Improved Operation Planning by 3-D Reconstruction and Computer-Assisted Imaging

A multi-institutional publication was issued in this month's Journal of the American College of Surgeons. It involved a 74-year-old man presented with a solitary colorectal metastasis
in the cranial part of the liver involving segments IVa/IVb/VIII and the middle hepatic vein (MHV).

CT scan showed a small right hepatic vein (RHV) in the presence of an inferior right hepatic vein and that tumor resection was possible by an extended left hepatectomy with preservation of the small RHV and the inferior right hepatic vein.

The calculated future liver remnant was large, about 45% of total liver volume, but a precise assessment of its venous drainage was not possible by CT scan. For better prediction, 3-D reconstruction of the liver anatomy and computer-assisted analysis were performed, revealing the RHV draining 20%, IRHV 32%, MHV 35%, LHV 12%, and caudate lobe veins 1% of total liver volume. At operation, the tumor was removed by an extended left hepatectomy, preserving the RHV and the IRHV.



These new techniques gave much more detailed information of the patient’s individual anatomy than conventional CT Image-based computer assistance and 3-D reconstruction may be particularly useful for planning liver resections with vascular anatomic variations.

JACS. Vol. 205, No. 4, October 2007

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