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Objective: To investigate the application effect of augmented reality and mixed reality navigation technology in three-dimensional(3D) laparoscopic narrow right hepatectomy(LRH). Methods: A retrospective analysis was performed on the clinical data of 5 patients with hepatic malignancy admitted to the First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University from September 2020 to June 2021,all of whom were males,aged from 42 to 74 years.Preoperative evaluation was performed using the self-developed 3D abdominal medical image visualization system; if all the 5 patients were to receive right hemihepatectomy,the remnant liver volume would be insufficient,so LRH were planned.During the operation,the independently developed 3D laparoscopic augmented reality and mixed reality surgical navigation system was used to perform real-time multi-modal image fusion and interaction between the preoperative 3D model and 3D laparoscopic scene.Meanwhile,intraoperative ultrasound assisted indocyanine green fluorescence was used to determine the surgical path.In this way,the LRH under the guidance of augmented reality and mixed reality navigation was completed.The predicted liver resection volume was evaluated before surgery,actual resected liver volume,surgical indicators and postoperative complications were analyzed. Results: All the 5 patients completed LRH under the guidance of augmented reality and mixed reality navigation technology,with no conversion to laparotomy.The median operative time was 300 minutes(range:270 to 360 minutes),no intraoperative blood transfusion was performed,and the median postoperative hospital stay was 8 days(range:7 to 9 days).There were no perioperative deaths,or postoperative complications such as liver failure,bleeding,or biliary fistula. Conclusion: For patients who need to undergo LRH,the use of augmented and mixed reality navigation technology can safely and effectively guide the implementation of surgery,retain more functional liver volume,improve surgical safety,and reduce postoperative complications.
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Adult , Aged , Humans , Male , Middle Aged , Augmented Reality , Hepatectomy/methods , Imaging, Three-Dimensional , Laparoscopy/methods , Liver Neoplasms/surgery , Retrospective Studies , TechnologyABSTRACT
After more than 20 years of multidisciplinary integration of medical science and technology,as well as research and practice in innovative diagnosis and treatment,digital medicine 4.0 has made a profound and important impact on the development of traditional surgery. To combine traditional surgery with digital medicine 4.0 technology is the direction of surgery development in the future.New technologies represented by digital intelligent navigation surgery have been deeply explored and widely applied in the diagnosis and treatment of many surgical diseases. With the innovative development and application of artificial intelligence,Big Data and mixed reality technology,the surgery will develop in ways similar to aerospace automatic and intelligent navigation,leading to the advent of digital medicine 5.0.
Subject(s)
Humans , Artificial Intelligence , Medicine , Surgery, Computer-Assisted , TechnologyABSTRACT
OBJECTIVE: To investigate the application value of fusion indocyanine green fluorescence imaging(FIGFI)in the surgical treatment of recurrent hepatocellular carcinoma.METHODS: From January 2015 to January 2018,theclinical data of 12 patients with recurrent hepatocellular carcinoma who received surgical treatment guided by three-dimensional visualization technology combined with FIGFI at Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University were analyzed. High-quality thin-slice CT data were collected for three-dimensionalvisualization and reconstruction,individualized liver segmentation and preoperative surgical planning. FIGFI was used todefine the demarcation of tumors,to determine the extent of hepatectomy,and to detect small hepatocellular carcinomaand metastases during the operation. The use of FIGFI in combination with three-dimensional visualization imagesguided the precision hepatectomy. postoperative efficacy was observed by follow-up.RESULTS: All the 12 patientsunderwent successful three-dimensional reconstruction and liver resection. Preoperative CT revealed 12 lesions(80%);intraoperative FIGFI detected 15 lesions(100%);of the three newly discovered lesions,2 were hepatocellular carcinomaand 1 was cirrhosis nodule. The operation time was 267.5(183,345)minutes and the amount of bleeding was 287.5(62.5,513.5)m L. No severe complications such as abdominal hemorrhage,abdominal infection,bile leakage and liverfailure occurred postoperatively. No death occurred during the perioperative period. The median follow-up period was 29 (3-36)months; during the follow-up period, 1 casewas lost and 4 cases had metastasis or recurrence.All the patients were alive at the end of the follow-up.CONCLUSION: FIGFI is helpful to achieveanatomical, functional and radical hepatectomy inthe treatment of recurrent hepatocellular carcinoma.
