Application of multimode imaging technology in real time navigation in anatomical liver resections / 中国实用外科杂志

ABSTRACT

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.