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Zeng X, Tao H, Dong Y, Zhang Y, Yang J, Xuan F, Zhou J, Jia W, Liu J, Dai C, Hu H, Xiang N, Zeng N, Zhou W, Lau W, Yang J, Fang C. Impact of three-dimensional reconstruction visualization technology on short-term and long-term outcomes after hepatectomy in patients with hepatocellular carcinoma: a propensity-score-matched and inverse probability of treatment-weighted multicenter study. Int J Surg 2024; 110:1663-1676. [PMID: 38241321 PMCID: PMC10942183 DOI: 10.1097/js9.0000000000001047] [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: 10/06/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Three-dimensional reconstruction visualization technology (3D-RVT) is an important tool in the preoperative assessment of patients undergoing liver resection. However, it is not clear whether this technique can improve short-term and long-term outcomes in patients with hepatocellular carcinoma (HCC) compared with two-dimensional (2D) imaging. METHOD A total of 3402 patients from five centers were consecutively enrolled from January 2016 to December 2020, and grouped based on the use of 3D-RVT or 2D imaging for preoperative assessment. Baseline characteristics were balanced using propensity score matching (PSM, 1:1) and stabilized inverse probability of treatment-weighting (IPTW) to reduce potential selection bias. The perioperative outcomes, long-term overall survival (OS), and recurrence-free survival (RFS) were compared between the two groups. Cox-regression analysis was used to identify the risk factors associated with RFS. RESULTS A total of 1681 patients underwent 3D-RVT assessment before hepatectomy (3D group), while 1721 patients used 2D assessment (2D group). The PSM cohort included 892 patient pairs. In the IPTW cohort, there were 1608.3 patients in the 3D group and 1777.9 patients in the 2D group. In both cohorts, the 3D group had shorter operation times, lower morbidity and liver failure rates, as well as shorter postoperative hospital stays. The 3D group had more margins ≥10 mm and better RFS than the 2D group. The presence of tumors with a diameter ≥5 cm, intraoperative blood transfusion and multiple tumors were identified as independent risk factors for RFS, while 3D assessment and anatomical resection were independent protective factors. CONCLUSION In this multicenter study, perioperative outcomes and RFS of HCC patients following 3D-RVT assessment were significantly different from those following 2D imaging assessment. Thus, 3D-RVT may be a feasible alternative assessment method before hepatectomy for these patients.
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Affiliation(s)
- Xiaojun Zeng
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Haisu Tao
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Yanchen Dong
- School of Traditional Chinese Medicine, Southern Medical University
| | - Yuwei Zhang
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Junying Yang
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Feichao Xuan
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Jian Zhou
- Department of Liver Surgery, Zhongshan Hospital, Fudan University
| | - Weidong Jia
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei
| | - Jingfeng Liu
- Liver Department, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou
| | - Chaoliu Dai
- Department of the Second General Surgery, Shengjing Hospital of China Medical University, Shenyang
| | - Haoyu Hu
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Nan Xiang
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Ning Zeng
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Weiping Zhou
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai
| | - Wanyee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Jian Yang
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
| | - Chihua Fang
- Department of Hepatobiliary Surgery, Zhujiang Hospital
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou
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Wang D, Hu H, Zhang Y, Wu X, Zeng X, Yang J, Fang C. Efficacy of Augmented Reality Combined with Indocyanine Green Fluorescence Imaging Guided Laparoscopic Segmentectomy for Hepatocellular Carcinoma. J Am Coll Surg 2024; 238:321-330. [PMID: 37991244 DOI: 10.1097/xcs.