The concept of precision medicine has brought revolutionary changes to human health and medical treatment. In a broad sense, precision medicine is the application of advanced technologies such as gene sequencing, digital medicine, artificial intelligence, navigation technology, and biomedical engineering to clinical, basic, and public health medical research and practice. The purpose is to promote the continuous development of medical standards. The concept of precision surgery was first proposed by academician Dong Jiahong, who has played an exemplary role in the field of liver surgery for the oncology and other professional fields of surgery. The development and application of computer-assisted surgery systems have promoted the development of precision liver surgery. The digital liver three-dimensional reconstruction provides a new basis for liver vascular anatomy and liver segmentation, assists in the realization of individualized surgical planning, and the measurement of residual liver volume guarantees the safety of operation. The great progress of adult precision liver surgery has provided important help and guidance for the development of pediatric liver surgery. Compared with adults, pediatric liver tumors have their particularities. Pediatric liver tumors are often huge, complex in location, fast growing, and highly malignant. Most children do not have liver cirrhosis and are sensitive to chemotherapy. The liver volume changes greatly with age and weight. These differences determine that the treatment of liver tumors in children needs to adopt different models, and the diagnosis and treatment standards need to be improved. The authors elaborate on the topic of "from adult to child-the development and prospect of precision liver surgery" to promote precision surgery and comprehensive treatment of liver tumors.

Objective:To investigate the application value of Hisense computer-assisted surgery system (CAS) three-dimensional reconstruction in the precision treatment of pediatric liver tumors.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 82 children with liver tumors who were admitted to Affiliated Hospital of Qingdao University from January 2013 to September 2021 were collected. There were 39 males and 43 females, aged 13(19)months. Children underwent upper abdominal dynamic enhanced computed tomography (CT) examination, and three-dimensional reconstruction was performed on CT images of arterial, equili-brium and venous phases with Hisense CAS. Surgical feasibility and scheme were evaluated and conducted based on the results of upper abdominal dynamic enhanced CT examination, and then revised according to three-dimensional reconstruction results of Hisense CAS. Observation indicators: (1) comparison of surgical scheme between two-dimensional enhanced CT images and three-dimensional reconstruction results of Hisense CAS; (2) intraoperative and postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination to detect postoperative compli-cations and residual liver compensation up to November 2021. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(IQR) or M(range). Count data were described as absolute numbers or percentages. Results:(1) Comparison of surgical scheme between two-dimensional CT images and three-dimensional reconstruction results of Hisense CAS. ① Based on the two-dimensional CT images, 42 cases of 82 children could undergo one-stage resection and 40 children could not. However, based on the three-dimensional reconstruction results of Hisense CAS, 48 cases of 82 children could undergo one-stage resection and 34 children could not. There were 6 children with one-stage resection feasibility based on the three-dimensional reconstruction results of Hisense CAS rather than the two-dimensional CT images. For the 34 children undergoing chemotherapy firstly, 31 cases had surgical feasibility after chemotherapy based on the two-dimensional CT images and 3 cases could not undergo surgery because of unapparent tumor regression or tumor surrounding impor-tant vessels. However, the 34 children had surgical feasibility after chemotherapy based on the three-dimensional reconstruction results of Hisense CAS. The revision rate of surgical feasibility was 11.0%(9/82) for the 82 children. ② Based on the two-dimensional CT images, 15 cases of 82 children underwent liver left lobectomy, 21 cases underwent liver right lobectomy, 7 cases underwent mesohepatectomy, 13 cases underwent extended left hemihepatectomy, 23 cases underwent extended right hemihepatectomy, 3 cases underwent segmental hepatectomy. However, based on the three-dimensional reconstruction results of Hisense CAS, 20 cases of 82 children underwent liver left lobectomy, 29 cases underwent liver right lobectomy, 7 cases underwent mesohepatectomy, 7 cases underwent extended left hemihepatectomy, 14 cases underwent extended right hemihepatectomy, 5 cases underwent segmental hepatectomy. The revision rate of surgical scheme was 36.6%(30/82) for the 82 children. (2) Intraoperative and postoperative situations. The operation time, volume of intraoperative blood loss, duration of postoperative hospital stay of the 82 children were (182±18)minutes, 20(10)mL, (10.2±1.9)days, respectively. (3) Follow-up. All the 82 children were followed up for 10 (range, 2?18)months. There was no obvious complication occurred to the 82 children after surgery, and the residual liver can satisfy the liver compensation of body. All the children survived well.Conclusion:Three-dimensional reconstruction of Hisense CAS is conducive to judging the surgical feasibility and formulation of accurate surgical plan of children with liver tumors.

