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：

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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.	中华医学会数字医学分会, 中国研究型医院学会数字医学临床外科专业委员会. 复杂性肝脏肿瘤三维可视化精准诊治专家共识. 中国实用外科杂志, 2017, 31(1): 53-59.
6.	董家鸿, 郑树森, 陈孝平, 等. 肝切除术前肝脏储备功能评估的专家共识(2011版). 中华消化外科杂志, 2011, 10(1): 20-25.
7.	彭驰涵, 李川, 文天夫, 等. 原发性肝癌行ALPPS的适应证与禁忌证初探(附15例报道). 中国普外基础与临床杂志, 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.	中华医学会外科学分会肝脏外科学组. 腹腔镜肝切除专家共识与手术操作指南(2013版). 中华消化外科杂志, 2013, 12(3): 161-165.
10.	中国医师协会外科医师分会微创外科医师委员会. 腹腔镜肝切除术加速康复外科中国专家共识(2017版). 中国实用外科杂志, 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.	鲍光进, 李树平, 孙静, 等. 肝动脉解剖变异的640层容积CT血管成像研究. 中国医学计算机成像杂志, 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, Hatipoğlu ES, Ertuğrul Ö, 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.	崔楷悦, 董蒨, 耿耿, 等. 基于计算机辅助手术系统的肝静脉分型及其对肝脏外科的临床意义. 中华肝胆外科杂志, 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.	中国研究型医院学会肝胆胰外科专业委员会. 精准肝切除术专家共识. 中华消化外科杂志, 2017, 16(9): 883-893.
22.	董家鸿, 黄志强. 精准肝切除—21世纪肝脏外科新理念. 中华外科杂志, 2009, 47(21): 1601-1605.
23.	董家鸿, 叶晟. 开启精准肝胆外科的新时代. 中华普外科手术学杂志(电子版), 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.	胡军, 鲁光锐, 鲁玲, 等. 不同肝血流阻断方式手术治疗原发性肝癌的临床体会. 临床外科杂志, 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. 中华医学会数字医学分会, 中国研究型医院学会数字医学临床外科专业委员会. 复杂性肝脏肿瘤三维可视化精准诊治专家共识. 中国实用外科杂志, 2017, 31(1): 53-59.
6. 董家鸿, 郑树森, 陈孝平, 等. 肝切除术前肝脏储备功能评估的专家共识(2011版). 中华消化外科杂志, 2011, 10(1): 20-25.
7. 彭驰涵, 李川, 文天夫, 等. 原发性肝癌行ALPPS的适应证与禁忌证初探(附15例报道). 中国普外基础与临床杂志, 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. 中华医学会外科学分会肝脏外科学组. 腹腔镜肝切除专家共识与手术操作指南(2013版). 中华消化外科杂志, 2013, 12(3): 161-165.
10. 中国医师协会外科医师分会微创外科医师委员会. 腹腔镜肝切除术加速康复外科中国专家共识(2017版). 中国实用外科杂志, 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. 鲍光进, 李树平, 孙静, 等. 肝动脉解剖变异的640层容积CT血管成像研究. 中国医学计算机成像杂志, 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, Hatipoğlu ES, Ertuğrul Ö, 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. 崔楷悦, 董蒨, 耿耿, 等. 基于计算机辅助手术系统的肝静脉分型及其对肝脏外科的临床意义. 中华肝胆外科杂志, 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. 中国研究型医院学会肝胆胰外科专业委员会. 精准肝切除术专家共识. 中华消化外科杂志, 2017, 16(9): 883-893.
22. 董家鸿, 黄志强. 精准肝切除—21世纪肝脏外科新理念. 中华外科杂志, 2009, 47(21): 1601-1605.
23. 董家鸿, 叶晟. 开启精准肝胆外科的新时代. 中华普外科手术学杂志(电子版), 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. 胡军, 鲁光锐, 鲁玲, 等. 不同肝血流阻断方式手术治疗原发性肝癌的临床体会. 临床外科杂志, 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

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