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Huang Z, Zeng S, Zeng X, Wen S, Zhou Y, Cai P, Zhong H, Liu Z, Xiang N, Zhou C, Fang C, Zeng N. Efficacy of hepatectomy for hepatolithiasis using 3D visualization combined with ICG fluorescence imaging: A retrospective cohort study. World J Surg 2024; 48:1242-1251. [PMID: 38530128 DOI: 10.1002/wjs.12157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/10/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Hepatolithiasis is a complex condition that poses challenges and difficulties in surgical treatment. Three-dimensional visualization technology combined with fluorescence imaging (3DVT-FI) enables accurate preoperative assessment and real-time intraoperative navigation. However, the perioperative outcomes of 3DVT-FI in hepatolithiasis have not been reported. We aim to evaluate the efficacy of 3DVT-FI in the treatment of hepatolithiasis. METHODS A retrospective analysis was performed on 128 patients who underwent hepatectomy for hepatolithiasis at the Department of Hepatobiliary Surgery, Zhujiang Hospital, between January 2017 and December 2022. Among them, 50 patients underwent hepatectomy using 3DVT-FI (3DVT-FI group), while 78 patients underwent conventional hepatectomy without 3DVT-FI (CH group). The operative data, postoperative liver function indices, complication rates and stone residue were compared between the two groups. RESULTS There were no significant differences in preoperative baseline data between the two groups (p > 0.05). Compared with the CH group, the 3DVT-FI group exhibited lower intraoperative blood loss (140.00 ± 112.12 vs. 225.99 ± 186.50 mL, p = 0.001), and a lower intraoperative transfusion rate (8.0% vs. 23.1%, p = 0.027). The overall incidence of postoperative complications did not differ significantly (22.0% vs. 35.9%, p = 0.096). The 3DVT-FI group was associated with a lower immediate residual stone rate (16.0% vs. 34.6%, p = 0.021). There were no perioperative deaths in the 3DVT-FI group, while one perioperative death occurred in the CH group. CONCLUSIONS The 3DVT-FI may offer significant benefits in terms of surgical safety, reduced intraoperative bleeding and decreased stone residue during hepatectomy for hepatolithiasis.
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Affiliation(s)
- Zhenju Huang
- Department of Hepatobiliary Surgery, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Silue Zeng
- Department of Hepatobiliary Surgery, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Xiaojun Zeng
- Department of Hepatobiliary Surgery, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Sai Wen
- Department of Hepatobiliary Surgery, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Yi Zhou
- Department of Hepatobiliary Surgery, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Peilin Cai
- Department of Hepatobiliary Surgery, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Hao Zhong
- Department of Hepatobiliary Surgery, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Zhihao Liu
- Department of Hepatobiliary Surgery, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Nan Xiang
- Department of Hepatobiliary Surgery, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Chenjie Zhou
- Department of Hepatobiliary Surgery, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Chihua Fang
- Department of Hepatobiliary Surgery, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Ning Zeng
- Department of Hepatobiliary Surgery, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
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Pan W, Li J, Liu L, Huang Y, Huang M, Liu H. Comparing triple scope-combined bile duct exploration lithotripsy with laparoscopic hepatectomy for hepatolithiasis (with video). Asian J Surg 2024; 47:946-952. [PMID: 38195279 DOI: 10.1016/j.asjsur.2023.12.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/23/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND To compare the efficacy of Three-scope combined (laparoscopic, rigid choledochoscopy and electronic choledochoscopy, TS) with laparoscopic hepatectomy (LH) for patients with hepatolithiasis (HL). METHODS Between January 2019 and January 2020, 118 consecutive patients with HL treated with TS (TS group, n = 57) or LH (LH group, n = 61) were analyzed in this study. Perioperative and long-term outcomes, including operative time, intraoperative blood loss, blood transfusion, postoperative bowel function recovery time, postoperative hospital stay, complication rate, stone removal rate, and stone recurrence rate, were compared and analyzed between the two groups. RESULTS Compared with the LH group, the TS group had significantly lower intraoperative blood loss and transfusions, significantly shorter operative time and hospital stay, and fewer complications (P < 0.05 for all). There was no significant difference in the final stone removal rate, stone recurrence rate and postoperative bowel function recovery time (P > 0.05 for all). CONCLUSION TS is a safe and effective treatment for HL and is superior to LH in terms of overall treatment outcome and complications.
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Affiliation(s)
- Wu Pan
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, 330000, China.
| | - JunJie Li
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, 330000, China.
| | - LingPeng Liu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, 330000, China.
| | - Yong Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, 330000, China.
| | - MingWen Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, 330000, China.
| | - HongLiang Liu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, 330000, China.