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND The internal anatomy of the liver is extremely complex. Laparoscopic anatomical segmentectomy requires reference to the position and alignment of intrahepatic vascular. However, the surface of the liver lacks anatomical landmarks and the liver segment boundaries cannot be identified with the naked eye. Augmented reality navigation (ARN) and indocyanine green fluorescence imaging (FI) are emerging navigation tools in liver resection. This study aimed to explore the efficacy and application value of laparoscopic anatomical segmentectomy guided by ARN combined with indocyanine green FI. STUDY DESIGN Ninety-eight patients who were diagnosed with hepatocellular carcinoma and underwent laparoscopic anatomical segmentectomy from January 2018 to January 2022 were retrospectively analyzed. They were divided into the ARN-FI group (45 patients) and the non-ARN-FI group (53 patients) based on whether ARN combined with FI was applied during the operation. The differences in intraoperative and postoperative outcomes were compared. RESULTS There was no significant difference in preoperative baseline data and postoperative complication rates between the 2 groups. Compared with the non-ARN-FI group, the ARN-FI group had much lower intraoperative blood loss (100 vs 200 mL, p = 0.005) and a lower incidence of remnant liver ischemia (13.3% vs 30.2%, p = 0.046). The 1- and 3-year disease-free survival rates in the ARN-FI and non-ARN-FI groups were 91.01% vs 71.15% and 70.01% vs 52.46%, respectively; the differences between the 2 groups were statistically significant (p = 0.047). CONCLUSIONS The ARN-FI technology provides a more standardized approach for liver parenchyma section during laparoscopic liver resection, effectively minimizing intraoperative blood loss, reducing postoperative remnant liver ischemia, and improving oncological prognosis. This method is safe and feasible and has good clinical application prospects.
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Affiliation(s)
- Dehui Wang
- From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Haoyu Hu
- From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Yuwei Zhang
- From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Xiwen Wu
- From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Xiaojun Zeng
- From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Jian Yang
- From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China
| | - Chihua Fang
- From the Department of Hepatobiliary Surgery and 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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Liu J, Xiu W, Lin A, Duan G, Jiang N, Wang B, Wang F, Dong Q, Xia N. Can Hisense computer-assisted surgery system (Hisense CAS) improve anatomy teaching in pediatric liver surgery? Surg Radiol Anat 2024; 46:117-124. [PMID: 38189912 DOI: 10.1007/s00276-023-03277-7] [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: 07/05/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE This study aimed to investigate the effectiveness of the Hisense computer-assisted surgery system (CAS) in teaching pediatric liver surgical anatomy. METHODS The research subjects were residents who underwent standardized training at the Department of Pediatric Surgery at Yijishan Hospital of Wannan Medical College from May 2022 to May 2023. RESULTS The study recruited a total of 62 students, with 31 students assigned to the Hisense CAS group (12 males and 19 females) and the remaining 31 students serving as controls (Control group, 15 males and 16 females). There were no significant differences in baseline characteristics observed between the two groups. This study found that the average scores of the Hisense CAS teaching group in the liver surgery evaluations were higher than those of the control group. Specifically, the Hisense CAS group had an average score of 84.25 ± 5.70 points in the liver surgery knowledge test, 77.10 ± 8.12 points in the image reading test, and 70.58 ± 8.79 points in the surgical simulation test, while the traditional teaching group had average scores of 73.45 ± 6.12 points, 69.81 ± 6.05 points, and 66.42 ± 6.61 points, respectively; the differences between the two groups were statistically significant (P < 0.05). Furthermore, this study also found that the Hisense CAS teaching model resulted in significantly better teaching satisfaction on the part of the residents in terms of standardized teaching for physicians in pediatric liver surgical anatomy. CONCLUSION In conclusion, this study demonstrated greater satisfaction of the residents with the use of 3D reconstruction added to traditional teaching sessions and better performance during the posttraining evaluation.
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Affiliation(s)
- Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
- Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, Qingdao University, No. 308, Ningxia Road, Shinan District, Qingdao, 266071, Shandong, China
| | - Wenli Xiu
- Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, Qingdao University, No. 308, Ningxia Road, Shinan District, Qingdao, 266071, Shandong, China
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, No. 16, Jiangsu Road, Shinan District, Qingdao, 266000, Shandong, China
| | - Aiqin Lin
- Department of Medical Biology of Wannan Medical College, Wannan Medical College, Wuhu, 241002, China
| | - Guangqi Duan
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Nannan Jiang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Bao Wang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Feifei Wang
- Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, Qingdao University, No. 308, Ningxia Road, Shinan District, Qingdao, 266071, Shandong, China.
