Surgical Simulation and Navigation for HPB Surgery

Abstract

Introduction: In Japan, preoperative 3D simulation and navigation are becoming popular in hepato-biliary-pancreatic (HPB) surgery. Herein, we report various surgical simulations and navigations in HPB surgery in our department. Methods:i)We have developed a novel liver surgical navigation system that measures the shape of liver, its position, the cut surface/cut line in real time and gives feedback to the simulation software, using 3D camera.ii)ICG fluorescence navigation has been performed in seven cases of laparoscopic cholecystectomy. ICG fluorescence was observed with VISERA ELITE II (Olympus Co., Ltd., Tokyo).iii)We perform simulation and navigation using 3DCT image when performing pancreatectomy. Results:i)A total of six cases have been performed: lateral, posterior segmentectomy and left, right lobectomy. The surgical field of a hepatectomy that progresses during the real operation was measured with two 3D cameras. The group of measurement points was converted to polygon, and the cut line was extracted. The position of the cut surface/cut line was projected on the 3DCG model.ii)Although the ICG fluorescence intensity in the bile duct was slightly weak and difficult to confirm in 3 cases with high inflammation, ICG fluorescence navigation was effective in 4 cases in which bile duct was confirmed.iii)In pancreatectomy, important blood vessels such as hepatic artery, GDA, SMA, SMV, and pancreatic arcade can be routinely confirmed by 3DCT before and during surgery, so that we were able to perform the operation safely. Conclusions: Surgical simulation and navigation for HPB surgery have become indispensable.