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Guo Q, Chen J, Pu T, Zhao Y, Xie K, Geng X, Liu F. The value of three-dimensional visualization techniques in hepatectomy for complicated hepatolithiasis: A propensity score matching study. Asian J Surg 2023; 46:767-773. [PMID: 35843823 DOI: 10.1016/j.asjsur.2022.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/06/2022] [Accepted: 07/06/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The present study aimed to investigate the safety, feasibility, and efficacy of three-dimensional visualization technique (3DVT)-guided hepatectomy in the treatment of complicated hepatolithiasis. METHODS The clinical and follow-up data of 279 patients with complicated hepatolithiasis were retrospectively analyzed. The patients were divided into a 3DVT group (group A, 66 cases) and a non-3DVT group (group B, 213 cases). After baseline data were balanced using propensity score matching (PSM), the clinical characteristics and follow-up data of the two groups were observed. RESULTS After 1:1 PSM, 58 patients in each group were successfully matched with each other. When the groups were compared, the surgical duration (p = 0.033) and intraoperative blood loss (p = 0.002) of group A were lower than those of group B. The immediate stone clearance rate (91.4% vs. 75.9%, p = 0.024) and quality of life outcome (p = 0.034) of group A were significantly higher than those of group B. Logistic regression analysis showed that history of two or more biliary tract operations (odds ratio [OR] = 6.544, 95% confidence interval [CI] = 1.193-35.890, p = 0.031), bilateral stone distribution (OR = 4.198, 95% CI = 1.186-14.854, p = 0.026), and Geng grade III or IV (OR = 12.262, 95% CI = 2.224-67.617, p = 0.004) were independent risk factors for poor outcomes in patients with complicated hepatolithiasis. CONCLUSION Compared to conventional imaging examinations, 3DVT can be used to guide and achieve accurate preoperative diagnosis of complicated hepatolithiasis and has good safety, feasibility, and efficacy.
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Affiliation(s)
- Qi Guo
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, China
| | - Jiangming Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, China
| | - Tian Pu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, China
| | - Yijun Zhao
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, China
| | - Kun Xie
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, China
| | - Xiaoping Geng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, China
| | - Fubao Liu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, China.
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Wang B, Ou C, Yu J, Ye J, Luo Y, Wang Y, Zhang P. Three-dimensional visual technique based on CT lymphography data combined with methylene blue in endoscopic sentinel lymph node biopsy for breast cancer. Eur J Med Res 2022; 27:274. [PMID: 36464689 PMCID: PMC9719621 DOI: 10.1186/s40001-022-00909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 11/21/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The combined application of blue dye and radioisotopes is currently the primary mapping technique used for sentinel lymph node biopsy (SLNB) in breast cancer patients. However, radiocolloid techniques have not been widely adopted, especially in developing countries, given the strict restrictions on radioactive materials. Consequently, we carried out a retrospective study to evaluate the feasibility and accuracy of three-dimensional visualization technique (3DVT) based on computed tomography-lymphography (CT-LG) in endoscopic sentinel lymph node biopsy (ESLNB) for breast cancer. METHODS From September 2018 to June 2020, 389 patients who underwent surgical treatment of breast cancer in our department were included in this study. The CT-LG data of these patients were reconstructed into digital 3D models and imported into Smart Vision Works V1.0 to locate the sentinel lymph node (SLN) and for visual simulation surgery. ESLNB and endoscopic axillary lymph node dissection were carried out based on this new technique; the accuracy and clinical value of 3DVT in ESLNB were analyzed. RESULTS The reconstructed 3D models clearly displayed all the structures of breast and axilla, which favors the intraoperative detection of SLNs. The identification rate of biopsied SLNs was 100% (389/389). The accuracy, sensitivity, and false-negative rate were 93.83% (365/389), 93.43% (128/137), and 6.57% (9/137), respectively. Upper limb lymphedema occurred in one patient 3 months after surgery during the 12-month follow-up period. CONCLUSIONS Our 3DVT based on CT-LG data combined with methylene blue in ESLNB ensures a high identification rate of SLNs with low false-negative rates. It, therefore, has the potential to serve as a new method for SLN biopsy in breast cancer cases.