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OBJECTIVE: To systematically review the effectiveness and safety of three-dimensional visualization technology(3 DVT) for precise diagnosis and treatment of primary liver cancer(PLC). METHODS: The cohort studies regarding using3 DVT in precise diagnosis and treatment of PLC were collected by searching several national and international online databases. The retrieval time was from inception of the database to June 2019. Two reviewers independently screened the literatures, extracted data and evaluated the methodological quality of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. RESULTS: A total of 8 studies were finally included involving 533 patients, with 263 cases in 3 DVT group and 270 in two-dimensional(2D) imaging group. The results of meta-analysis showed that in 3 DVT group, compared with 2 D imaging group, the intraoperative blood loss was reduced(MD=-76.00, 95%CI-127.25—-24.74, P=0.004);the operative time was shortened(MD=-44.81, 95%CI-64.64—-24.98, P0.05). CONCLUSION: The application of3 DVT in precise diagnosis and treatment of PLC is safe and effective, and it can effectively reduce the intraoperative blood loss and the incidence of postoperative complications, accelerate the recovery of postoperative liver function, shorten the operation time and hospitalization time, and reduce the recurrence rate of liver cancer in short-term follow-up.
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OBJECTIVE: To systematically review the safety and effectiveness of indocyanine green(ICG) fluorescence imaging for precise diagnosis and treatment of liver neoplasms.METHODS: PubMed,EMbase,The Cochrane Library,CNKI,WanFang Data and VIP databases were electronically searched to collect cohort Studies which involved ICG fluorescence imaging for precise diagnosis and treatment of liver neoplasms. The retrieval time was from inception of the database to June 2019. Screened the literatures,extracted data,and Meta-analysis was performed by using RevMan 5.3 software.RESULTS: 10 studies were finally included involving 803 patients,with 328 cases in ICG molecular fluorescence imaging group and 475 patients in the control group. The results of meta-analysis showed that in ICG fluorescence imaging group,compared with the control group,the blood transfusion rate was decreased(OR=0.42,95%CI0.22～0.80,P=0.008),the rate of negative incision margin was increased(OR=3.22,95%CI 1.09～9.51,P=0.03),the incidence of postoperative complications was decreased(OR=0.49,95%CI 0.28～0.85,P=0.01). However,there was no statistical differences between the two groups in terms of perioperative blood loss,operation time or hospitalization time(all P>0.05).CONCLUSION: The application of ICG fluorescence imaging in precise diagnosis and treatment of liver neoplasms can effectively reduce the incidence of blood transfusion,the incidence of postoperative complications,and increase the rate of negative incision margin.
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Digital intelligent diagnostic and treatment technology refers to a novel technology which is based by associating digitalized and intelligent high-tech with modern science to form a multi-knowledge and multi-disciplinary domain; it includes three-dimensional visualization,3 D printing,molecular fluorescence imaging,mixed reality,photoacoustic imaging,artificial intelligence-radiomis and real-time multimodal image surgical navigation.It plays a significant role in precision diagnosis,preoperative planning and intraoperative navigation of diseases.The authors' team,combining digital intelligent technology with the actual vascular distribution of patients,has been committed to the realization of individualized liver segmentation,volume calculation,simulation surgery,preoperative planning,mixed reality,tumor boundary definition and real-time image fusion for navigation in liver surgery.The research results were applied clinically,and achieved anatomical,functional,and radical hepatectomy for liver tumors.