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, No. 16, Jiangsu Road, Shinan District, Qingdao, 266000, Shandong, China.
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
| | - Qian Dong
- Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, Qingdao University, No. 308, Ningxia Road, Shinan District, Qingdao, 266071, Shandong, China.
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, No. 16, Jiangsu Road, Shinan District, Qingdao, 266000, Shandong, China.
| | - Nan Xia
- Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, Qingdao University, No. 308, Ningxia Road, Shinan District, Qingdao, 266071, Shandong, China.
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
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Tao H, Wang Z, Zeng X, Hu H, Li J, Lin J, Lin W, Fang C, Yang J. Augmented Reality Navigation Plus Indocyanine Green Fluorescence Imaging Can Accurately Guide Laparoscopic Anatomical Segment 8 Resection. Ann Surg Oncol 2023; 30:7373-7383. [PMID: 37606841 DOI: 10.1245/s10434-023-14126-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Laparoscopic anatomical Segment 8 (S8) resection is a highly challenging hepatectomy. Augmented reality navigation (ARN), which could be combined with indocyanine green (ICG) fluorescence imaging, has been applied in various complex liver resections and may also be applied in laparoscopic anatomical S8 resection. However, no study has explored how to apply ARN plus ICG fluorescence imaging (ARN-FI) in laparoscopic anatomical S8 resection, or explored its accuracy. PATIENTS AND METHODS This study is a post hoc analysis that included 31 patients undergoing laparoscopic anatomical S8 resection from the clinical NaLLRFI trial, and the resected liver volume was measured in each patient. The perioperative parameters of safety and feasibility, as well as the accuracy analysis outcomes were compared. RESULTS There were 16 patients in the ARN-FI group and 15 patients underwent conventional laparoscopic hepatectomy without ARN or fluorescence imaging (non-ARN-FI group). There was no significant difference in baseline characteristics between the two groups. Compared with the non-ARN-FI group, the ARN-FI group had lower intraoperative bleeding (median 125 vs. 300 mL, P = 0.003). No significant difference was observed in other postoperative short-term outcomes. Accuracy analysis indicated that the actual resected liver volume (ARLV) in the ARN-FI group was more accurate. CONCLUSIONS ARN-FI was associated with less intraoperative bleeding and more accurate resection volume. These techniques may address existing challenges and provide rational guidance for laparoscopic anatomical S8 resection.
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Affiliation(s)
- Haisu Tao
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Zhuangxiong Wang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Xiaojun Zeng
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Haoyu Hu
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Jiang Li
- The First Affiliated Hospital, College of Medicine, Shihezi University, Shihezi, China
| | - Jinyu Lin
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Wenjun Lin
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Chihua Fang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China.
- Pazhou Lab, Guangzhou, China.
| | - Jian Yang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China.
- Pazhou Lab, Guangzhou, China.