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Affiliation(s)
- Baiye Wang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong China
| | - Caifeng Ou
- Present Address: Department of Breast Care Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510080 China
- Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, 253, Gongye Dadao Zhong, Haizhu District, Guangzhou, 510282 Guangdong China
| | - Jingang Yu
- School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong China
| | - Jianping Ye
- Shenzhen Smart Vision Co. LTD., Shenzhen, Guangdong China
| | - Yunfeng Luo
- Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, 253, Gongye Dadao Zhong, Haizhu District, Guangzhou, 510282 Guangdong China
| | - Yu Wang
- Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong China
| | - Pusheng Zhang
- Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, 253, Gongye Dadao Zhong, Haizhu District, Guangzhou, 510282 Guangdong China
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Li X, Duan R, He Y, Qin J, Liu R, Dai S, Zhou J, Zeng X, Duan J, Gao P, Yang X, Li C. Application of three-dimensional visualization technology in the anatomical variations of hilar bile ducts in Chinese population. Front Surg 2022; 9:934183. [PMID: 35983555 PMCID: PMC9379322 DOI: 10.3389/fsurg.2022.934183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022] Open
Abstract
This study aimed to establish three-dimensional models of the biliary tract of Chinese people using the Hisense computer-aided surgery (CAS) system and to explore the branching patterns and variation types of the biliary system under the study of 3D reconstruction of the biliary tract. Three-dimensional models of the biliary tract were reconstructed in 50 patients using the Hisense CAS system. The branching patterns of intrahepatic bile ducts were observed. The biliary tract was classified according to the confluence of the right posterior sectoral duct (RPSD), right anterior sectoral duct (RASD) and left hepatic duct (LHD), and the presence or absence of accessory hepatic ducts. The 3D models of the bile ducts were successfully reconstructed in 50 Chinese patients. The branching patterns of the bile ducts were classified into seven types. The anatomy of the bile ducts was typical in 54% of cases (n = 27), showed triple confluence in 10% (n = 5), and crossover anomaly in 14% (n = 7), which means anomalous drainage of the RPSD into the LHD, anomalous drainage of the RPSD into the common hepatic duct (CHD) in 10% (n = 5), anomalous drainage of the RPSD into the cystic duct (CD) in 2% (n = 1), absence of left main hepatic duct in 1% (n = 1), presence of accessory duct in 8% (n = 4). Among them, there were three cases of accessory hepatic ducts coexisting with other variation types. By using the Hisense CAS system to establish 3D models of the biliary tract of the Chinese people, we established the branching model of the second-order bile ducts, which has important value for the classification of the biliary system and its variation types.
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Pu T, Chen JM, Li ZH, Jiang D, Guo Q, Li AQ, Cai M, Chen ZX, Xie K, Zhao YJ, Wang C, Hou H, Lu Z, Geng XP, Liu FB. Clinical online nomogram for predicting prognosis in recurrent hepatolithiasis after biliary surgery: A multicenter, retrospective study. World J Gastroenterol 2022; 28:715-731. [PMID: 35317276 PMCID: PMC8891727 DOI: 10.3748/wjg.v28.i7.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/20/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Methods for predicting the prognosis of patients undergoing surgery for recurrent hepatolithiasis after biliary surgery are currently lacking.
AIM To establish a nomogram to predict the prognosis of patients with recurrent hepatolithiasis after biliary surgery.
METHODS In this multicenter, retrospective study, data of consecutive patients in four large medical centers who underwent surgery for recurrent hepatolithiasis after biliary surgery were retrospectively analyzed. We constructed a nomogram to predict the prognosis of recurrent hepatolithiasis in a training cohort of 299 patients, following which we independently tested the nomogram in an external validation cohort of 142 patients. Finally, we used the concordance index (C-index), calibra-tion, area under curve, decision curve analysis, clinical impact curves, and visual fit indices to evaluate the accuracy of the nomogram.
RESULTS Multiple previous surgeries [2 surgeries: Odds ratio (95% confidence interval), 1.451 (0.719-2.932); 3 surgeries: 4.573 (2.015-10.378); ≥ 4 surgeries: 5.741 (1.347-24.470)], bilateral hepatolithiasis [1.965 (1.039-3.717)], absence of immediate clearance [2.398 (1.304-4.409)], neutrophil-to-lymphocyte ratio ≥ 2.462 [1.915 (1.099-3.337)], and albumin-to-globulin ratio ≤ 1.5 [1.949 (1.056-3.595)] were found to be independent factors influencing the prognosis. The nomogram constructed on the basis of these variables showed good reliability in the training (C-index: 0.748) and validation (C-index: 0.743) cohorts. Compared with predictions using traditional classification models, those using our nomogram showed better agreement with actual observations in the calibration curve for the probability of endpoints and the receiver operating characteristic curve. Dichloroacetate and clinical impact curves showed a larger net benefit of the nomogram.
CONCLUSION The nomogram developed in this study demonstrated superior performance and discriminative power compared to the three traditional classifications. It is easy to use, highly accurate, and shows excellent calibration.
