Application of three-dimensional printing technology to precise hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Jian , TAN Yifei , JIANG Li , YANG Jiayin ,  YAN Lunan

Center of Liver transplantation and Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

YAN Lunan, Email: yanlunan668@163.com

Keywords：

three-dimensional printing; precise hepatectomy

DOI：

10.7507/1007-9424.201712100

Video：

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Objective To explore feasibility and effectiveness of three-dimensional (3D) printing technology in precise hepatectomy. Methods The patient was a 60-year-old woman with diagnosis of liver malignancy. The liver model was reconstructed using the IQQA Liver System (EDDA Technology, Inc. USA) based on the CT scan data. The volumes of the liver and the lesion were measured and recorded. The CT data were further digitally reconstructed by means of cloud computing and storage with RevoCloud (V1.0) Medical Imaging System. The best surgical plan was determined by the repeated virtual surgical resection with the reconstruction system, based on the corresponding resected liver volume and the remaining liver volume. Results The reconstruction of liver clearly showed that the tumor invaded the right hepatic and middle hepatic veins, as well as the anterior branch of right portal vein, which was consistent with the conclusion of CT scan. In the other hand, the right posterior branch of the portal vein was completely distributed in the segment Ⅴ and Ⅵ, while a relatively large right posterior inferior vena presented and drained segment Ⅴ and Ⅵ. The anatomic resection of segment Ⅶ, Ⅷ , and Ⅳa was completed according to the preoperative plan. The liver function kept recovering, and the patient discharged a week later. Conclusion Results of this patient show that 3D printing technology can accurately assess anatomic construction of liver and determine relationship between lesion and its surrounding tissue, which can be effectively used in precise hepatectomy.

Citation： YANG Jian, TAN Yifei, JIANG Li, YANG Jiayin, YAN Lunan. Application of three-dimensional printing technology to precise hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(1): 71-76. doi: 10.7507/1007-9424.201712100 Copy