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Wang J, Xu J, Lei K, You K, Liu Z. Prevalence and clinical significance of the Sg6/Sg7 intersegmental veins based on re-evaluation of the Couinaud classification for the right posterior portal vein. Updates Surg 2023; 75:1941-1948. [PMID: 37632610 DOI: 10.1007/s13304-023-01637-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023]
Abstract
Although Segment 6(Sg6) and Segment 7(Sg7) are two independent units, there are currently no clear anatomical boundary markers between Sg6 and Sg7. This study aimed to identify intersegmental veins (ISV) in the intersegmental plane of Sg6 and Sg7, and evaluate the prevalence of ISV, and its clinical significance in anatomical hepatectomy. We analyzed data from 180 patients undergoing abdominal computed tomography (CT) examination, and simultaneously performed 3D reconstruction models of the liver for each patient. The right posterior portal vein was analyzed and re-typed. Furthermore, the existence of ISV was defined, and prevalence and confluence patterns of ISV were analyzed. The author attempted to apply ISV to laparoscopic S6/S7 segmentectomy. We sorted data from the right posterior portal vein and divided it into six types. The ISV could be identified in 82.2% (148/180) of the patients, which were derived from the right hepatic vein (RHV) (91.9%) and right posterior inferior vein (IRHV) (8.1%). Ten ISV-guided laparoscopic Sg6/Sg7 segmentectomy were successfully carried out, seven patients underwent Sg6 segmentectomy, and three patients underwent Sg7 segmentectomy. There was no perioperative mortality. The median operative time was 223 min (range 181-260 min). The median blood loss was 200 ml (range 150-310 ml). The R0 resection rate was 100%. The ISV may be a candidate vessel to distinguish the boundary of the right posterior sector; it is expected to be a landmark in the liver parenchyma of anatomical hepatectomy.
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Affiliation(s)
- Jiaguo Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 76, Linjiang Road, Chongqing, 400010, China
| | - Jie Xu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 76, Linjiang Road, Chongqing, 400010, China
| | - Kai Lei
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 76, Linjiang Road, Chongqing, 400010, China
| | - Ke You
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 76, Linjiang Road, Chongqing, 400010, China
| | - Zuojin Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 76, Linjiang Road, Chongqing, 400010, China.
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Laparoscopic Microwave Ablation: Which Technologies Improve the Results. Cancers (Basel) 2023; 15:cancers15061814. [PMID: 36980701 PMCID: PMC10046461 DOI: 10.3390/cancers15061814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Liver resection is the best treatment for hepatocellular carcinoma (HCC) when resectable. Unfortunately, many patients with HCC cannot undergo liver resection. Percutaneous thermoablation represents a valid alternative for inoperable neoplasms and for small HCCs, but it is not always possible to accomplish it. In cases where the percutaneous approach is not feasible (not a visible lesion or in hazardous locations), laparoscopic thermoablation may be indicated. HCC diagnosis is commonly obtained from imaging modalities, such as CT and MRI, However, the interpretation of radiological images, which have a two-dimensional appearance, during the surgical procedure and in particular during laparoscopy, can be very difficult in many cases for the surgeon who has to treat the tumor in a three-dimensional environment. In recent years, more technologies have helped surgeons to improve the results after ablative treatments. The three-dimensional reconstruction of the radiological images has allowed the surgeon to assess the exact position of the tumor both before the surgery (virtual reality) and during the surgery with immersive techniques (augmented reality). Furthermore, indocyanine green (ICG) fluorescence imaging seems to be a valid tool to enhance the precision of laparoscopic thermoablation. Finally, the association with laparoscopic ultrasound with contrast media could improve the localization and characteristics of tumor lesions. This article describes the use of hepatic three-dimensional modeling, ICG fluorescence imaging and laparoscopic ultrasound examination, convenient for improving the preoperative surgical preparation for personalized laparoscopic approach.