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Affiliation(s)
- Tian Pu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Jiang-Ming Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Zi-Han Li
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Dong Jiang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Qi Guo
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Ang-Qing Li
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Ming Cai
- Department of General Surgery, The First Affiliated Hospital of the University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Zi-Xiang Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Kun Xie
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Yi-Jun Zhao
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Cheng Wang
- Department of General Surgery, The First Affiliated Hospital of the University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Hui Hou
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Zheng Lu
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233030, Anhui Province, China
| | - Xiao-Ping Geng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Fu-Bao Liu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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Alvarez chica LF, Rico-Juri JM, Carrero-Rivera SA, Castro-Villegas F. Coledocolitiasis y exploración laparoscópica de la vía biliar. Un estudio de cohorte. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La coledocolitiasis es la presencia de cálculos en las vías biliares. En la mayoría de los casos se trata mediante la colangio pancreatografía retrógrada endoscópica y menos comúnmente por intervención quirúrgica laparoscópica. El objetivo de este estudio fue describir una cohorte retrospectiva de pacientes sometidos a exploración laparoscópica de la vía biliar.
Métodos. Se incluyeron pacientes intervenidos entre los años 2014 y 2018, en dos instituciones de nivel III en Cali, Colombia, referidos para valoración por cirugía hepato-biliar, por dificultad para la extracción de los cálculos por colangio pancreatografia retrograda endoscópica, debido al tamaño, la cantidad, o la dificultad para identificar o canular la papila duodenal.
Resultados. De los 100 pacientes incluidos, se encontró que el 72 % fueron mujeres, con rango de edad entre 14 y 92 años. Al 39 % de los pacientes se les extrajo un solo cálculo y al 16 % 10 cálculos. Un 12 % presentaron cálculos gigantes (mayores de 2,5 cm de ancho) y un 44 % presentaron litiasis múltiple. Al 69 % de los pacientes se les realizó colecistectomía. El porcentaje de éxito de limpieza de la vía biliar por laparoscopia fue del 95 %.
Discusión. La exploración laparoscópica de la vía biliar es una técnica posible, reproducible, segura y con excelentes resultados para el manejo de la coledocolitiasis.
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One-Step Multichannel Percutaneous Transhepatic Cholangioscopic Lithotripsy Applied in Bilateral Hepatolithiasis. World J Surg 2021; 44:1586-1594. [PMID: 31993722 DOI: 10.1007/s00268-020-05368-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to compare the outcomes of one-step multichannel percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) with traditional PTCSL in the treatment of bilateral hepatolithiasis. METHODS From February 2011 to June 2015, 156 patients with bilateral hepatolithiasis received surgical treatment in our department. Among these patients, 81 received one-step multichannel PTCSL (group A), and the remaining 75 received traditional PTCSL (group B). RESULTS Compared with group B, group A was characterized by a significantly shorter operation time (83.7 ± 28.5 min vs 118.1 ± 41.5 min; P = 0.000), hospital stay (11.1 ± 3.4 d vs 17.8 ± 5.6 d; P = 0.034), and postoperative hospital stay (6.9 ± 3.1 d vs 9.6 ± 4.5 d; P = 0.026). In addition, the immediate clearance (62.9% vs 45.3%, P = 0.027) and final clearance (90.1% vs 78.7%, P = 0.048) rates were higher in group A than in group B. During the follow-up period, stone recurrence was significantly less common in group A than in group B (13.6% vs 26.7%, P = 0.041). Multivariate Cox analysis showed that the PTCSL method (HR = 2.32, 95% confidence interval [CI] = 1.09-4.90, P = 0.028), bilateral biliary stricture (HR = 4.17, 95% CI = 1.73-10.03, P = 0.001), and stones located in segments I (HR = 7.75, 95% CI = 3.67-16.38, P = 0.000) were independent predictors of recurrence. CONCLUSIONS Compared with traditional PTCSL, one-step multichannel PTCSL was more efficient and effective in the treatment of bilateral hepatolithiasis.