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OBJECTIVE:To explore the value of three dimensional(3 D) visualization combined with indocyanine green(ICG) fluorescent imaging and virtual reality(VR) technique in real-time navigation in anatomical liver resections.METHODS:Data of 64 patients with liver neoplasms were collected from January 2016 to June 2018 in Hapatobiliary Surgery,Zhujiang Hospital,Southern Medical University. Pre-operative 64-slice CT or 256-slice CT examination was performed.Thin-slice CT image data were imported into MI-3 DVS to perform 3 D reconstruction of liver, intrahepatic vessels and tumors. The 3 D reconstruction model was then imported into a VR development engine to transform into a VR model, so as to instruct preoperative planning and decision-making; intraoperative Pinpoint fluorescence imager was used to detect liver and tumor, and 3 DV and VR techniques were combined to assist the hepatectomy.During the period of this research,RESULTS: four patients with MI-3 DVS 3 D reconstruction showed clear liver, tumor, and intrahepatic vascular structures.The manipulator with a head-mounted display and a sensor for capturing hand and finger movement was integrated into a 3 D-VR environment to visualize the immersion, spatial and stereoscopic sensation of the pre-3 DV model. FIGFI could be used to define the tumor boundary and the hepatic margin, as well as to detect the small liver cancer and the residual lesion of the liver margin. In the group of 64 patients, left lateral loberesection was performed in 4 cases, left hepatectomy in 16 cases, right anterior resection of the liver in 5 cases, right hepatic resection in 5 cases, right lobe resection in 17 cases, middle hepatectomy in 5 cases and hepatic segmentectomy in11 cases(5 segments, 3 cases, 6 segments, 6 cases, 7 segments, 1 case, 8 segments, 1 case) and caudate lobectomy in 1 case. The actual operation procedure was consistent with the preoperative planning. No severe complications such as intraperitoneal hemorrhage, bile leakage, liver failure, death occurred after operation.CONCLUSION:Multimode imaging technique has important application value in preoperative accurate imaging diagnosis and intraoperative anatomic, functional and radical hepatectomy.
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The digital intelligent medical technology such as three dimensional visualization, three dimensional printing,enhanced/virtual reality technology, indocyanine green molecular imaging are widely used in the clinical diagnosis and treatment of hepatobiliary and pancreatic diseases and showed a booming trend. Perihepatic hilar biliary tract diseases with complex anatomical structure, special physiological pathology character and lower efficiency of diagnosis and treatment are the major and difficult disease in the field of surgery. Efficient preoperative evaluation is the key to improve the efficiency of diagnosis and treatment. The digital intelligent medical technology can be used to obtain the comprehensive, individualized image diagnostic information,and comprehensive analysis the anatomy relations of the hepatic artery, portal vein, bile duct and lesions, and quantitatively measure the liver volume, formulate the reasonable operation scheme, determine the best approach of surgery, predict intraoperative injury risk and improve the surgical treatment effect.
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<p><b>OBJECTIVE</b>To study the value of 3D visualization technique in breast-preserving surgery for breast cancer with immediate breast reconstruction using laparoscopically harvested pedicled latissimus dorsi muscle flap.</p><p><b>METHODS</b>From January, 2015 to May, 2016, 30 patients with breast cancer underwent breast-preserving surgery with immediate breast reconstruction using pedicled latissimus dorsi muscle flap. The CT data of the arterial phase and venous phase were collected preoperatively and imported into the self-developed medical image 3D visualization system for image segmentation and 3D reconstruction. The 3D models were imported into the simulation surgery platform for virtual surgery to prepare for subsequent surgeries. The cosmetic outcomes of the patients were evaluated 6 months after the surgery. Another 18 patients with breast cancer who underwent laparoscopic latissimus dorsi muscle breast reconstruction without using 3D visualization technique from January to December, 2014 served as the control group. The data of the operative time, intraoperative blood loss and postoperative appearance of the breasts were analyzed.</p><p><b>RESULTS</b>The reconstructed 3D model clearly displayed the anatomical structures of the breast, armpit, latissimus dorsi muscle and vessels and their anatomical relationship in all the 30 cases. Immediate breast reconstruction was performed successfully in all the cases with median operation time of 226 min (range, 210 to 420 min), a median blood loss of 95 mL (range, 73 to 132 mL). Evaluation of the appearance of the breast showed excellent results in 22 cases, good appearance in 6 cases and acceptable appearance in 2 cases. In the control group, the median operation time was 283 min (range, 256 to 313 min) and the median blood loss was 107 mL (range, 79 to 147 mL) with excellent appearance of the breasts in 10 cases, good appearance in 4 cases and acceptable appearance in 4 cases.