1.	Yan LN. Operative techniques in liver resection. New York: Springer, 2014.
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3.	Tian F, Wu JX, Rong WQ, et al. Three-dimensional morphometric analysis for hepatectomy of centrally located hepatocellular carcinoma: a pilot study. World J Gastroenterol, 2015, 21(15): 4607-4619.
4.	彭驰涵, 李川, 文天夫, 等. 原发性肝癌行 ALPPS 的适应证与禁忌证初探 (附 15 例报道). 中国普外基础与临床杂志, 2015, 22(10): 1183-1186.
5.	Cai YL, Song PP, Tang W, et al. An updated systematic review of the evolution of ALPPS and evaluation of its advantages and disadvantages in accordance with current evidence. Medicine (Baltimore), 2016, 95(24): e3941.
6.	严律南. 肝叶切除术中的半肝血流阻断法. 中国普外基础与临床杂志, 1995, 2(1): 54-55.
7.	严律南. 肝门板及其在肝胆外科的应用. 中国普外基础与临床杂志, 1998, 5(4): 239-239.
8.	严律南, 曾勇, 林琦远, 等. 半肝血流阻断的临床应用. 中国现代普通外科进展, 1998, 1(1): 36-38.
9.	严律南, 卢实春, 陈晓理, 等. 用生物泵行体外静脉转流下的肝叶切除术. 中华肝胆外科杂志, 2000, 6(1): 37-38.
10.	严律南, 袁朝新, 张肇达, 等. 应用半肝血流阻断行肝叶切除术 29 例报告. 中华外科杂志, 1994, 32(1): 35-36.
11.	Wen T, Chen Z, Yan L, et al. Continuous normothermic hemihepatic vascular inflow occlusion over 60 min for hepatectomy in patients with cirrhosis caused by hepatitis B virus. Hepatol Res, 2007, 37(5): 346-352.
12.	Okamura Y, Ito T, Sugiura T, et al. Anatomic versus nonanatomic hepatectomy for a solitary hepatocellular carcinoma: a case-controlled study with propensity score matching. J Gastrointest Surg, 2014, 18(11): 1994-2002.
13.	Cucchetti A, Cescon M, Trevisani F, et al. Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients. World J Gastroenterol, 2012, 18(44): 6398-6408.
14.	孟祥军, 米其武, 梁铸林, 等. CT 三维重建在腹腔镜肾部分切除术中的应用价值. 中国内镜杂志, 2014, 20(2): 189-192.
15.	Zein NN, Hanouneh IA, Bishop PD, et al. Three-dimensional print of a liver for preoperative planning in living donor liver transplantation. Liver Transpl, 2013, 19(12): 1304-1310.
16.	Yang X, Qiu Y, Huang B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: a study of 31 cases. Am J Transplant, 2017, [Epub ahead of print].
17.	范应方, 向飞, 蔡伟,等. 基于三维可视化技术的右半肝门静脉 3D 分型及分段. 南方医科大学学报, 2016, 36(1): 26-31.
18.	Fang CH, Li XF, Li Z, et al. Application of a medical image processing system in liver transplantation. Hepatobiliary Pancreat Dis Int, 2010, 9(4): 370-375.
19.	Ishizawa T, Gumbs AA, Kokudo N, et al. Laparoscopic segmentectomy of the liver: from segment Ⅰ to Ⅷ. Ann Surg, 2012, 256(6): 959-964.
20.	闫峻. 三维重建在精准肝切除术中的应用进展. 世界最新医学信息文摘, 2017, 47(17): 15-16.
21.	Tan Y, Zhang W, Jiang L, et al. Efficacy and safety of anatomic resection versus nonanatomic resection in patients with hepatocellular carcinoma: A systemic review and meta-analysis. PLoS One, 2017, 12(10): e0186930.
22.	Kamiyama T, Nakanishi K, Yokoo H, et al. The impact of anatomical resection for hepatocellular carcinoma that meets the Milan criteria. J Surg Oncol, 2010, 101(1): 54-60.
23.	Yamazaki O, Matsuyama M, Horii K, et al. Comparison of the outcomes between anatomical resection and limited resection for single hepatocellular carcinomas no larger than 5 cm in diameter: a single-center study. J Hepatobiliary Pancreat Sci, 2010, 17(3): 349-358.
24.	Cucchetti A, Qiao GL, Cescon M, et al. Anatomic versus nonanatomic resection in cirrhotic patients with early hepatocellular carcinoma. Surgery, 2014, 155(3): 512-521.
25.	Kudo A, Tanaka S, Ban D, et al. Anatomic resection reduces the recurrence of solitary hepatocellular carcinoma ≤5 cm without macrovascular invasion. Am J Surg, 2014, 207(6): 863-869.
26.	Cucchetti A, Cescon M, Ercolani G, et al. A comprehensive meta-regression analysis on outcome of anatomic resection versus nonanatomic resection for hepatocellular carcinoma. Ann Surg Oncol, 2012, 19(12): 3697-3705.
27.	Hu JX, Dai WD, Miao XY, et al. Bisegmentectomy Ⅶ, Ⅷ for hepatocellular carcinoma in cirrhotic livers. Hepatogastroenterology, 2007, 54(77): 1311-1314.
28.	Kang CM, Choi GH, Kim DH, et al. Revisiting the role of nonanatomic resection of small. J Surg Res, 2010, 160(1): 81-89.
29.	Yamashita Y, Taketomi A, Itoh S, et al. Longterm favorable results of limited hepatic resections for patients with hepatocellular carcinoma: 20 years of experience. J Am Coll Surg, 2007, 205(1): 19-26.