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Fang C, An J, Bruno A, Cai X, Fan J, Fujimoto J, Golfieri R, Hao X, Jiang H, Jiao LR, Kulkarni AV, Lang H, Lesmana CRA, Li Q, Liu L, Liu Y, Lau W, Lu Q, Man K, Maruyama H, Mosconi C, Örmeci N, Pavlides M, Rezende G, Sohn JH, Treeprasertsuk S, Vilgrain V, Wen H, Wen S, Quan X, Ximenes R, Yang Y, Zhang B, Zhang W, Zhang P, Zhang S, Qi X. Consensus recommendations of three-dimensional visualization for diagnosis and management of liver diseases. Hepatol Int 2020; 14:437-453. [PMID: 32638296 PMCID: PMC7366600 DOI: 10.1007/s12072-020-10052-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 05/04/2020] [Indexed: 12/14/2022]
Abstract
Three-dimensional (3D) visualization involves feature extraction and 3D reconstruction of CT images using a computer processing technology. It is a tool for displaying, describing, and interpreting 3D anatomy and morphological features of organs, thus providing intuitive, stereoscopic, and accurate methods for clinical decision-making. It has played an increasingly significant role in the diagnosis and management of liver diseases. Over the last decade, it has been proven safe and effective to use 3D simulation software for pre-hepatectomy assessment, virtual hepatectomy, and measurement of liver volumes in blood flow areas of the portal vein; meanwhile, the use of 3D models in combination with hydrodynamic analysis has become a novel non-invasive method for diagnosis and detection of portal hypertension. We herein describe the progress of research on 3D visualization, its workflow, current situation, challenges, opportunities, and its capacity to improve clinical decision-making, emphasizing its utility for patients with liver diseases. Current advances in modern imaging technologies have promised a further increase in diagnostic efficacy of liver diseases. For example, complex internal anatomy of the liver and detailed morphological features of liver lesions can be reflected from CT-based 3D models. A meta-analysis reported that the application of 3D visualization technology in the diagnosis and management of primary hepatocellular carcinoma has significant or extremely significant differences over the control group in terms of intraoperative blood loss, postoperative complications, recovery of postoperative liver function, operation time, hospitalization time, and tumor recurrence on short-term follow-up. However, the acquisition of high-quality CT images and the use of these images for 3D visualization processing lack a unified standard, quality control system, and homogeneity, which might hinder the evaluation of application efficacy in different clinical centers, causing enormous inconvenience to clinical practice and scientific research. Therefore, rigorous operating guidelines and quality control systems need to be established for 3D visualization of liver to develop it to become a mature technology. Herein, we provide recommendations for the research on diagnosis and management of 3D visualization in liver diseases to meet this urgent need in this research field.
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Affiliation(s)
- Chihua Fang
- The First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510282, China.
| | - Jihyun An
- Department of Gastroenterology, Hanyang University College of Medicine and Hanyang University Guri Hospital, Guri, 11923, South Korea
| | - Antonio Bruno
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Xiujun Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Fudan University, Shanghai, 200032, China.,Key Laboratory of Medical Epigenetics and Metabolism, Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
| | - Jiro Fujimoto
- Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Rita Golfieri
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Xishan Hao
- Department of Gastrointestinal Cancer Biology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Hongchi Jiang
- Department of Liver Surgery, The First Affiliated Hospital Harbin Medical University, Harbin, 150001, Heilongjiang, China
| | - Long R Jiao
- HPB Surgical Unit, Department of Surgery and Cancer, Imperial College, London, W12 0HS, UK
| | - Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Hauke Lang
- Department of General, Visceral and Transplantation Surgery, University Medical Center of the Johannes Gutenberg-University, Langenbeckst. 1, 55131, Mainz, Germany
| | - Cosmas Rinaldi A Lesmana
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, 10430, Indonesia
| | - Qiang Li
- National Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Lianxin Liu
- Department of Hepatobillirary Surgery, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Yingbin Liu
- Department of General Surgery, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanyee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Qiping Lu
- Department of General Surgery, Central theater General Hospital of the Chinese people's Liberation Army, Wuhan, 430070, Hubei, China
| | - Kwan Man
- Department of Surgery, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Cristina Mosconi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Necati Örmeci
- Department of Gastroenterology, Ankara University Medical School, Ibn'i Sina Hospital, Sihhiye, 06100, Ankara, Turkey
| | - Michael Pavlides
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Guilherme Rezende
- Internal Medicine Department, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Joo Hyun Sohn
- Department of Gastroenterology, Hanyang University College of Medicine and Hanyang University Guri Hospital, Guri, 11923, South Korea
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, 10700, Thailand
| | - Valérie Vilgrain
- Department of Radiology, Assistance-Publique Hôpitaux de Paris, APHP, HUPNVS, Hôpital Beaujon, 100 bd du Général Leclerc, 92110, Clichy, France
| | - Hao Wen
- Department of Hydatid & Hepatobiliary Surgery, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Sai Wen
- The First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510282, China
| | - Xianyao Quan
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Rafael Ximenes
- Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Yinmo Yang
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Bixiang Zhang
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiqi Zhang
- The First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510282, China
| | - Peng Zhang
- The First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510282, China
| | - Shaoxiang Zhang
- Institute of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Xiaolong Qi
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China.