</p><p><b>CONCLUSION</b>3D reconstruction technique can clearly display the morphology of the latissimus dorsi and the thoracic dorsal artery, allows calculation of the volume of the breast and the latissimus dorsi, and helps in defining the scope of resection of the latissimus dorsi to avoid injuries of the pedicled vessels. This technique also helps to shorten the operation time, reduce intraoperative bleeding, and improve the appearance of the reconstructed breast using pedicled latissimus dorsi muscle flap.</p>
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<p><b>OBJECTIVE</b>To study the clinical value of digital 3D technique combined with nanocarbon-aided navigation in endoscopic sentinel lymph node biopsy for breast cancer.</p><p><b>METHODS</b>Thirty-nine female patients with stage I/II breast cancer admitted in our hospital between September 2014 and September 2015 were recruited. CT lymphography data of the patients were segmented to reconstruct digital 3D models, which were imported into FreeForm Modeling Surgical System Platform for visual simulation surgery before operation. Endoscopic sentinel lymph node biopsy and endoscopic axillary lymph node dissection were then carried out, and the accuracy and clinical value of digital 3D technique in endoscopic sentinel lymph node biopsy were analyzed.</p><p><b>RESULTS</b>s The 3D models faithfully represented the surgical anatomy of the patients and clearly displayed the 3D relationship among the sentinel lymph nodes, axillary lymph nodes, axillary vein, pectoralis major, pectoralis minor muscle and latissimus dorsi. In the biopsy, the detection rate of sentinel lymph nodes was 100% in the patients with a coincidence rate of 87.18% (34/39), a sensitivity of 91.67% (11/12), and a false negative rate of 8.33% (1/12). Complications such as limb pain, swelling, wound infection, and subcutaneouseroma were not found in these patients 6 months after the operation.</p><p><b>CONCLUSION</b>Endoscopic sentinel lymph node biopsy assisted by digital 3D technique and nanocarbon-aided navigation allows a high detection rate of sentinel lymph nodes with a high sensitivity and a low false negative rate and can serve as a new method for sentinel lymph node biopsy for breast cancer.</p>
Subject(s)
Female , Humans , Axilla , Breast Neoplasms , Diagnosis , Endoscopy , Imaging, Three-Dimensional , Lymph Node Excision , Lymphatic Metastasis , Nanoparticles , Sentinel Lymph Node , Pathology , Sentinel Lymph Node BiopsyABSTRACT
<p><b>OBJECTIVE</b>To assess the value of three-dimensional (3D) visualization technique in preoperative diagnosis, preoperative evaluation and surgical guidance for hepatolithiasis.</p><p><b>METHODS</b>The 64-slice spiral CT data of 30 hepatolithiasis cases were imported in a self-designed medical image processing system for 3D reconstruction of the intrahepatic bile duct. The preoperative diagnosis and pathological classification were derived from the reconstructed model, with which the feasibility and safety of the surgical plan were assessed by simulation of the surgical procedures. The consistency between the simulated procedure and the actual operation was evaluated, and the residual stones were detected using cholangiography with a T-shaped tube.</p><p><b>RESULTS</b>When the model setting was configured to render the liver translucent, the system clearly displayed the site and number of the bile duct calculi as well as the expansion or narrowing of the intrahepatic bile duct. A total consistency (100%) was found between the surgical findings and the preoperative findings based on the 3D model, and also between the actual surgical procedures and the preoperative simulation in 30 cases. The consistency rate between the actual surgical protocols and the preoperative surgical plan was 90%. Follow-up of 27 of the patients for 6 months showed a recurrence rate of 7.4% (2/27) after the operation.</p><p><b>CONCLUSION</b>The 3D visualization system allows accurate preoperative diagnosis and precise surgical operation to reduce the postoperative recurrence rate, and can be of value as a new diagnostic and treatment modality in biliary surgery.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bile Ducts, Intrahepatic , Diagnostic Imaging , General Surgery , Cholangiography , Gallstones , Diagnostic Imaging , General Surgery , Imaging, Three-Dimensional , Tomography, Spiral Computed , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To study the application of digitized three-dimensional (3D) image reconstruction in living-related kidney transplantation.