Application of three-dimensional visualization system in surgical operation for hilar cholangiocarcinoma

Abstract

Objective To investigate the application value of three-dimensional visualization system (MI-3DVS software system) in the preoperative evaluation and surgical planning for hilar cholangiocarcinoma. Methods Thirteen patients with hilar cholangiocarcinoma undergoing preoperative evaluation with MI-3DVS software in Zhujiang Hospital, Southern Medical University between June 2009 and December 2013 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 13 patients, 8 were males and 5 were females with the age ranging from 34 to 81 years old and the median of 55 years old. Enhanced scan of liver, gallbladder, pancreas, spleen and blood vessels in abdominal cavity was performed on the patients with 64-slice or 256-slice spiral CT. Four sets of medical digital imaging and data of plain scan phase, arterial phase, portal venous phase and venous phase were collected. The data of each phase were introduced into MI-3DVS to perform image segmentation and three-dimensional reconstruction. The three-dimensional relationship between tumor and intrahepatic bile duct, hepatic artery, portal venous system and hepatic venous system was observed after the reconstructed images were visualized and Bismuth-Corlette classification was determined for the tumors. Moreover, surgery was simulated and surgical planning was formulated. Results The reconstructed models of 13 patients all exactly displayed the shape of liver and anatomic landmark of duct system. The structure and shape of hilar cholangiocarcinoma and various intrahepatic duct systems were realistic and stereoscopic and the direction of various branches was clear. Bismuth-Corlette classification of tumors was determined according to the results of three-dimensional reconstruction. One case was type Ⅲa, 7 were type Ⅲb and 5 were type Ⅳ. The accuracy rate of tumor classification was 100%(13/13) by preoperative three-dimensional reconstruction. The coincidence rate of simulated surgery and actual operative procedure was 85% (11/13). The median operation time was 630 (300~720) min and the intraoperative blood loss was 410 (110~1 800) ml. The incidence of surgical complications was 23% (3/13). Two patients developed incision infection and 1 developed bile leakage. All were cured with conservative treatment. Conclusion Three-dimensional visualization system may accurately, directly and dynamically display the hilar cholangiocarcinoma and its three-dimensional adjacent relation, which may be used to perform accurate preoperative evaluation and surgical planning for patients. Key words: Imaging, three-dimensional; Three-dimensional visualization system; Bile duct neoplasms; Hilar cholangiocarcinoma; Surgical procedures, operative