Study on the clinical application of abdominal medical image proceeding system in extended hepatectomy / 中华外科杂志

<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>

Digital medical technology based on 64-slice computed tomography in hepatic surgery / 中华医学杂志(英文版)

<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>

Value of virtual surgery in arterial reconstruction in liver recipients with type II hepatic artery variation / 南方医科大学学报

<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>

Study on visualized virtual surgery of living-related donor liver transplantation / 中华外科杂志

<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>

Study on the application of value of digital medical technology in the operation on primary liver cancer / 中华外科杂志

<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>

Study on the applied value of digital medical technology in diagnosis and treatment of the hepatolithiasis / 中华外科杂志

<p><b>OBJECTIVE</b>To study the value of digital medical technology in diagnosis and treatment of the hepatolithiasis.</p><p><b>METHODS</b>64-slice spiral computer tomography (CT) scan data of 14 cases (11 female, 3 male; median age, 48 years) with hepatolithiasis admitted from February to September 2008 were collected. The data were imported into medical image proceeding system (MIPS) for sequence segmenting and three-dimensional (3D) reconstruction. The reconstructed models were imported into FreeForm Modeling System for performing simulation surgery with simulation surgical instruments. According to the results of 3D reconstruction and simulation surgery, reasonable operation strategies were chosen. Finally, the value of clinical application of simulation surgery was evaluated according to the findings of clinical operation on hepatolithiasis patients and postoperative T-tube angiography.</p><p><b>RESULTS</b>The 3D reconstructed models of 14 cases with hepatolithiasis revealed 7 cases of left liver hepatolithiasis, 2 cases of right liver hepatolithiasis, 5 cases of bilateral hepatolithiasis, including 6 cases of hepatolithiasis with common bile duct calculi, 6 cases of biliary system models with absolute stricture, 8 cases with relative stricture. The results were of agreement with clinical diagnosis. A variety of operation plans were simulated before operation. Simulation equipment used in process of simulation surgery was a powerful sense of feedback.</p><p><b>CONCLUSIONS</b>Digital medical technology is helpful to understand the calculi distribution, bile ducts stricture and deformity. Through preoperative training, simulation surgery are able to guide for choosing operative strategies. It reduces the operation risks.</p>