1. Yan LN. Operative techniques in liver resection. New York: Springer, 2014.
2. 许戈良, 刘文斌, 李建生, 等. 位于 7 或 8 段肝癌手术切除效果分析. 中华外科杂志, 2012 50(6): 498-501.
3. Tian F, Wu JX, Rong WQ, et al. Three-dimensional morphometric analysis for hepatectomy of centrally located hepatocellular carcinoma: a pilot study. World J Gastroenterol, 2015, 21(15): 4607-4619.
4. 彭驰涵, 李川, 文天夫, 等. 原发性肝癌行 ALPPS 的适应证与禁忌证初探 (附 15 例报道). 中国普外基础与临床杂志, 2015, 22(10): 1183-1186.
5. Cai YL, Song PP, Tang W, et al. An updated systematic review of the evolution of ALPPS and evaluation of its advantages and disadvantages in accordance with current evidence. Medicine (Baltimore), 2016, 95(24): e3941.
6. 严律南. 肝叶切除术中的半肝血流阻断法. 中国普外基础与临床杂志, 1995, 2(1): 54-55.
7. 严律南. 肝门板及其在肝胆外科的应用. 中国普外基础与临床杂志, 1998, 5(4): 239-239.
8. 严律南, 曾勇, 林琦远, 等. 半肝血流阻断的临床应用. 中国现代普通外科进展, 1998, 1(1): 36-38.
9. 严律南, 卢实春, 陈晓理, 等. 用生物泵行体外静脉转流下的肝叶切除术. 中华肝胆外科杂志, 2000, 6(1): 37-38.
10. 严律南, 袁朝新, 张肇达, 等. 应用半肝血流阻断行肝叶切除术 29 例报告. 中华外科杂志, 1994, 32(1): 35-36.
11. Wen T, Chen Z, Yan L, et al. Continuous normothermic hemihepatic vascular inflow occlusion over 60 min for hepatectomy in patients with cirrhosis caused by hepatitis B virus. Hepatol Res, 2007, 37(5): 346-352.
12. Okamura Y, Ito T, Sugiura T, et al. Anatomic versus nonanatomic hepatectomy for a solitary hepatocellular carcinoma: a case-controlled study with propensity score matching. J Gastrointest Surg, 2014, 18(11): 1994-2002.
13. Cucchetti A, Cescon M, Trevisani F, et al. Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients. World J Gastroenterol, 2012, 18(44): 6398-6408.
14. 孟祥军, 米其武, 梁铸林, 等. CT 三维重建在腹腔镜肾部分切除术中的应用价值. 中国内镜杂志, 2014, 20(2): 189-192.
15. Zein NN, Hanouneh IA, Bishop PD, et al. Three-dimensional print of a liver for preoperative planning in living donor liver transplantation. Liver Transpl, 2013, 19(12): 1304-1310.
16. Yang X, Qiu Y, Huang B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: a study of 31 cases. Am J Transplant, 2017, [Epub ahead of print].
17. 范应方, 向飞, 蔡伟,等. 基于三维可视化技术的右半肝门静脉 3D 分型及分段. 南方医科大学学报, 2016, 36(1): 26-31.
18. Fang CH, Li XF, Li Z, et al. Application of a medical image processing system in liver transplantation. Hepatobiliary Pancreat Dis Int, 2010, 9(4): 370-375.
19. Ishizawa T, Gumbs AA, Kokudo N, et al. Laparoscopic segmentectomy of the liver: from segment Ⅰ to Ⅷ. Ann Surg, 2012, 256(6): 959-964.
20. 闫峻. 三维重建在精准肝切除术中的应用进展. 世界最新医学信息文摘, 2017, 47(17): 15-16.
21. Tan Y, Zhang W, Jiang L, et al. Efficacy and safety of anatomic resection versus nonanatomic resection in patients with hepatocellular carcinoma: A systemic review and meta-analysis. PLoS One, 2017, 12(10): e0186930.
22. Kamiyama T, Nakanishi K, Yokoo H, et al. The impact of anatomical resection for hepatocellular carcinoma that meets the Milan criteria. J Surg Oncol, 2010, 101(1): 54-60.
23. Yamazaki O, Matsuyama M, Horii K, et al. Comparison of the outcomes between anatomical resection and limited resection for single hepatocellular carcinomas no larger than 5 cm in diameter: a single-center study. J Hepatobiliary Pancreat Sci, 2010, 17(3): 349-358.
24. Cucchetti A, Qiao GL, Cescon M, et al. Anatomic versus nonanatomic resection in cirrhotic patients with early hepatocellular carcinoma. Surgery, 2014, 155(3): 512-521.
25. Kudo A, Tanaka S, Ban D, et al. Anatomic resection reduces the recurrence of solitary hepatocellular carcinoma ≤5 cm without macrovascular invasion. Am J Surg, 2014, 207(6): 863-869.
26. Cucchetti A, Cescon M, Ercolani G, et al. A comprehensive meta-regression analysis on outcome of anatomic resection versus nonanatomic resection for hepatocellular carcinoma. Ann Surg Oncol, 2012, 19(12): 3697-3705.
27. Hu JX, Dai WD, Miao XY, et al. Bisegmentectomy Ⅶ, Ⅷ for hepatocellular carcinoma in cirrhotic livers. Hepatogastroenterology, 2007, 54(77): 1311-1314.
28. Kang CM, Choi GH, Kim DH, et al. Revisiting the role of nonanatomic resection of small. J Surg Res, 2010, 160(1): 81-89.
29. Yamashita Y, Taketomi A, Itoh S, et al. Longterm favorable results of limited hepatic resections for patients with hepatocellular carcinoma: 20 years of experience. J Am Coll Surg, 2007, 205(1): 19-26.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of three-dimensional printing technology to precise hepatectomy

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