Application value of computer assisted surgery system in precision surgeries for pediatric complex liver tumors

Abstract

We discussed the diagnostic and treatment value and clinical significance of computer assisted surgery system (Higemi) in precision surgeries for pediatric complex liver tumors. A total of 21 pediatric cases receiving hepatectomy for tumors in the portal vein and giant liver tumors from June 2012 to January 2015 were analyzed. Higemi was used for 3-dimensional (3D) reconstruction of thin-slice CT images and surgical planning. Tumors were precisely located and blood vessel neighborhood was determined so as to evaluate surgical feasibility. In addition, pathological classification, surgical time, intraoperative blood loss, transfusion rate and complications were predicted. After 3D reconstruction using Higemi, the neighboring relationship of tumors with blood vessels and the running direction of the blood vessels were clearly visualized. Of 21 cases, 10 cases had tumors located in the left lobe, 5 cases in the right lobe, 3 cases showing involvement of right trilobes, and 3 cases in the middle lobe. Lobes exceeding one third of the total liver volume were resected in 18 cases. Postoperative pathological examination indicated 10 cases of hepatoblastoma, 3 cases of hepatocellular carcinoma, 3 cases of hamartoma, 3 cases of infantile hemangioendothelioma, 1 case of teratoma and 1 case of undifferentiated malignant mesenchymoma. The surgical time was 90-240 min with an average of 130 min; the medium intraoperative blood loss was 60 ml and the minimum blood loss was 3 ml; the transfusion rate was 42.9% (9/21). Surgeries were successful in 20 cases, who were discharged after recovery. However, one case had giant liver tumor combined with severe obstructive jaundice and hepatic insufficiency and died of postoperative liver failure and DIC. 3D reconstruction of CT data using Higemi can clearly visualize the running direction of blood vessels and the neighboring relationship with tumors. Higemi can improve the precision and safety of complex hepatectomy.

Keywords: 3D; Surgery; computer assisted; imaging; liver resection.

Figure 1

3D reconstruction using Higemi and 2D CT images. A. 3D reconstruction using Higemi clearly visualizes liver, gall bladder, pancreas, liver, tumor and neighboring blood vessels; B. 2D CT images show liver, gall bladder, pancreas and spleen.

Figure 2

Medical records of one case with tumor in the middle lobe of liver. A. The arrow in ordinary contrast-enhanced CT image indicates a tumor in the middle lobe; B. 3D reconstructed image using multiplanar reconstruction (MPR) shows the rough position of tumor. However, the precise anatomical relationship between tumor, portal vein and its branches, hepatic artery and hepatic vein could not be visualized. The success rate of surgery was predicted only approximately; C. 3D reconstructed image using Higemi clearly shows the boundaries of tumor and the neighboring relationship with blood vessels: ① liver, ② tumor, ③ inferior vena cava, ④ hepatic artery, ⑤ hepatic vein, ⑥ portal vein, ⑦ gall bladder; D. The arrow indicates the tumor in the middle lobe in intraoperative finding; E. Gross specimen of tumor, pathologically classified as malignant mesenchymoma with high malignancy and low differentiation.

Figure 3

Medical records of one case with tumor in the right lobe. A. The arrow in the 2D CT image indicates tumor in the right lobe; B. 3D reconstructed image using Higemi clearly visualizes the boundaries of tumor and the neighboring blood vessels: ① liver, ② tumor, ③ inferior vena cava, ④ hepatic artery, ⑤ hepatic vein, ⑥ portal vein, ⑦ gall bladder; C. 3D reconstructed image using Higemi shows the anatomical relationship between tumor and portal vein and non-involvement of main trunk of the portal vein; D. 3D reconstructed image using Higemi displays the relationship between tumor and hepatic vein, with involvement of right hepatic vein; E. The arrow indicates tumor in intraoperative finding, which was pathologically confirmed as hepatoblastoma.