Clinical Application of Hepatic Operative Simulation on Liver Resection for Right Lobe Tumor_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHEN Gang ¹ , LI Xuecheng ¹ , XIONG Xiaofeng ¹ , WU Guoqing ¹ , YANG Rigao ¹ , WANG Yi ² , FAN Guihua ² , FANG Bin ² , YANG ShiZhong ³ , DONG Jiahong ³

1.Department of General Surgery, The No.324 Hospital of PLA, Chongqing 400020, China;;
2.School of Computer Science, Chongqing University, Chongqing 400038, China;;
3.Department of Hepatobiliary Surgery, General Hospital of PLA, Beijing 100853, China;

Corresponding author：

CHEN Gang , Email: cgang997@163.com

Keywords：

Liver; Tumor; Three-dimension; Liver right lobe; Hepatectomy

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Objective To develop hepatic surgical planning software for hepatic operation on deciding the rational operational scheme and simulating procedures before the operation to accomplish the precise liver resection and decrease the operational risk.
Methods 3D-econstruction of liver was restored from spiral computed tomography (CT) data by using LiVirtue software. The liver and its anatomic structures were reconstructed to illuminate the location of the tumor and its related vessels to design a rational operational scheme. The virtul results, such as liver volume, hepatic sections, anatomy of portal vein and hepatic veins or possible operation plans, were compared with the actual situations during the operations.
Results 3D models of liver, tumor and their relative vessels were reconstructed successfully. Preoperative planning and intra-perative navigation based on the models ensured the safety of liver resection in our 32 cases of right lobe tumors. This preoperative simulation allowed surgeons to dissect the liver with reduced complications. These models could be also viewed and manipulated on personal computers.
Conclusion The LiVirtue is very helpful in the hepatic surgery, for clearly disclosing hepatic structures, rationally deciding operation schemes, virtually simulating the operations. This preoperative estimation from 3D model of liver benefits a lot to complicated liver resection.

Citation： CHEN Gang ,LI Xuecheng,XIONG Xiaofeng,WU Guoqing,YANG Rigao,WANG Yi,FAN Guihua,FANG Bin,YANG ShiZhong,DONG Jiahong. Clinical Application of Hepatic Operative Simulation on Liver Resection for Right Lobe Tumor. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(1): 64-67. doi: Copy

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15.	Radtke A, Nadalin S, Sotiropoulos GC, et al. Computerassisted operative planning in adult living donor liver transplantation: a new way to resolve the dilemma of the middle hepatic vein [J]. World J Surg, 2007; 31(1): 175185.
16.	Glombitza G, Lamade W, Demiris AM, et al. Virtual planning of liver resections: image processing, visualization and volumetric evaluation [J]. Int J Med Inform, 1999; 53(23): 225237.
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18.	Uchida M, Ishibashi M, Sakoda J, et al. CT image fusion for 3D depiction of anatomic abnormalities of the hepatic hilum [J]. Am J Roentgenol, 2007; 189(4): W184W191.
19.	沈啸洪, 李慧锴, 张倜, 等. 肝癌外科规范化治疗若干问题探讨 [J]. 中国普外基础与临床杂志, 2009; 16(4): 261264.
20.	樊嘉, 黄成. 原发性肝癌外科治疗的进展 [J]. 中国普外基础与临床杂志, 2009; 16(4): 257260.
21.	方驰华, 周五一, 黄立伟, 等. 虚拟中国人女性一号肝脏图像三维重建和虚拟手术的切割 [J]. 中华外科杂志, 2005; 43(11): 748752.
22.	朱新勇, 方驰华, 鲍苏苏, 等. 基于64排螺旋CT扫描数据的肝脏图像分割和三维重建 [J]. 南方医科大学学报, 2008; 28(3): 345347.
23.	陈刚, 晋云, 谭立文, 等. 三维数字虚拟人体肝脏系统的建立及其应用 [J]. 第三军医大学学报, 2008; 30(22): 21032106.
24.	陈刚, 张绍祥, 晋云, 等. 三维数字虚拟肝脏对肝脏尾状叶外科应用解剖的研究 [J]. 中华肝胆外科杂志; 2008; 14 (12): 858861.
25.	Chen G, Zhang SX, Tan LW, et al. The study of threedimensional reconstruction of Chinese adult liver [J].Surg Radiol Anat, 2009; 31(6): 453460.