Objective To classify the types of hepatic vein and to measure their corresponding liver venous drainage volumes based on analysis of data obtained from a computer-assisted surgery system with an aim to provide an anatomical basis on individualized anatomical hepatectomy.Methods Thin-layer computed tomography (CT) imaging on 570 patients were reconstructed using the Hisense CAS.The types of hepatic vein were classified according to their anatomical variations.The margins of the hemilivers or sectors and their corresponding hepatic venous drainage volumes were displayed.Results The major hepatic veins were classified into three types:Type Ⅰ (270/570,47.4％),type Ⅱ (294/570,51.6％),and type Ⅲ (6/570,1.0％).The left hepatic vein (LHV) was classified as type Ⅰ in 190/570 (33.3％),type Ⅱ in 79/570 (13.9％),and type Ⅲ in 301/570 (52.8％).The middle hepatic vein (MHV) was classified as type Ⅰ in313/570 (54.9％),type Ⅱ in 174/570 (30.5％),and type Ⅲ in 83/570 (14.6％).The right hepatic vein (RHV) was classified as type Ⅰ in 456/570 (80.0％),type Ⅱ in 79/570 (13.9％),and type Ⅲ in 35/570 (6.1％).Type Ⅰ was further classified into four subtypes of A (26/456,5.7％),B (404/456,88.6％),C (20/456,4.4％),and D (6/456,1.3％).The LHV volume was (25.0± 6.6) ％,the MHV volume was (34.8 ± 9.5) ％ and the RHV volume was (25.1 ± 11.6) ％ in 63 patients with inferior right hepatic veins (IRHV).The IRHV and other branches volumes were (14.7 ± 7.4) ％.The RHV volume was (40.7 ± 8.6) ％ in 68 patients without IRHV.Conclusions Hepatic venous variations are complex.Significant differences existed in the hepatic venous drainage volumes.The Hisense CAS clearly delineated the relationship between the intrahepatic vascular structures and the liver carcinoma which hopefully can lead to improvement in the success rate of complex hepatectomy.

Objective: To study the segment of liver according to the large amount of three-dimensional(3D) reconstructive images of normal human livers and the vascular system, and to recognize the basic functional liver unit based on the anatomic features of the intrahepatic portal veins. Methods: The enhanced CT primitive DICOM files of 1 260 normal human livers from different age groups who treated from October 2013 to February 2017 provided by 16 hospitals were analyzed using the computer-aided surgery system.The 3D liver and liver vascular system were reconstructed, and the digital liver 3D model was established.The vascular morphology, anatomical features, and anatomical distributions of intrahepatic portal veins were statistically analyzed. Results: The digital liver model obtained from the 3D reconstruction of CAS displayed clear intrahepatic portal vein vessels of level four.Perform a digital liver segments study based on the analysis of level four vascular distribution areas.As the less anatomical variation of left hepatic portal vein, the liver was classified into four types of liver segmentation mainly based on right hepatic portal vein.Type A was similar to Couinaud or Cho′s segmentation, containing 8 segments(537 cases, 42.62%). Type B contained 9 segments as there are three ramifications of right-anterior portal vein(464 cases, 36.82%). The main difference for Type C was the variation of right-posterior portal vein which was sector shape(102 cases, 8.10%). Type D contained the cases with special portal vein variations, which needs three-dimensional simulation to design individualized liver resection plan(157 cases, 12.46%). These results showed that there was no significant difference in liver segmental typing between genders(χ²=2.179, P=0.536) and did not reveal any significant difference in liver segmental typing among the different age groups(χ²=0.357, P=0.949). Conclusions The 3D digital liver model can demonstrate the true 3D anatomical structures, and its spatial vascular variations.The observation of anatomic features, distribution areas of intrahepatic portal veins and individualized liver segmentation achieved via digital medical 3D visualization technology is of great value for understand the complexity of liver anatomy and to guide the precise hepatectomy.