</p><p><b>METHODS</b>The image data of 16-slice spiral CT in 5 cases of living-related kidney transplantation were collected to reconstruct the 3D model of the donor and recipient, which were then imported in the FreeForm Modeling System. The optimal surgical approach for each individual case was planned and simulated for verification. During the actual surgeries, the surgical findings were compared against the reconstructed model and the results of simulated surgery.</p><p><b>RESULTS</b>The 3D model clearly displayed the anatomy of the kidney and the variation of the related vessels. The optimal surgical approaches were planned through the simulated surgery. The anatomy of the kidney and the related vessels found in the actual surgeries were consistent with that displayed by the reconstructed 3D model. All the operations were completed successfully according to the surgical plan, and the patients recovered uneventfully without obvious complications.</p><p><b>CONCLUSION</b>Three-dimensional reconstruction and simulated surgery allow optimization of the surgical approaches of living-related kidney transplantation to ensure successful operation and minimize the surgical risks.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Computer Simulation , Imaging, Three-Dimensional , Kidney Transplantation , Diagnostic Imaging , Methods , Living Donors , Tomography, Spiral ComputedABSTRACT
<p><b>OBJECTIVE</b>To assess the clinical value of digitalized minimally invasive technique in the treatment of the hepatolithiasis.</p><p><b>METHODS</b>The 64-slice spiral CT data were acquired from 4 hepatolithiasis patients for three-dimensional reconstruction and simulation operation using abdominal medical image-3D visualization system (MI-3DVS). Three-dimensional reconstruction was performed for the liver, hepatic arteries, hepatic veins, portal veins, intrahepatic bile ducts and calculi. Based on the size and position of the calculi and the distribution of the dilated or stenotic biliary ducts, several simulation operations such as partial hepatectomy and hepaticojejunstomy were performed. With guidance by the findings in the simulation operation, the actual minimally invasive operation was performed.</p><p><b>RESULTS</b>The three-dimensional models of the liver, hepatic arteries, hepatic veins, portal veins, intrahepatic bile ducts and calculi were reconstructed successfully, which clearly visualized the site and the number of calculi and the condition of the involved intrahepatic bile ducts. Guided by the three-dimensional models and the simulation operations, partial hepatectomy and hepaticojejunstomy were performed and the calculi were removed completely in all the 4 cases with maximum preservation of the residual liver volume.</p><p><b>CONCLUSION</b>Three-dimensional reconstruction and simulation operation allows digital minimally invasive treatment of hepatolithiasis, which can be a new approach to hepatobiliary surgery.</p>
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Bile Ducts, Extrahepatic , Diagnostic Imaging , General Surgery , Bile Ducts, Intrahepatic , Diagnostic Imaging , General Surgery , Computer Simulation , Gallstones , Diagnostic Imaging , General Surgery , Hepatectomy , Methods , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Methods , Minimally Invasive Surgical Procedures , Methods , Tomography, Spiral ComputedABSTRACT
<p><b>OBJECTIVE</b>To study the value and the clinical application of the Medical Image three-dimensional Visualization System of Abdomen (MI-3DVS) in diagnosis and evaluating resectability of pancreatic tumor.</p><p><b>METHODS</b>Twelve patients with pancreatic tumor were tested with 64-slice helical CT (64-MSCT) angiography, and the CT data was reconstructed with MI-3DVS from November 2008 to August 2009. The 3D findings were adopted in diagnosis and evaluating resectability, and the results were compared with surgical operation and the pathological finding. There were 7 male and 5 female, aged from 14 to 83 years. Within the 12 cases, there were 4 cases with pancreatic carcinoma, 5 cases with pancreatic solid pseudopapillary tumor, 2 cases with pancreatic serous cystadenoma, 1 case with pancreatic cyst (ductal epithelial papillary hyperplasia).</p><p><b>RESULTS</b>Nine tumors which had been regarded as removable pre-operatively with MI-3DVS were removed successfully. Three patients who were considered unresectable by other hospitals with CT were operated successfully with MI-3DVS. The other 3 patients' tumors were actually not able to be removed as pre-operative evaluation.</p><p><b>CONCLUSION</b>MI-3DVS plays an important role in diagnosis and assessment of resectability of pancreatic tumor.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Imaging, Three-Dimensional , Pancreatic Neoplasms , Diagnostic Imaging , General Surgery , Radiography, Abdominal , Methods , Tomography, Spiral ComputedABSTRACT
