Abstract
Objective To explore the value of computer-assisted surgical systems (Higemi) for precise surgery in complex liver tumor in children. Methods The clinical data of 21 cases with tumors in middle lobe or giant liver tumors from June 2012 to January 2015 were analyzed. Computer-assisted surgical system (Higemi) was used to three-dimensional reconstruction and surgical planning based upon thin-layer computed tomography (CT) imaging. It could accurately determine the location of tumor and adjacent relationship with surrounding vessels, ascertain surgical feasibility and guide surgery. The tumor pathological type, operative duration, intraoperative blood loss volume, blood transfusion rate and complications were analyzed. Results Three-dimensional reconstruction of computer-assisted surgical system depicted distinctly the adjacent relationship of tumor and vascular course. Among them, 10 tumors were located in left lobe, 5 in right lobe, 3 beyond right lobe and 3 in middle lobe. The volume of removed lobes exceeded one-third of liver in 18 cases. Pathological diagnoses were hepatoblastoma (n=11), hepatocellular carcinoma (n=3), hamartoma (n=3), infantile hemangioendothelioma (n=3), teratoma (n=1) and undifferentiated mesenchymal sarcoma (n=1). The average operative duration was 130 (90-240) min. The median volume of intraoperative blood loss was 60 ml, minimal volume of intraoperative blood loss 3 ml and blood transfusion rate 42.9% (9/21). Surgical tumor removal was achieved successfully in 20 cases. Only one neonatal case of huge liver tumor died of postoperative liver failure and disseminated intravascular coagulation (DIC) because of severe obstructive jaundice and liver dysfunction. Conclusions The three-dimensional reconstruction of CT data by computer-assisted surgical system (Higemi) can delineate distinctly the vascular system and adjacent relationship of tumor so as to improve the accuracy and safety during complex hepatectomy. Key words: Surgery, computer-assisted; Hepatectomy; Imaging, three-dimensional
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