Digital intelligent technology assisted three-dimensional laparoscopic extended left hepatectomy with resection of the middle hepatic vein(Video)

Laparoscopic right hemi-hepatectomy plus total caudate lobectomy for perihilar cholangiocarcinoma via anterior approach with augmented reality navigation: a feasibility study

BACKGROUND

Right hemi-hepatectomy plus total caudate lobectomy is the appropriate procedure for type IIIa or partial type II pCCA. However, the laparoscopic implementation of this procedure remains technically challenging, especially hilar vascular dissection and en bloc resection of the total caudate lobe. Augmented reality navigation can provide intraoperative navigation to enhance visualization of invisible hilar blood vessels and guide the parenchymal transection plane.

METHODS

Eleven patients who underwent laparoscopic right hemi-hepatectomy plus total caudate lobectomy from January 2021 to January 2023 were enrolled in this study. Augmented reality navigation technology and the anterior approach were utilized in this operation. Routine operative and short-term postoperative outcomes were assessed to evaluate the feasibility of the novel navigation method in this operation.

RESULTS

Right hemi-hepatectomy plus total caudate lobectomy was successfully performed in all 11 enrolled patients. Among the 11 patients, the mean operation time was 454.5 ± 25.0 min and the mean estimated blood loss was 209.1 ± 56.1 ml. Negative surgical margins were achieved in all patients. The postoperative course of all the patients was uneventful, and the mean length of postoperative hospital stay was 10.5 ± 1.2 days.

CONCLUSION

Laparoscopic right hemi-hepatectomy plus total caudate lobectomy via the anterior approach may be feasible and safe for pCCA with the assistance of augmented reality navigation.

Laparoscopic anatomic combined subsegmentectomy of segment 8 via the tailored strategy using digital intelligent technology

INTRODUCTION

Segment 8 is considered the largest liver segment, and its portal vein branches are generally divided into four parts, including ventral, dorsal, dorsolateral and medial branches (Shindoh et al., 2010; Takayasu et al., 1985) [1,2]. An anatomic combined subsegmentectomy could satisfy both the oncological quality of anatomical resection and the safety of parenchyma sparing principle if a small hepatocellular carcinoma is located between the hepatic subsegments (Berardi et al., 2021) [3]. Yet, laparoscopic anatomic combined subsegmentectomy of segment 8 is still technically challenging. The development of digital intelligent technology has made it possible to tailored preoperative planning and accurate intraoperative navigation in laparoscopic surgery.

VIDEO

A 57-year-old man underwent a routine CT scan and was found to have a mass occupation in segment 8 of the liver. Three-dimensional reconstruction was performed to evaluate liver anatomy, vascular variations, and volume of each vascular unit as well as the location of the tumor, its relationship with the liver anatomy, and the Glissonian pedicles feeding the tumor-bearing area. Based on the reconstructed model, resection was planned aiming to the narrowest but oncologically safe anatomical tumor-bearing area. Upon evaluation, anatomic combined subsegmentectomy of segment 8 (ventral and medial subsegments) was confirmed. The operation was performed precisely under assistance of the Laparoscopic Hepatectomy Navigation System (LHNS, software copyright No. 2018SR840555) (Yang et al., 2020) [4].

RESULTS

The operation lasted 200 min with 50 ml intraoperative blood loss. There were no postoperative complications, and the patient was discharged after 6 days.

CONCLUSION

Digital intelligent technology could provide tailored strategy for laparoscopic liver surgery, which makes laparoscopic anatomic combined subsegmentectomy of segment 8 feasible and effective.