<p><b>OBJECTIVE</b>To study the applied value of abdominal medical image proceeding system (AMIPS) in extended hepatectomy.</p><p><b>METHODS</b>Sixty-four-slice spiral computer tomography (CT) scan data of 32 cases treated from September 2007 to July 2009 (15 male, 17 female; mean age 52 years old) with liver tumor was collected, among which there were 9 cases with huge liver tumor. The data was imported into AMIPS for sequence segmenting and three-dimensional (3D) reconstruction. The reconstructed models were imported into virtual system of AMIPS for digital hepatic segment partition and extended hepatectomy analysis for huge liver tumor of 9 cases. According to the calculated data, suitable modus operandi were selected.</p><p><b>RESULTS</b>In the AMIPS, the 3D models could show the relationships between the lesions to the surrounding tissue more intuitively and the type of blood supply. Digital hepatic segment partition made localize lesions more exactly. It was possible to hepatic segmentectomy and analysis of extended hepatectomy by calculating the relative volume of hepatic segment of huge liver tumor. Huge liver tumor of 9 cases performed different modus operandi, including two cases with right hemi hepatectomies, five cases with hepatic segmentectomy of S6 and S7, two cases with hepatic segmentectomy of S5-7 and part of the S8. There were margin-free tumor cells and no complications such as liver failure in all cases. The average hospitalization time was 21 d.</p><p><b>CONCLUSION</b>AMIPS is helpful in the diagnosis of hepatic disease and in the optimizing surgical plans which can decrease surgical risk and help prevent postoperative hepatic failure.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Computer Simulation , Hepatectomy , Methods , Imaging, Three-Dimensional , Liver Neoplasms , General Surgery , Tomography, Spiral Computed , User-Computer InterfaceABSTRACT
<p><b>OBJECTIVE</b>To study the effect of SiRNA-EGFR on the expression of hyaluronidase gene in human breast cancer cells.</p><p><b>METHODS</b>Reverse transcription-polymerse chain reaction was used to detect the changes in the expression of EGFR mRNA in human breast cancer cell lines MDA-MB-231, MDA-MB-435S, ZR-75 and ZR-75-30 after transfection by SiRNA-EGFR.</p><p><b>RESULTS</b>After transfection with SiRNA-EGFR, the expression levels of EGFR were significantly inhibited in MDA-MB-231, MDA-MB-435S, ZR-75 and ZR-75-30 cells (P<0.05).</p><p><b>CONCLUSION</b>Transfection by SiRNA-EGFR can inhibit the expression of EGFR mRNA in human breast cancer cells.</p>
Subject(s)
Female , Humans , Breast Neoplasms , Metabolism , Pathology , Cell Line, Tumor , Hyaluronoglucosaminidase , Genetics , RNA Interference , RNA, Messenger , Genetics , Metabolism , RNA, Small Interfering , Genetics , ErbB Receptors , Genetics , Metabolism , TransfectionABSTRACT
<p><b>BACKGROUND</b>With the rapid development of computer technology, digital medicine has become a new direction in surgery. The application of digital medicine in hepatic surgery is still at the early stage and less reported in the literature. The aim of this study was to apply digital medical technology in the context of hepatic surgery.</p><p><b>METHODS</b>Data from 64-slice helical computed tomography of 17 patients, including 13 with hepatocellular carcinoma and 4 with hepatic hemangioma, were imported into independently developed medical image software program, segmentation and three-dimensional reconstruction were performed. The three-dimensional models were then processed with the FreeForm Modeling System. We used virtual surgical instruments to perform surgery on the models. Simulated surgeries included six hepatic segmentectomies, four left hemihepatectomies, three right hemihepatectomies for hepatocellular carcinoma, one hepatic segmentectomy, two stripping surgeries, and one irregular segmentectomy combined with stripping surgery for hemangioma. For resections involving more than three hepatic segments, total and residual functional hepatic volumes were measured before and after simulation surgery, and the resection ratio was calculated.</p><p><b>RESULTS</b>The anatomy of the models was distinct and was used to localize lesions. We used virtual surgical instruments to perform simulated surgeries and used the models to optimize actual surgeries. We were able to minimize resection volume as well as surgical risk.</p><p><b>CONCLUSIONS</b>Digital medical technology is helpful in the diagnosis of hepatic disease and in optimizing surgical plans. Three-dimensional models can decrease surgical risk and help prevent postoperative hepatic failure.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Liver , Diagnostic Imaging , General Surgery , Tomography, X-Ray Computed , MethodsABSTRACT
