In recent years, the emerging optical imaging technologies have shown their unique value in diagnosis of disease and surgical navigation. This article focus on describing the optical imaging technology mediated by the only one near-infrared light imaging molecule--indocyanine green which has already been approved by FDA to use in clinical and inmates a characteristics of passive targeting liver cancer tissue. This article reviews the application of the technology in liver cancer surgery and demonstrates the value, deficiency and possible improvements of this technology.
Diagnostic Imaging ; Fluorescent Dyes ; Humans ; Indocyanine Green ; Infrared Rays ; Liver Neoplasms ; surgery

OBJECTIVETo investigate the methodology of mimic resection system on liver.

METHODSHepatic arteries, portal vein, inferior cava vein, hepatic veins and biliary ducts of liver with integrate hepatic portal were perfused with filling materials in different colors. And then the sample was embedded, frozen and slice-cut to obtain serial sectional images. After image registration and segmentation, the 3D reconstruction model which contained the liver's surface and its internal structures was constructed with MIMICS 9.0. Based on the freeform modeling system and its accessories (the software GHOST and the force-feedback equipment PHANTOM), the virtual hepatectomy system was established which could manipulate the virtual scalpel to perform optional resection on virtual liver model.

RESULTSAfter slice-cutting the cast liver, 910 serial cross-section images were obtained sharply and clearly. The 3D reconstructed liver model looked like the liver sample exactly, and could be magnified, contracted and rotated. In the virtual surgery system with good interaction, powerful immersion and great imagination, the virtual scalpel could be manipulated to perform optional resection on 3D liver model with the haptic device (PHANTOM).

CONCLUSIONSThe 3D visualized liver and the virtual hepatectomy system has been satisfactorily developed using the hepatic serial sectional images. The process of simulation operation was consistent with clinical practice.

Adult ; Anatomy, Cross-Sectional ; Hepatectomy ; methods ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Liver ; anatomy & histology ; blood supply ; surgery ; Models, Anatomic ; Models, Biological ; User-Computer Interface

OBJECTIVETo study the value of hepatic segment resection combined with rigid choledochoscope by the three-dimensional (3D) visualization technology in the diagnosis and treatment of complex hepatolithiasis.

METHODSEnhance computed tomography (CT) data of 46 patients with complex hepatolithiasis who were admitted to the Zhujiang Hospital of the Southern Medical University from July 2010 to June 2014 were collected.All of the CT data were imported into the medical image three-dimensional visualization system (MI-3DVS) for 3D reconstruction and individual 3D types. The optimal scope of liver resection and the remnant liver volume were determined according to the individualized liver segments which were made via the distribution and variation of hepatic vein and portal vein, the distribution of bile duct stones and stricture of the bile duct, which provided guidance for intraoperative hepatic lobectomy and rigid choledochoscope for the remnant calculus lithotripsy.

RESULTSOutcomes of individual 3D types: 10 cases of type I, 11 cases of IIa, 23 cases of IIb, 2 cases of IIc, 19 cases coexisted with history of biliary surgery. The variation of hepatic artery was appeared 6 cases. The variation of portal vein was appeared 8 cases. The remaining liver volume for virtual hepatic lobectomy controlled more than 50%. Eighteen cases underwent left lateral hepatectomy, 8 cases underwent left liver resection, 8 cases underwent right posterior lobe of liver resection, 4 cases underwent the right hepatic resection, 4 cases underwent IV segment liver resection, 2 cases underwent right anterior lobe of liver resection, 2 cases underwent left lateral hepatectomy combined with right posterior lobe of liver resection, 26 cases underwent targeting treatment of rapid choledochoscope and preumatic lithotripsy. The actual surgical procedure was consistent with the preoperative surgical planning. There was no postoperative residual liver ischemia,congestion, liver failure occurred in this study. The intraoperative calculus clearance rate was 91.3% (42/46) because 4 cases of postoperatively residual calculi were not suitable for one stage management due to suppurative cholangitis but removed calculus successfully with rigid choledochoscope through T tube fistula.

CONCLUSIONHepatic segment resection combined with rigid choledochoscope under the guidance of three-dimensional visualization technology achieves accurate preoperative diagnosis and higher complete stone clearance rate of complicated hepatolithiasis.

Calculi ; surgery ; Endoscopy ; Hepatectomy ; methods ; Hepatic Artery ; Hepatic Veins ; Humans ; Imaging, Three-Dimensional ; Lithotripsy ; Liver Diseases ; surgery ; Portal Vein ; Tomography, X-Ray Computed

OBJECTIVETo study the clinical efficacy of three dimensional visualization technique assisted hepatectomy for the treatment of primary liver cancer.

METHODSA total of 108 primary liver cancer patients who had been admitted to Zhujiang Hospital of Southern Medical University from September 2013 to December 2014 were assigned to three dimensional visualization technique assisted hepatectomy group (n = 55) and routine hepatectomy group (n = 53) according to different methods of hepatectomy. The observed variable in two groups as fellow: the operative time, intraoperative blood loss, intraoperative blood transfusion, the change of postoperative liver function and biochemical indicators in 1, 3, 5 days, postoperative complication. The patients were followed up via-return visit or telephone.A student's t test was used to compare continuous parametric variables, and the Mann-Whitney U test was used to compare non-parametric or discrete variables, as appropriate. Categorical data were compared using the Chi-square test or Fisher's exact test.

RESULTSIn 3D group and routine hepatectomy group, the patients' intraoperative blood transfusion volume were 300 ml (200-600 ml) and 400 ml (300-700 ml) (χ² = -2.609, P = 0.009) respectively, intraoperative blood loss volume were 400 ml (250-600 ml) and 550 ml (400-800 ml) (χ² = -2.277, P = 0.023), the operative time were (247 ± 57) min and (262 ± 53) min (χ² = -1.787, P = 0.074), the deterioration of the mainly liver function indicators peak in routine hepatectomy group were higher than that in 3D group (P < 0.05). The ALT, AST, TBIL in 3D group were lower than that in routine group on postoperative day 1, 3, 5, respectively (χ² = -5.740- -0.692, all P < 0.05). The ALB in 3D group was higher than that in routine group on postoperative day 3, 5 ((33.0 ± 5.6) g/L vs. (31.2 ± 4.1) g/L, (36.7 ± 4.4) g/L vs. (34.7 ± 4.2) g/L) (t = 1.922-2.573, both P < 0.05). In 3D group and routine hepatectomy group, the incidence of postoperative complications were 10.9% and 30.1% (χ² = 6.185, P = 0.013), the length of postoperative hospital day were (12.6 ± 3.6) days and (14.4 ± 3.5) days (χ² = -3.384, P = 0.031), the positive rate of resection margin were 0 and 9.4% respectively (Fisher test: P = 0.026), the 1-year tumor recurrence rate were 22.2% and 37.5% (P > 0.05), 1-year survival rate was 82.2% and 77.5% (P > 0.05). No perioperative mortality was occured in the two groups.

CONCLUSIONThree dimensional visualization technique assisted hepatectomy for the treatment of primary liver cancer could reduce surgical injury, lower the rate of postoperative complications, improve the safety and the efficacy of the operation and achieve a good prognosis.

Blood Loss, Surgical ; Blood Transfusion ; Chi-Square Distribution ; Hepatectomy ; methods ; Humans ; Imaging, Three-Dimensional ; Liver Neoplasms ; surgery ; Neoplasm Recurrence, Local ; Operative Time ; Postoperative Complications ; Survival Rate