Preoperative three-dimensional reconstruction assisted laparoscopic liver cancer resection with vascular variation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Ke , LI Jing , YOU Nan , GU Huiying , WANG Liang , WANG Zheng , ZHU Yi’nan , LI Hongyan ,  ZHENG Lu

Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Military University, Chongqing 400037, P. R. China;

Corresponding?author：

ZHENG Lu, Email: xqyyzl1@163.com

Keywords：

laparoscopic liver resection; three-dimensional reconstruction; precise hepatectomy; vascular variation

DOI：

10.7507/1007-9424.201807044

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate feasibility and safety of laparoscopic liver resection with vascular variation.Methods The clinical data of one patient with preoperative diagnosis of primary liver cancer, who was admitted into the Department of Hepatobiliary Surgery of the Second Affiliated Hospital of Army Military University in October 2017, were analyzed retrospectively. The three-dimensional (3D) reconstruction was completed basing on the preoperative CT data, then the liver volume was calculated and the preoperative planning was made, finally the subsequent surgery was performed.Results The results of the 3D reconstruction suggested that the tumor was situated in the central of the right liver, including the segment Ⅴ, Ⅵ, Ⅶ, and Ⅷ. There was a type Ⅱ portal vein variation, the right anterior branch of the portal vein divided a branch into the left medial lobe. The right hepatic vein was divided into the ventral and dorsal branches. There was a thick right posterior inferior vein in this case. The preoperative planning was that the right posterior lobectomy or right anterior lobectomy could not completely remove the tumor. According to the standard right hemihepatectomy, the remaining liver volume accounted for 27% of the standard liver volume. If preserving the right anterior branch of the portal vein for the right hemihepatectomy, the remaining liver volume accounted for 41% of the standard liver volume. According to the concept of precise hepatectomy, the laparoscopic partial right hepatectomy with preservation of the main branch of the right anterior portal vein was performed smoothly. The liver function recovered well after the surgery. The right pleural effusion appeared after the surgery, then was relieved by the thoracentesis.Conclusion For primary liver cancer patient with vascular variation, laparoscopic liver resection is feasible and safe basing on guide of 3D reconstruction technology.

Citation： WU Ke, LI Jing, YOU Nan, GU Huiying, WANG Liang, WANG Zheng, ZHU Yi’nan, LI Hongyan, ZHENG Lu. Preoperative three-dimensional reconstruction assisted laparoscopic liver cancer resection with vascular variation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(12): 1496-1501. doi: 10.7507/1007-9424.201807044 Copy