<p><b>OBJECTIVE</b>To investigate the value of virtual surgery in hepatic artery reconstruction in liver recipients with type II hepatic artery variation.</p><p><b>METHODS</b>A patient with cholangiocellular carcinoma and a healthy individual were scanned using 64-slice spiral CT, and image segmentation and three-dimensional (3D) reconstruction were performed using an image processing system. The 3D models in STL format were then imported to the FreeForm Modeling System for smoothing and refinement. Hepatic artery reconstruction was performed in simulated liver transplantation using the virtual surgery system with force feedback (PHANTOM).</p><p><b>RESULTS</b>The reconstructed model contained the liver, hepatic arteries, biliary system, and bile duct tumor emboli and displayed the entire branching of the hepatic artery with type II variation. Using the virtual surgery system, arterial reconstruction was performed by anastomosing the donor celiac trunk and the recipient abdominal aorta with the virtual scalpel and needle.</p><p><b>CONCLUSION</b>The reconstructed model allows clearer views of the 3D structures of the arteries in the liver and helps in preoperative preparations and surgical planning of artery reconstruction during liver transplantation. This approach may also help reduce the surgical risks and potential complications.</p>
Subject(s)
Female , Humans , Middle Aged , Computer Simulation , Computer-Assisted Instruction , Methods , Hepatic Artery , Congenital Abnormalities , General Surgery , Imaging, Three-Dimensional , Methods , Liver Neoplasms , Diagnostic Imaging , Pathology , General Surgery , Liver Transplantation , Surgery, Computer-Assisted , Methods , Tomography, Spiral ComputedABSTRACT
<p><b>OBJECTIVE</b>To investigate the significance of three dimensional visualization and virtual surgery system in living related donor liver transplantation surgery.</p><p><b>METHODS</b>Two patients suffered biliary calculi were scanned by 64 slice helical computer tomography (CT) on livers and the data were imported into medical image proceeding system (MIPS) for sequence. Man-made segmentation and true-up on the image from the data were carried out. Three dimensional (3D) models of the liver and the intrahepatic vessels were reconstructed by VTK software respectively. The models were exported with format STL from it and then were imported into the FreeForm Modeling System for smoothing and modifying. At last, living related donor liver transplantation were simulated with the force-feedback equipment (PHANToM).</p><p><b>RESULTS</b>It had great verisimilar image for the reconstructed 3D liver models with artery, hepatic vein, portal vein and bile duct. By seeing through liver, it had high fidelity and strong 3D effect for the intrahepatic artery, hepatic vein, portal vein and bile duct, and their spatial disposition and course and co-relationship were shown clearly. In the virtual surgery system, the virtual scalpel could be manipulated on 3D liver model with PHANToM. The simulating effect was the same as the clinic operation for living related donor liver transplantation.</p><p><b>CONCLUSIONS</b>The visualized liver model reconstructed is 3D and verisimilar, and it is helpful to design reasonable scheme for liver transplantation. It can improve the surgical effect, decrease the surgical risk, reduce the complication, enhance the communication between doctor and patient through designing surgical plan and demonstrating visualized operation before surgery.</p>
Subject(s)
Adult , Female , Humans , Computer Simulation , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Liver , Diagnostic Imaging , Liver Transplantation , Living Donors , Models, Anatomic , Tomography, Spiral Computed , User-Computer InterfaceABSTRACT
<p><b>OBJECTIVE</b>To study the clinical application of digital medical in the operation on primary liver cancer.</p><p><b>METHODS</b>The patients (n=11) with primary hepatic carcinoma treated between February and July 2008, including 9 cases of hepatocellular carcinoma, 2 cases of cholangiocellular carcinoma, were scanned using 64 slices helicon computerized tomography (CT) and the datasets was collected. Segment and three-dimensional (3D) reconstruction of the CT image was carried out by the medical image processing system which was developed. And the 3D moulds were imported to the FreeForm Modeling System for smoothing. Then the hepatectomy in treatment of hepatoma and implanting of catheter were simulated with the force-feedback equipment (PHANToM). Finally, 3D models and results of simulation surgery were used for choosing mode of operation and comparing with the findings during the operation.</p><p><b>RESULTS</b>The reconstructed models were true to life, and their spatial disposition and correlation were shown clearly; Blood supply of primary liver cancer could be seen easily. In the simulation surgery system, the process of virtual partial hepatectomy and implanting of catheter using simulation scalpel and catheter on 3D moulds with PHANToM was consistent with the clinical course of surgery. Life-like could be felt and power feeling can be touched during simulation operation.</p><p><b>CONCLUSIONS</b>Digital medical benefited knowing the relationship between primary liver cancer and the intrahepatic pipe. It gave an advantage to complete primary liver cancer resection with more liver volume remained. It can improve the surgical effect and decrease the surgical risk and reduce the complication through demonstrating visualized operation before surgery.</p>