Achieving precision surgery in laparoscopic liver resection with the aid of preoperative three-dimensional reconstruction: A case report. (April 2021)

• Record Type: Journal Article
• Authors: Banchini, Filippo; Luzietti, Enrico; Cecconi, Sara; Ribolla, Marta; Palmieri, Gerardo; Capelli, Patrizio
• Is Part Of: International journal of surgery case reports. Volume 81(2021)
• Publication Date: 2021-04
• Subjects: Three-dimensional -- 3D -- Liver -- Metastases -- Laparoscopy -- Hepatectomy -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.105792
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Laparoscopic liver surgery is evolving and its spread is now starting to take place. Three-dimensional reconstruction imaging still remains a scarcely used technique. Considering the difficulty of liver resection surgery, a precise knowledge of the patient's anatomy is essential in the preoperative planning of the intervention. Three-dimensional reconstruction imaging provides useful information in addition to conventional imaging, allowing a more accurate preoperative planning, and being used as a navigation instrument during liver resection. The use of three-dimensional reconstruction imaging allows to predict the precise location and direction of anatomical structures with high approximation, allowing to reach a high degree of precision surgery. Abstract: Introduction: The use of three-dimensional image reconstruction in liver surgery is well-known and has got many applications: It was first developed for vein reconstruction in liver transplantation and for liver volumetry to prevent post hepatectomy liver failure (PHLF) after major resections. There are many other advantages described in the literature provided by three-dimensional reconstruction, however its diffusion is currently limited. Clinical case: We present the case of a woman with a single colon cancer metastasis in segment 5 of the liver. Using CT scan images we created a three dimensional reconstruction of the patient's liver and its inners structures. The rendering was used to hypothesize the plan of dissection and to predict the pedicles that needed to be dissected during the procedure. Discussion: We try to demonstrate that, thanks to three dimensional image reconstruction, all the structures that need to be dissected could be effectively located prior to the the surgery with a high grade of approximation. Furthermore the 3D reconstruction could be used as a step by step guide during the whole surgical procedure, showing all the pedicles To be encountered and dissected at every stage. Conclusion: 3d reconstruction of the liver is a valid aid in the interpretation of preoperative imaging and intraoperative ultrasound, both for the surgeon and for the entire equipe, facilitating comprehension of patient's liver anatomical features. It allows to predict the location and direction of the pedicles that need to be dissected and resected with high approximation, in order to achieve a more precise and tailored surgery.