1.	Ogiso S, Hatano E, Nomi T, et al. Laparoscopic liver resection: Toward a truly minimally invasive approach. World J Gastrointest Endosc, 2015, 7(3): 159-161.
2.	Hibi T, Cherqui D, Geller DA, et al. Expanding indications and regional diversity in laparoscopic liver resection unveiled by the International Survey on Technical Aspects of Laparoscopic Liver Resection (INSTALL) study. Surg Endosc, 2016, 30(7): 2975-2983.
3.	Wakabayashi G, Cherqui D, Geller DA, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg, 2015, 261(4): 619-629.
4.	Dong J, Yang S, Zeng J, et al. Precision in liver surgery. Semin Liver Dis, 2013, 33(3): 189-203.
5.	中華醫學會數字醫學分會, 中國研究型醫院學會數字醫學臨床外科專業委員會. 復雜性肝臟腫瘤三維可視化精準診治專家共識. 中國實用外科雜志, 2017, 31(1): 53-59.
6.	董家鴻, 鄭樹森, 陳孝平, 等. 肝切除術前肝臟儲備功能評估的專家共識(2011版). 中華消化外科雜志, 2011, 10(1): 20-25.
7.	彭馳涵, 李川, 文天夫, 等. 原發性肝癌行ALPPS的適應證與禁忌證初探(附15例報道). 中國普外基礎與臨床雜志, 2015, 22(10): 1183-1186.
8.	Cai YL, Song PP, Tang W, et al. An updated systematic review of the evolution of ALPPS and evaluation of its advantages and disadvantages in accordance with current evidence. Medicine (Baltimore), 2016, 95(24): e3941.
9.	中華醫學會外科學分會肝臟外科學組. 腹腔鏡肝切除專家共識與手術操作指南(2013版). 中華消化外科雜志, 2013, 12(3): 161-165.
10.	中國醫師協會外科醫師分會微創外科醫師委員會. 腹腔鏡肝切除術加速康復外科中國專家共識(2017版). 中國實用外科雜志, 2017, 37(5): 517-524.
11.	Chen J, Li H, Liu F, et al. Surgical outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma for various resection extent. Medicine (Baltimore), 2017, 96(12): e6460.
12.	Fonseca-Neto OCLD, Lima HCS, Rabelo P, et al. Anatomic variations of hepatic artery: a study in 479 liver transplantations. Arq Bras Cir Dig, 2017, 30(1): 35-37.
13.	鮑光進, 李樹平, 孫靜, 等. 肝動脈解剖變異的640層容積CT血管成像研究. 中國醫學計算機成像雜志, 2014, 20(6): 555-560.
14.	Khamanarong K, Woraputtaporn W, Amarttayakong P, et al. Classification of portal vein tributaries in Thai cadavers including a new type V. Surg Radiol Anat, 2016, 38(6): 735-739.
15.	ülger BV, Hatipo?lu ES, Ertu?rul ?, et al. Variations in the vascular and biliary structures of the liver: a comprehensive anatomical study. Acta Chir Belg, 2018: 1-18.
16.	Reichert PR, Renz JF, D'Albuquerque LA, et al. Surgical anatomy of the left lateral segment as applied to living-donor and split-liver transplantation: a clinicopathologic study. Ann Surg, 2000, 232(5): 658-664.
17.	Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava. Surg Gynecol Obstet, 1981, 152(1): 43-50.
18.	Shilal P, Tuli A. Anatomical variations in the pattern of the right hepatic veins draining the posterior segment of the right lobe of the liver. J Clin Diagn Res, 2015, 9(3): AC08-AC12.
19.	崔楷悅, 董蒨, 耿耿, 等. 基于計算機輔助手術系統的肝靜脈分型及其對肝臟外科的臨床意義. 中華肝膽外科雜志, 2017, 23(9): 585-590.
20.	Xiang N, Fang C, Fan Y, et al. Application of liver three-dimensional printing in hepatectomy for complex massive hepatocarcinoma with rare variations of portal vein: preliminary experience. Int J Clin Exp Med, 2015, 8(10): 18873-18878.
21.	中國研究型醫院學會肝膽胰外科專業委員會. 精準肝切除術專家共識. 中華消化外科雜志, 2017, 16(9): 883-893.
22.	董家鴻, 黃志強. 精準肝切除—21世紀肝臟外科新理念. 中華外科雜志, 2009, 47(21): 1601-1605.
23.	董家鴻, 葉晟. 開啟精準肝膽外科的新時代. 中華普外科手術學雜志(電子版), 2016, 10(3): 181-184.
24.	Zhang Y, Yang H, Deng X, et al. Intermittent Pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection. Surg Endosc, 2016, 30(3): 961-970.
25.	胡軍, 魯光銳, 魯玲, 等. 不同肝血流阻斷方式手術治療原發性肝癌的臨床體會. 臨床外科雜志, 2017, 25(3): 190-193.

