Application value of three-dimensional reconstruction technique in laparoscopic hepatectomy

Abstract

Objective To evaluate the application value of three-dimensional (3D) reconstruction technique in laparoscopic hepatectomy. Methods The retrospective cohort study was conducted. The clinicopathological data of 189 patients with liver cancer who were admitted to the Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from January 2014 to December 2018 were collected. There were 142 males and 47 females, aged from 27 to 86 years, with an average age of 60 years. According to the difficulty score of surgery, 50 of 189 patients underwent laparoscopic complex hepatectomy, including 23 with preoperative 3D reconstruction in the complex reconstruction group and 27 with no preoperative 3D reconstruction in the complex control group; other 139 patients underwent laparoscopic non-complex hepatectomy, including 25 with preoperative 3D reconstruction in the non-complex reconstruction group and 114 with no preoperative 3D reconstruction in the non-complex control group. Observation indicators: (1) vascular assessment of patients who received 3D reconstruction; (2) surgical and postoperative situations; (3) typical case analysis. Measurement data with normal distribution were presented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were presented as M (range), and comparison between groups was done using the Mann-Whitney U test. Count data were represented as absolute number or percentage, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Results (1) Vascular assessment of patients who received 3D reconstruction: 48 of 189 patients were performed preoperative 3D reconstruction. Vascular assessment of 48 patients showed 41 of hepatic arterial Michels Ⅰ type, 4 of Michels Ⅱ type, 1, 1, and 1 of Michels Ⅲ, Ⅳ, Ⅷ type, respectively. There were 35 belonging to hepatic venous Ⅰ type and 12 belonging to hepatic venous Ⅱ type and 1 with unclear distribution of hepatic vein. There were 5 and 3 belonging to portal venous Ⅰ type and Ⅱ type, 38 with normal distribution of portal vein, and 2 with unclear distribution of portal vein, respectively. (2) Surgical and postoperative situations: 50 of 189 patients underwent laparoscopic complex hepatectomy, and 139 underwent laparoscopic non-complex hepatectomy. The operation time and volume of intraoperative blood loss were (234±64)minutes and 200 mL (range, 100-408 mL) in the complex reconstruction group, and (289±80)minutes and 500 mL (range, 400-800 mL) in the complex control group, respectively, showing statistically significant differences between the two groups (t=-2.474, Z=-2.981, P 0.05). The operation time, volume of intraoperative blood loss, cases of postoperative complications and duration of postoperative hospital stay were 160.0 minutes (range, 117.5-221.0 minutes), 100 mL (range, 75-200 mL), 8, 5 days (range, 4-8 days) in the non-complex reconstruction group, 157.5 min (range, 100.0-222.5 minutes), 100 mL (range, 50-200 mL), 43, 6 days (range, 4-7 days) in the non-complex control group, showing no significant difference between the two groups (Z=-0.525, -0.797, χ2=0.289, Z=-0.011, P>0.05). (3) Typical case analysis: one 48-year-old male patient with primary liver cancer developed a personalized hepatectomy plan through simulation function of vascular drainage area in 3D reconstruction. One 49-year-old female patient achieved indirect intraoperative navigation through emulation function of 3D reconstruction. Conclusions The 3D reconstruction of liver in preoperative assessment is beneficial to choice of surgical options and personalized surgical plan in the precise hepatectomy. Especially in the laparoscopic complex hepatectomy, preoperative 3D reconstruction can shorten operation time, and reduce volume of intraoperative blood loss. Key words: Liver neoplasms; Liver cancer; Three-dimensional reconstruction; Surgery planning; Liver resection; Laparoscopy