical practice guidelines for precision diagnosis and treatment of complex liver tumor guided by three-dimensional visualization technology (version 2019)]

Virtual resection of liver structures guided by three-dimensional visualization technology (3DVT) has been extensively used in China. This technique provides a safe and effective method for accurate diagnosis of liver tumors and has important applications in preoperative evaluation, surgical planning and intraoperative guidance of liver cancer surgeries. The technical advantages and clinical significance of 3DVT in the diagnosis and treatment of complex liver tumors have been recognized. In order to standardize the application of 3DVT in the precision diagnosis and treatment of complex liver tumors, this guideline provides explanations and recommendations in the following aspects: (1) the establishment of homogenization processing and quality control system of 3D reconstruction; (2) the establishment of 3D reconstructed models of abdominal organs and lesions; (3) the individualized classification and quantitative analysis of blood vessels based on 3DVT; (4) 3DVT-based classification and grading of hepatic vessels in complex hepatic tumors; (5) evaluation system for surgery evaluation after reconstruction of the 3D visualization model; (6) application of 3D printing in complex hepatectomy; (7) virtual reality technology; (8) ICG fluorescence imaging; (9) multi-modal images for real-time navigation; (10) three-dimensional visualization to guide the preoperative surgical planning of precision hepatectomy; (11) application of 3DVT guidance in other therapeutic methods of hepatocellular carcinoma; (12) application of 3DVT in follow-up evaluation of the patients after liver cancer surgeries. 3DVT for visualization of the liver structures has important clinical values for accurate preoperative evaluation, preoperative planning and surgical navigation of complex liver tumors, and it facilitates precision surgeries to improve the outcomes and promote postoperative recovery of the patients.

Digital and intelligent liver surgery in the new era: Prospects and dilemmas

Despite tremendous advances in traditional imaging technology over the past few decades, the intraoperative identification of lesions is still based on naked eye observation or pre-operative image evaluation. However, these two-dimensional image data cannot objectively reflect the complex anatomical structure of the liver and the detailed morphological features of the lesion, which directly limits the clinical application value of these imaging data in surgery in that it cannot improve the curative efficacy of surgery and the prognosis of the patient. This traditional mode of diagnosis and treatment has been changed by digital medical imaging technology in the new era with its significant function of accurate and efficient diagnosis of diseases, selection of reasonable treatment schemes, improvement of radical resection rate and reduction of surgical risk. In this paper, we reviewed the latest application of digital intelligent diagnosis and treatment technology related to liver surgery in the hope that it may help to achieve accurate treatment of liver surgery diseases.