Virtual surgery of cholecystotomy for calculus removal and cholecystectomy in patients with cholecystolithiasis / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the two-dimensional (2D) image segmentation, three-dimensional (3D) reconstruction and virtual surgery of cholecystectomy based on the 2D image data of the liver, biliary track and cholecystolithiasis obtained by 64-slice spiral CT.</p><p><b>METHODS</b>The image data of the liver, biliary track and cholecystolithiasis were obtained by 64-slice spiral CT scanning. Segmentation and automatic extraction of the images were performed using auto-adapting region growing algorithm. 3D reconstruction of the segmented data was carried out using MIMICS10.0 and self-designed software, and the data of the 3D model of the liver with the billiary tract were imported into FreeForm Modeling System for registration and smoothing. Virtual surgery of cholecystotomy for calculus removal and cholecystectomy were performed with Phantom.</p><p><b>RESULTS</b>The auto-adapting region growing algorithm allowed rapid image segmentation, and the 3D model of the liver based on the segmentation data clearly displayed vivid 3D structures of the liver. Virtual operations of cholecystectomy could be performed in the FreeForm Modeling System.</p><p><b>CONCLUSION</b>The algorithm we proposed can correctly and rapidly complete image segmentation and 3D reconstruction of cholecystolithiasis from the data 64-slice spiral CT, and allows virtual operations on the gallbladder.</p>

Study on three dimensional reconstruction and simulation surgery of spleen / 中华外科杂志

<p><b>OBJECTIVE</b>To study the three-dimensional (3D) reconstruction and the visualization simulation surgery of spleen based on the scanning data of 64-slice helical computed tomograph (CT).</p><p><b>METHODS</b>The original data of 64-slice helical CT of spleen was collected, and then the CT image sequences were segmented and automatically extracted using auto-adapted region growth algorithm, and were conducted with the segmented images by adopt self-developed image processing software for 3D reconstruction. Finally, the 3D models were imported into FreeForm Modeling System for modifying and smooth. And the visualization simulation surgery was performed before splenectomy.</p><p><b>RESULTS</b>It was fast and effective to utilize auto-adapted region growth algorithm to conduct spleen image program segmentation; the reconstructed models were seen clearly and could reappear the structure of the spleen and the important surrounding organs. The effect of the splenectomy simulation surgery was similar to the practical surgery.</p><p><b>CONCLUSIONS</b>The research on 3D models of spleen and visualization simulation surgery of splenectomy could lead to clinical benefits. It maybe improve the surgical effect and decrease the surgical risk and reduce the complication demonstrating visualized operation before surgery.</p>

Establishment of a three-dimensional pancreas model for simulating surgical resection of pancreatic tail carcinoma using virtual-reality technique / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the feasibility of visual-reality technique for simulating surgical resection of pancreatic tail carcinoma using a 3-dimensional pancreas model reconstructed on the basis of the CT data.</p><p><b>METHODS</b>The original image data of 64-slice spiral CT was obtained from a patient with pancreatic tail carcinoma. Using adaptive region growing algorithm, the serial CT images were segmented and automatically extracted for 3-dimensional reconstruction of the pancreas and the anatomically related structures with a self-designed program. The model was then processed with Freeform Modeling System for image modification and smoothing. With the assistance of GHST SDK and PHANTOM software systems, preoperative simulation of surgical resection of the carcinoma was performed on the basis of the established pancreatic model.</p><p><b>RESULTS</b>The reconstructed 3-dimensional pancreatic model with the related structures clearly visualized the 3-dimensional structures of the pancreas, the pancreatic tail compromised by the carcinoma, and the adjacent organs, displaying also the distribution, courses and the anatomical relations of the ductal systems including the main pancreatic duct, abdominal aorta, portal vein system, and the biliary tract. During simulated surgery for pancreatic tail carcinoma resection, the GHOST SDK system allowed effective application of the virtual surgical instruments, and the use of PHANTOM software produced a surgical experience with high resemblance of that from an actual operation.</p><p><b>CONCLUSION</b>The serial CT data-based reconstruction of 3-dimensional pancreas model and simulated operation on this model using virtual-reality technique has great potentials for application in individualized surgical planning and surgical risk assessment in cases of pancreatic tail carcinoma, and also facilitates clinical training of the surgeons.</p>

Common failure reasons and improvement ways in treatment of gallstones by choledochoscope in operation / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze common problems, failing causes and improvement ways for curing gallstones by choledochoscope in operation.</p><p><b>METHOD</b>To analyze a case group of 762 individual patients who had undergone choledochoscope operations in the period of Jan, 1995 approximately Sep, 2005.</p><p><b>RESULTS</b>136 cases are found with residual stones in the bile duct after the operations. Residual stone rate amounts to 17.8%. 55 patients are known that bile duct stones could not be remove completely during operations. 81 patients are proved that stones still remain in their bile ducts by T-tube cholangiography and choledochoscope after operations. Among them, 29 patients complicate with narrow in intrahepatic bile ducts and debouch of bile ducts, 39 patients complicate with stones of intrahepatic bile and variation of bile duct, 13 patients complicate with stones and narrow at the inferior segment of choledochus.</p><p><b>CONCLUSIONS</b>It is important to pay attention for bile duct variation and debouch of affection bile duct or inferior segment of choledochus stenosis. B-ultrasound is useful to reduce residual stones in operations. The surgeon should check different lengths of the duct methodically, and use the endoscope to explore the bile duct in order not to omit any stones.</p>

Treatment and surgery of primary hepatic cancer with portal vengus tumor thrombosis / 中华外科杂志

<p><b>OBJECTIVE</b>To study the methods of surgery for hepatocellular carcinoma (HCC) with tumor thrombi in portal vein (TTPV).</p><p><b>METHODS</b>To Analyze and summarize the clinical information from 138 HCC patients with tumor thrombi in portal vein collected during January 1990 and January 2003.</p><p><b>RESULTS</b>Thirty-seven patients receiving palliative therapy died from 1 to 8 months, and average survival time is 3.9 months. 101 patients had operation treatment, 23 of them underwent hepatoma resection, and average survival time was 10.9 months; 78 patients underwent hepatoma resection and removal of tumor thrombi, and average survival time was 26.8 months. 52 of whom underwent hepatic artery and portal vein chemoembolization, the 1-, 3-, 5-year survival rates was 96.2%, 51.9%, 11.5%, the 1-, 3-, 5-year survival rates of the 26 patients who didn't undergo chemoembolization were 76.9%, 23.1%, 0%.</p><p><b>CONCLUSIONS</b>Operation treatment can comparatively extend the survival time of hepatocellular carcinoma with tumor thrombi in portal vein patients, and the best choice is hepatoma resection and removal of tumor thrombi, hepatic artery and portal vein chemoembolization after operation can enhance the effect.</p>