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Li A, Tang R, Rong Z, Zeng J, Xiang C, Yu L, Zhao W, Dong J. The Use of Three-Dimensional Printing Model in the Training of Choledochoscopy Techniques. World J Surg 2019; 42:4033-4038. [PMID: 30066020 PMCID: PMC6244985 DOI: 10.1007/s00268-018-4731-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM To evaluate the application value of a three-dimensional (3D) printing model in the training of choledochoscopy techniques. MATERIALS AND METHODS Imaging data from two patients with biliary dilatation were used to produce two 3D reconstruction models which were subsequently constructed into 3D printing models (No. 1 and No. 2). Four hepatobiliary surgeons evaluated the anatomical accuracy and academic teaching value of the printed models. Twenty resident trainees with no prior experience in any kind of endoscopic techniques were randomly and symmetrically divided into two groups. The training group (A) used the 3D model No. 1 in the learning of biliary tract anatomy and practice techniques of choledochoscopy. The control group (B) got the virtual 3D image of the same model on computer for learning. After 4 weeks, the model No. 2 was used to reassess the trainees' subjective and objective progress in anatomy familiarity and choledochoscopy manipulations. RESULTS All consulted surgeons agreed that the 3D models realistically reproduced the anatomy of the biliary system. All trainees in group A agreed or strongly agreed that the 3D models provided good anatomical realism, enhanced their experience in the training of choledochoscopy techniques, and aided in their learning of biliary anatomy. With the practice went on, they increased the accuracy and showed a reduction in operation time on the model No. 1. During final examination with model No. 2, the rate of correct anatomical structure identification in training group was significantly higher than group B (p < 0.05). CONCLUSION The 3D printed biliary tract model is an excellent teaching tool in the training of choledochoscopy techniques. The 3D model is anatomically realistic and can improve the trainee's anatomical knowledge and endoscopic skills.
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Affiliation(s)
- Ang Li
- Department of Hepatopancreatobiliary Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Rui Tang
- Department of Hepatopancreatobiliary Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Zhixia Rong
- Service of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada
| | - Jianping Zeng
- Department of Hepatopancreatobiliary Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Canhong Xiang
- Department of Hepatopancreatobiliary Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Lihan Yu
- Department of Hepatopancreatobiliary Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Wenping Zhao
- Department of Hepatopancreatobiliary Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Jiahong Dong
- Department of Hepatopancreatobiliary Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, No. 168 Litang Road, Changping District, Beijing, 102218, China.
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Tang R, Ma L, Li A, Yu L, Rong Z, Zhang X, Xiang C, Liao H, Dong J. Choledochoscopic Examination of a 3-Dimensional Printing Model Using Augmented Reality Techniques: A Preliminary Proof of Concept Study. Surg Innov 2018; 25:492-498. [PMID: 29909727 DOI: 10.1177/1553350618781622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND We applied augmented reality (AR) techniques to flexible choledochoscopy examinations. METHODS Enhanced computed tomography data of a patient with intrahepatic and extrahepatic biliary duct dilatation were collected to generate a hollow, 3-dimensional (3D) model of the biliary tree by 3D printing. The 3D printed model was placed in an opaque box. An electromagnetic (EM) sensor was internally installed in the choledochoscope instrument channel for tracking its movements through the passages of the 3D printed model, and an AR navigation platform was built using image overlay display. The porta hepatis was used as the reference marker with rigid image registration. The trajectories of the choledochoscope and the EM sensor were observed and recorded using the operator interface of the choledochoscope. RESULTS Training choledochoscopy was performed on the 3D printed model. The choledochoscope was guided into the left and right hepatic ducts, the right anterior hepatic duct, the bile ducts of segment 8, the hepatic duct in subsegment 8, the right posterior hepatic duct, and the left and the right bile ducts of the caudate lobe. Although stability in tracking was less than ideal, the virtual choledochoscope images and EM sensor tracking were effective for navigation. CONCLUSIONS AR techniques can be used to assist navigation in choledochoscopy examinations in bile duct models. Further research is needed to determine its benefits in clinical settings.