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Zeng X, Zhu W, Lin W, Tian J, Yang J, Fang C. Laparoscopic Anatomical Extended Right Posterior Sectionectomy Using Virtual Liver Segment Projection Navigation and Indocyanine Green Fluorescence Imaging. Ann Surg Oncol 2023; 30:375-376. [PMID: 36209326 DOI: 10.1245/s10434-022-12551-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Extended right posterior sectionectomy is an alternative to right hepatectomy (RH) for tumors located mainly in the right posterior section (RPS) and partially in the right anterior section (RAS).1 Anatomical extended right posterior sectionectomy (AERPS) combining RPS and right anterior subsegmental resections not only achieves anatomical hepatectomy to reduce remnant liver ischemia2 but also preserves more functional liver parenchyma than RH. AERPS can be extremely challenging, especially under laparoscopy. PATIENT AND METHODS A 48-year-old male was admitted to our institution for a tumor in the right liver. The three-dimensional (3D) model revealed that the subsegments innervated by the P5dor and the P8lat could cover the territory of the tumor in the RAS.3 Therefore, laparoscopic AERPS was performed. First, an intrafascial approach was adopted to dissect and ligate the right posterior Glissonean pedicle. Then, we used intraoperative ultrasound and virtual liver segment projection by Laparoscopic Hepatectomy Navigation System4 to identify the intersegmental fissure between the dorsal and ventral segments of S5. Partial parenchymal transection was used to reach the common stem of G5dor and G8lat.5 Finally, using indocyanine green (ICG) negative staining fluorescence imaging, the precise transection interface was determined. RESULTS The operation lasted 360 min with 100 ml of intraoperative blood loss. There were no postoperative complications, and the patient was discharged after 3 days. CONCLUSION Laparoscopic AERPS is technically feasible and can be performed with greater precision coupled with virtual liver segment projection and ICG fluorescence imaging.
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Affiliation(s)
- Xiaojun Zeng
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Wen Zhu
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Wenjun Lin
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
| | - Jian Yang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China.
- Pazhou Lab, Guangzhou, China.
| | - Chihua Fang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China.
- Pazhou Lab, Guangzhou, China.
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Ishii N, Harimoto N, Kogure K, Araki K, Hagiwara K, Tsukagoshi M, Igarashi T, Watanabe A, Kubo N, Shirabe K. Study on the portal ramification pattern of the right anterior sector of the liver and a unique medial branch (PV8c) of the right anterior portal vein. Ann Gastroenterol Surg 2022; 6:679-687. [PMID: 36091302 PMCID: PMC9444865 DOI: 10.1002/ags3.12561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/03/2022] [Accepted: 02/20/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Norihiro Ishii
- Department of General Surgical Science Division of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Gunma University Gunma Japan
- Department of General Surgical Science Graduate School of Medicine Gunma University Gunma Japan
| | - Norifumi Harimoto
- Department of General Surgical Science Division of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Gunma University Gunma Japan
- Department of General Surgical Science Graduate School of Medicine Gunma University Gunma Japan
| | - Kimitaka Kogure
- Department of General Surgical Science Graduate School of Medicine Gunma University Gunma Japan
| | - Kenichiro Araki
- Department of General Surgical Science Division of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Gunma University Gunma Japan
- Department of General Surgical Science Graduate School of Medicine Gunma University Gunma Japan
| | - Kei Hagiwara
- Department of General Surgical Science Division of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Gunma University Gunma Japan
- Department of General Surgical Science Graduate School of Medicine Gunma University Gunma Japan
| | - Mariko Tsukagoshi
- Department of General Surgical Science Division of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Gunma University Gunma Japan
- Department of Innovative Cancer Immunotherapy Gunma University Graduate School of Medicine Gunma Japan
| | - Takamichi Igarashi
- Department of General Surgical Science Division of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Gunma University Gunma Japan
- Department of General Surgical Science Graduate School of Medicine Gunma University Gunma Japan
| | - Akira Watanabe
- Department of General Surgical Science Division of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Gunma University Gunma Japan
- Department of General Surgical Science Graduate School of Medicine Gunma University Gunma Japan
| | - Norio Kubo
- Department of General Surgical Science Division of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Gunma University Gunma Japan
- Department of General Surgical Science Graduate School of Medicine Gunma University Gunma Japan
| | - Ken Shirabe
- Department of General Surgical Science Division of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Gunma University Gunma Japan
- Department of General Surgical Science Graduate School of Medicine Gunma University Gunma Japan
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Manenti A, Manco G, Farinetti A, Roncati L. The intrahepatic branches of portal vein: a relevant surgical topic. Surgery 2020; 169:1265. [PMID: 33334581 DOI: 10.1016/j.surg.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Luca Roncati
- Department of Pathology, University of Modena, Italy
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