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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Liver Manipulation Causes Hepatocyte Injury and Precedes

The Department of Surgery of the Maastricht University Hospital, Netherlands, published an article in this month's issue of the World Journal of Surgery.

The aim of this study was to elucidate the causes of hepatocellular injury in patients undergoing liver resection.Markers of hepatocyte injury (AST, GSTa, and L-FABP) and inflammation (IL-6) were measured in plasma of patients undergoing liver resection with and without intermittent inflow occlusion.

During liver manipulation, liver injury markers increased significantly. Intermittent hepatic
inflow occlusion, anesthesia, and liver transection did not further enhance arterial L-FABP and GSTa levels. Hepatocyte injury was followed by an inflammatory response.

This study shows that liver manipulation is a leading cause of hepatocyte injury during liver surgery. A potential causal relation between liver manipulation and systemic inflammation remains to be established; but since the inflammatory response is apparently initiated early
during major abdominal surgery, interventions aimed at reducing postoperative inflammation and related complications should be started early during surgery or beforehand.

World J Surg (2007) 31:2033–2038

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