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Affiliation(s)
- Rui Tang
- 1 Department of Hepatopancreatobiliary Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Longfei Ma
- 2 Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Ang Li
- 1 Department of Hepatopancreatobiliary Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Lihan Yu
- 1 Department of Hepatopancreatobiliary Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Zhixia Rong
- 3 Hepatobiliary and Pancreatic Surgery and Liver Transplantation Team, Medical Center of University of Montreal (CHUM), Montreal, Quebec, Canada
| | - Xinjing Zhang
- 1 Department of Hepatopancreatobiliary Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Canhong Xiang
- 1 Department of Hepatopancreatobiliary Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Hongen Liao
- 2 Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jiahong Dong
- 1 Department of Hepatopancreatobiliary Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
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Hu M, Hu H, Cai W, Mo Z, Xiang N, Yang J, Fang C. The Safety and Feasibility of Three-Dimensional Visualization Technology Assisted Right Posterior Lobe Allied with Part of V and VIII Sectionectomy for Right Hepatic Malignancy Therapy. J Laparoendosc Adv Surg Tech A 2017; 28:586-594. [PMID: 29172950 DOI: 10.1089/lap.2017.0479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hepatectomy is the optimal method for liver cancer; the virtual liver resection based on three-dimensional visualization technology (3-DVT) could provide better preoperative strategy for surgeon. We aim to introduce right posterior lobe allied with part of V and VIII sectionectomy assisted by 3-DVT as a promising treatment for massive or multiple right hepatic malignancies to retain maximum residual liver volume on the basis of R0 resection. METHODS Among 126 consecutive patients who underwent hepatectomy, 9 (7%) underwent right posterior lobe allied with part of V and VIII sectionectomy. 21 (17%) underwent right hemihepatectomy (RH). The virtual RH was performed with 3-DVT, which provided better observation of spatial position relationship between tumor and vessels, and the more accurate estimation of the remnant liver volume. If remnant liver volume was <40%, right posterior lobe allied with part of V and VIII sectionectomy should be undergone. Then, the precut line ought to be planned on the basis of protecting the portal branch of subsegment 5 and 8. The postoperative outcome of patients was compared before and after propensity score matching. RESULTS Nine patients meeting the eligibility criteria received right posterior lobe allied with part of V and VIII sectionectomy. The variables, including the overall mean operation time, blood transfusion, operation length, liver function, and postoperative complications, were similar between two groups before and after propensity matching. The postoperative first, third, fifth, and seventh days mean value of aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), and total bilirubin had no significant difference compared with preoperative value. One patient in each group had recurrence six months after surgery. CONCLUSION Right posterior lobe allied with part of V and VIII sectionectomy based on 3-DVT is safe and feasible surgery way, and can be a very promising method in massive or multiple right hepatic malignancy therapy.
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Affiliation(s)
- Min Hu
- 1 Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University , Guangzhou, China
- 2 Guangdong Provincial Clinical and Engineering Technology Research Center of Digital Medicine , Guangzhou, China
| | - Haoyu Hu
- 1 Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University , Guangzhou, China
- 2 Guangdong Provincial Clinical and Engineering Technology Research Center of Digital Medicine , Guangzhou, China
| | - Wei Cai
- 1 Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University , Guangzhou, China
- 2 Guangdong Provincial Clinical and Engineering Technology Research Center of Digital Medicine , Guangzhou, China
| | - Zhikang Mo
- 1 Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University , Guangzhou, China
- 2 Guangdong Provincial Clinical and Engineering Technology Research Center of Digital Medicine , Guangzhou, China
| | - Nan Xiang
- 1 Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University , Guangzhou, China
- 2 Guangdong Provincial Clinical and Engineering Technology Research Center of Digital Medicine , Guangzhou, China
| | - Jian Yang
- 1 Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University , Guangzhou, China
- 2 Guangdong Provincial Clinical and Engineering Technology Research Center of Digital Medicine , Guangzhou, China
| | - Chihua Fang
- 1 Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University , Guangzhou, China
- 2 Guangdong Provincial Clinical and Engineering Technology Research Center of Digital Medicine , Guangzhou, China
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Wen XD, Wang T, Huang Z, Zhang HJ, Zhang BY, Tang LJ, Liu WH. Step-by-step strategy in the management of residual hepatolithiasis using post-operative cholangioscopy. Therap Adv Gastroenterol 2017; 10:853-864. [PMID: 29147136 PMCID: PMC5673016 DOI: 10.1177/1756283x17731489] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/16/2017] [Indexed: 02/04/2023] Open
Abstract
Hepatolithiasis is the presence of calculi within the intrahepatic bile duct specifically located proximal to the confluence of the left and right hepatic ducts. The ultimate goal of hepatolithiasis treatment is the complete removal of the stone, the correction of the associated strictures and the prevention of recurrent cholangitis. Although hepatectomy could effectively achieve the above goals, it can be restricted by the risk of insufficient residual liver volume, and has a 15.6% rate of residual hepatolithiasis. With improvements in minimally invasive surgery, post-operative cholangioscopy (POC), provides an additional option for hepatolithiasis treatment with higher clearance rate and fewer severe complications. POC is very safe, and can be performed repeatedly until full patient benefit is achieved. During POC three main steps are accomplished: first, the analysis of the residual hepatolithiasis distribution indirectly by imaging methods or directly endoscopic observation; second, the establishment of the surgical pathway to relieve the strictures; and third, the removal of the stone by a combination of different techniques such as simple basket extraction, mechanical fragmentation, electrohydraulic lithotripsy or laser lithotripsy, among others. In summary, a step-by-step strategy of POC should be put forward to standardize the procedures, especially when dealing with complicated residual hepatolithiasis. This review briefly summarizes the classification, management and complications of hepatolithiasis during the POC process.