1. Ogiso S, Hatano E, Nomi T, et al. Laparoscopic liver resection: Toward a truly minimally invasive approach. World J Gastrointest Endosc, 2015, 7(3): 159-161.
2. Hibi T, Cherqui D, Geller DA, et al. Expanding indications and regional diversity in laparoscopic liver resection unveiled by the International Survey on Technical Aspects of Laparoscopic Liver Resection (INSTALL) study. Surg Endosc, 2016, 30(7): 2975-2983.
3. Wakabayashi G, Cherqui D, Geller DA, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg, 2015, 261(4): 619-629.
4. Dong J, Yang S, Zeng J, et al. Precision in liver surgery. Semin Liver Dis, 2013, 33(3): 189-203.
5. 中華醫學會數字醫學分會, 中國研究型醫院學會數字醫學臨床外科專業委員會. 復雜性肝臟腫瘤三維可視化精準診治專家共識. 中國實用外科雜志, 2017, 31(1): 53-59.
6. 董家鴻, 鄭樹森, 陳孝平, 等. 肝切除術前肝臟儲備功能評估的專家共識(2011版). 中華消化外科雜志, 2011, 10(1): 20-25.
7. 彭馳涵, 李川, 文天夫, 等. 原發性肝癌行ALPPS的適應證與禁忌證初探(附15例報道). 中國普外基礎與臨床雜志, 2015, 22(10): 1183-1186.
8. Cai YL, Song PP, Tang W, et al. An updated systematic review of the evolution of ALPPS and evaluation of its advantages and disadvantages in accordance with current evidence. Medicine (Baltimore), 2016, 95(24): e3941.
9. 中華醫學會外科學分會肝臟外科學組. 腹腔鏡肝切除專家共識與手術操作指南(2013版). 中華消化外科雜志, 2013, 12(3): 161-165.
10. 中國醫師協會外科醫師分會微創外科醫師委員會. 腹腔鏡肝切除術加速康復外科中國專家共識(2017版). 中國實用外科雜志, 2017, 37(5): 517-524.
11. Chen J, Li H, Liu F, et al. Surgical outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma for various resection extent. Medicine (Baltimore), 2017, 96(12): e6460.
12. Fonseca-Neto OCLD, Lima HCS, Rabelo P, et al. Anatomic variations of hepatic artery: a study in 479 liver transplantations. Arq Bras Cir Dig, 2017, 30(1): 35-37.
13. 鮑光進, 李樹平, 孫靜, 等. 肝動脈解剖變異的640層容積CT血管成像研究. 中國醫學計算機成像雜志, 2014, 20(6): 555-560.
14. Khamanarong K, Woraputtaporn W, Amarttayakong P, et al. Classification of portal vein tributaries in Thai cadavers including a new type V. Surg Radiol Anat, 2016, 38(6): 735-739.
15. ülger BV, Hatipo?lu ES, Ertu?rul ?, et al. Variations in the vascular and biliary structures of the liver: a comprehensive anatomical study. Acta Chir Belg, 2018: 1-18.
16. Reichert PR, Renz JF, D'Albuquerque LA, et al. Surgical anatomy of the left lateral segment as applied to living-donor and split-liver transplantation: a clinicopathologic study. Ann Surg, 2000, 232(5): 658-664.
17. Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava. Surg Gynecol Obstet, 1981, 152(1): 43-50.
18. Shilal P, Tuli A. Anatomical variations in the pattern of the right hepatic veins draining the posterior segment of the right lobe of the liver. J Clin Diagn Res, 2015, 9(3): AC08-AC12.
19. 崔楷悅, 董蒨, 耿耿, 等. 基于計算機輔助手術系統的肝靜脈分型及其對肝臟外科的臨床意義. 中華肝膽外科雜志, 2017, 23(9): 585-590.
20. Xiang N, Fang C, Fan Y, et al. Application of liver three-dimensional printing in hepatectomy for complex massive hepatocarcinoma with rare variations of portal vein: preliminary experience. Int J Clin Exp Med, 2015, 8(10): 18873-18878.
21. 中國研究型醫院學會肝膽胰外科專業委員會. 精準肝切除術專家共識. 中華消化外科雜志, 2017, 16(9): 883-893.
22. 董家鴻, 黃志強. 精準肝切除—21世紀肝臟外科新理念. 中華外科雜志, 2009, 47(21): 1601-1605.
23. 董家鴻, 葉晟. 開啟精準肝膽外科的新時代. 中華普外科手術學雜志(電子版), 2016, 10(3): 181-184.
24. Zhang Y, Yang H, Deng X, et al. Intermittent Pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection. Surg Endosc, 2016, 30(3): 961-970.
25. 胡軍, 魯光銳, 魯玲, 等. 不同肝血流阻斷方式手術治療原發性肝癌的臨床體會. 臨床外科雜志, 2017, 25(3): 190-193.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Preoperative three-dimensional reconstruction assisted laparoscopic liver cancer resection with vascular variation

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content