ABSTRACT
INTRODUCTION: Recent technical innovation in liver surgery is remarkable. Now, for example, a preoperative 3D-simulation of the liver is a routine modality, and indispensable (or essential) for liver surgery. The aim of this presentation is to clarify various kinds of progresses and future perspective in liver surgery. PREOPERATIVE MODALITIES 1) One-stop shopping of 3D-simulation of the liver: We newly developed 3D-simulation using a software of SYNAPSE VINCENT Ver. 3.1 (Fujifilm Medical, Tokyo, Japan), in which biliary system is simultaneously reconstructed in one dynamic MD-CT. This technique avoids position error which occurred in 3D fusion image using another modality such as DIC–CT or MRCP, as well as unnecessary radiation exposure. 2) Assessment of partial functional reserve: We have reported new methods to astimate regional hepatic functional reserve using hepatocyte-phase of EOB-MRI (J Gastroenterol 2012), and fusion image of 3D-CT and asialoscintigraphy using 99m-Tc galactosyl human albumin. The method of EOB-MRI utilized character of hepatocyte-uptake of EOB through membrane transporters on hepatocytes. The other used fusion of both asialoscintigram of hepatic functional reserve and 3D-simulation by the above-mentioned software. Those techniques provided accurate estimation of partial functional volume, and help surgeons’ decision making of resection volume. INTRAOPERATIVE MODALITIES: 1) Navigation using iPad: navigation using iPad in which preoperative 3D-image data are uploaded in advance, tumor location, accurate and anatomical orientation can confirm in the operative field during operation. This technique enable not only operators also assistants or students to better understand precise anatomy. 2) Indocyanine green (ICG) fluorescent image-guided navigation: this technique using HyperEye Medical System (MIZUHO IKAKOGYO Co., Ltd. Tokyo, Japan) help us to confirm tattooing of target segment and parenchymal intersegmental plane, and detect hepatic tumors (metastatic and HCC) near liver surface as well as invisible tumor inside the liver. CONCLUSIONS: Various advancements such as preoperative 3D-simulation including partial functional reserve estimation and intraoperative navigation techniques enabled surgeons to easily and safely perform hepatic resection.