1. Bruix J, Hessheimer AJ, Forner A, et al. New aspects of diagnosis and therapy of hepatocellular carcinoma [J]. Oncogene, 2006; 25(27): 38483856.
2. DeMatteo RP, Fong Y, Blumgart LH. Surgical treatment of malignant liver tumours [J]. Baillieres Best Pract Res Clin Gastroenterol, 1999; 13(4): 557574.
3. Yong T, Bohmer R, Pande G, et al. Liver resection: a regional hospital experience [J]. ANZ J Surg, 2007; 77(Suppl.1): A40.
4. Lau WY, Lai EC. Hepatocellular carcinoma: current management and recent advances [J]. Hepatobiliary Pancreat Dis Int, 2008; 7(3): 237257.
5. Parks RW, Garden OJ. Liver resection for cancer [J]. World J Gastroenterol, 2001; 7(6): 766771.
6. Heriot AG, Karanjia ND. A review of techniques for liver resection [J]. Ann R Coll Surg Engl, 2002; 84(6): 371380.
7. Dulucq JL, Wintringer P, Rashid LM. Virtually bloodless laparoscopic liver resection of recurrent hepatoma with a new laparoscopic sealer device: report of our initial laparoscopic experience [J]. Surg Laparosc Endosc Percutan Tech, 2007; 17(5): 413415.
8. Billingsley KG, Jarnagin WR, Fong Y, et al. Segmentoriented hepatic resection in the management of malignant neoplasms of the liver [J]. J Am Coll Surg, 1998; 187(5): 471481.
9. Herfarth C, Lamade W, Fischer L, et al. The effect of virtual reality and training on liver operation planning [J]. Swiss Surg, 2002; 8(2): 6773.
10. Lang H, Radtke A, Liu C, et al. Extended left hepatectomymodified operation planning based on threedimensional visualization of liver anatomy [J]. Langenbecks Arch Surg, 2004; 389(4): 306310.
11. Urata K, Kawasaki S, Matsunami H, et al. Calculation of child and adult standard liver volume for liver transplantation [J]. Hepatology, 1995; 21(5): 13171321.
12. Bjerner T, Johansson L, Haglund U, et al. 3D surface rendering of images from multiple MR pulse sequences in the preoperative evaluation of hepatic lesions [J]. Acta Radiol, 1998; 39(6): 698700.
13. Soler L, Delingette H, Malandain G, et al. An automatic virtual patient reconstruction from CTscans for hepatic surgical planning [J]. Stud Health Technol Inform, 2000; 70: 316322.
14. Hiroshige S, Nishizaki T, Soejima Y, et al. Beneficial effects of 3dimensional visualization on hepatic vein reconstruction in living donor liver transplantation using right lobe graft [J]. Transplantation, 2001; 72(12): 19931996.
15. Radtke A, Nadalin S, Sotiropoulos GC, et al. Computerassisted operative planning in adult living donor liver transplantation: a new way to resolve the dilemma of the middle hepatic vein [J]. World J Surg, 2007; 31(1): 175185.
16. Glombitza G, Lamade W, Demiris AM, et al. Virtual planning of liver resections: image processing, visualization and volumetric evaluation [J]. Int J Med Inform, 1999; 53(23): 225237.
17. Mortele KJ, McTavish J, Ros PR. Current techniques of computed tomography. Helical CT, multidetector CT, and 3D reconstruction [J]. Clin Liver Dis, 2002; 6(1): 2952.
18. Uchida M, Ishibashi M, Sakoda J, et al. CT image fusion for 3D depiction of anatomic abnormalities of the hepatic hilum [J]. Am J Roentgenol, 2007; 189(4): W184W191.
19. 沈啸洪, 李慧锴, 张倜, 等. 肝癌外科规范化治疗若干问题探讨 [J]. 中国普外基础与临床杂志, 2009; 16(4): 261264.
20. 樊嘉, 黄成. 原发性肝癌外科治疗的进展 [J]. 中国普外基础与临床杂志, 2009; 16(4): 257260.
21. 方驰华, 周五一, 黄立伟, 等. 虚拟中国人女性一号肝脏图像三维重建和虚拟手术的切割 [J]. 中华外科杂志, 2005; 43(11): 748752.
22. 朱新勇, 方驰华, 鲍苏苏, 等. 基于64排螺旋CT扫描数据的肝脏图像分割和三维重建 [J]. 南方医科大学学报, 2008; 28(3): 345347.
23. 陈刚, 晋云, 谭立文, 等. 三维数字虚拟人体肝脏系统的建立及其应用 [J]. 第三军医大学学报, 2008; 30(22): 21032106.
24. 陈刚, 张绍祥, 晋云, 等. 三维数字虚拟肝脏对肝脏尾状叶外科应用解剖的研究 [J]. 中华肝胆外科杂志; 2008; 14 (12): 858861.
25. Chen G, Zhang SX, Tan LW, et al. The study of threedimensional reconstruction of Chinese adult liver [J].Surg Radiol Anat, 2009; 31(6): 453460.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Application of Hepatic Operative Simulation on Liver Resection for Right Lobe Tumor

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