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Affiliation(s)
| | | | | | - Hong-jian Zhang
- Department of General Surgery, The 515th Hospital of PLA, Wuxi, Jiangsu Province, China
| | - Bing-yin Zhang
- General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan Province, China
| | - Li-jun Tang
- General Surgery Center of PLA, Chengdu Military General Hospital, 270 Rongdu Avenue, Jinniu District, Chengdu, Sichuan Province, 610083, China
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RETRACTED: Long-Term Outcomes of Hepatectomy for Bilateral Hepatolithiasis with Three-Dimensional Reconstruction: A Propensity Score Matching Analysis. J Laparoendosc Adv Surg Tech A 2016; 26:680-8. [DOI: 10.1089/lap.2016.0165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Kong X, Nie L, Zhang H, Wang Z, Ye Q, Tang L, Li J, Huang W. Do Three-dimensional Visualization and Three-dimensional Printing Improve Hepatic Segment Anatomy Teaching? A Randomized Controlled Study. JOURNAL OF SURGICAL EDUCATION 2016; 73:264-269. [PMID: 26868314 DOI: 10.1016/j.jsurg.2015.10.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/25/2015] [Accepted: 10/02/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Hepatic segment anatomy is difficult for medical students to learn. Three-dimensional visualization (3DV) is a useful tool in anatomy teaching, but current models do not capture haptic qualities. However, three-dimensional printing (3DP) can produce highly accurate complex physical models. Therefore, in this study we aimed to develop a novel 3DP hepatic segment model and compare the teaching effectiveness of a 3DV model, a 3DP model, and a traditional anatomical atlas. MATERIALS AND METHODS A healthy candidate (female, 50-years old) was recruited and scanned with computed tomography. After three-dimensional (3D) reconstruction, the computed 3D images of the hepatic structures were obtained. The parenchyma model was divided into 8 hepatic segments to produce the 3DV hepatic segment model. The computed 3DP model was designed by removing the surrounding parenchyma and leaving the segmental partitions. Then, 6 experts evaluated the 3DV and 3DP models using a 5-point Likert scale. A randomized controlled trial was conducted to evaluate the educational effectiveness of these models compared with that of the traditional anatomical atlas. RESULTS The 3DP model successfully displayed the hepatic segment structures with partitions. All experts agreed or strongly agreed that the 3D models provided good realism for anatomical instruction, with no significant differences between the 3DV and 3DP models in each index (p > 0.05). Additionally, the teaching effects show that the 3DV and 3DP models were significantly better than traditional anatomical atlas in the first and second examinations (p < 0.05). Between the first and second examinations, only the traditional method group had significant declines (p < 0.05). CONCLUSION A novel 3DP hepatic segment model was successfully developed. Both the 3DV and 3DP models could improve anatomy teaching significantly.
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Affiliation(s)
- Xiangxue Kong
- Department of Anatomy, Guangdong Province Key Laboratory of Medical Biomechanics, School of Basic Medicine Science, Southern Medical University, Guangzhou, Guangdong, China
| | - Lanying Nie
- Department of Traumatic Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huijian Zhang
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhanglin Wang
- Department of Anatomy, Guangdong Province Key Laboratory of Medical Biomechanics, School of Basic Medicine Science, Southern Medical University, Guangzhou, Guangdong, China
| | - Qiang Ye
- Department of Radiology, The 3rd Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Lei Tang
- Department of Anatomy, Guangdong Province Key Laboratory of Medical Biomechanics, School of Basic Medicine Science, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianyi Li
- Department of Anatomy, Guangdong Province Key Laboratory of Medical Biomechanics, School of Basic Medicine Science, Southern Medical University, Guangzhou, Guangdong, China.
| | - Wenhua Huang
- Department of Anatomy, Guangdong Province Key Laboratory of Medical Biomechanics, School of Basic Medicine Science, Southern Medical University, Guangzhou, Guangdong, China.
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