Application of three-dimensional printing technology to precise hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Jian , TAN Yifei , JIANG Li , YANG Jiayin ,  YAN Lunan

Center of Liver transplantation and Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

YAN Lunan, Email: yanlunan668@163.com

Keywords：

three-dimensional printing; precise hepatectomy

DOI：

10.7507/1007-9424.201712100

Video：

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Objective To explore feasibility and effectiveness of three-dimensional (3D) printing technology in precise hepatectomy. Methods The patient was a 60-year-old woman with diagnosis of liver malignancy. The liver model was reconstructed using the IQQA Liver System (EDDA Technology, Inc. USA) based on the CT scan data. The volumes of the liver and the lesion were measured and recorded. The CT data were further digitally reconstructed by means of cloud computing and storage with RevoCloud (V1.0) Medical Imaging System. The best surgical plan was determined by the repeated virtual surgical resection with the reconstruction system, based on the corresponding resected liver volume and the remaining liver volume. Results The reconstruction of liver clearly showed that the tumor invaded the right hepatic and middle hepatic veins, as well as the anterior branch of right portal vein, which was consistent with the conclusion of CT scan. In the other hand, the right posterior branch of the portal vein was completely distributed in the segment Ⅴ and Ⅵ, while a relatively large right posterior inferior vena presented and drained segment Ⅴ and Ⅵ. The anatomic resection of segment Ⅶ, Ⅷ , and Ⅳa was completed according to the preoperative plan. The liver function kept recovering, and the patient discharged a week later. Conclusion Results of this patient show that 3D printing technology can accurately assess anatomic construction of liver and determine relationship between lesion and its surrounding tissue, which can be effectively used in precise hepatectomy.

Citation： YANG Jian, TAN Yifei, JIANG Li, YANG Jiayin, YAN Lunan. Application of three-dimensional printing technology to precise hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(1): 71-76. doi: 10.7507/1007-9424.201712100 Copy

1.	Yan LN. Operative techniques in liver resection. New York: Springer, 2014.
2.	許戈良, 劉文斌, 李建生, 等. 位于 7 或 8 段肝癌手術切除效果分析. 中華外科雜志, 2012 50(6): 498-501.
3.	Tian F, Wu JX, Rong WQ, et al. Three-dimensional morphometric analysis for hepatectomy of centrally located hepatocellular carcinoma: a pilot study. World J Gastroenterol, 2015, 21(15): 4607-4619.
4.	彭馳涵, 李川, 文天夫, 等. 原發性肝癌行 ALPPS 的適應證與禁忌證初探 (附 15 例報道). 中國普外基礎與臨床雜志, 2015, 22(10): 1183-1186.
5.	Cai YL, Song PP, Tang W, et al. An updated systematic review of the evolution of ALPPS and evaluation of its advantages and disadvantages in accordance with current evidence. Medicine (Baltimore), 2016, 95(24): e3941.
6.	嚴律南. 肝葉切除術中的半肝血流阻斷法. 中國普外基礎與臨床雜志, 1995, 2(1): 54-55.
7.	嚴律南. 肝門板及其在肝膽外科的應用. 中國普外基礎與臨床雜志, 1998, 5(4): 239-239.
8.	嚴律南, 曾勇, 林琦遠, 等. 半肝血流阻斷的臨床應用. 中國現代普通外科進展, 1998, 1(1): 36-38.
9.	嚴律南, 盧實春, 陳曉理, 等. 用生物泵行體外靜脈轉流下的肝葉切除術. 中華肝膽外科雜志, 2000, 6(1): 37-38.
10.	嚴律南, 袁朝新, 張肇達, 等. 應用半肝血流阻斷行肝葉切除術 29 例報告. 中華外科雜志, 1994, 32(1): 35-36.
11.	Wen T, Chen Z, Yan L, et al. Continuous normothermic hemihepatic vascular inflow occlusion over 60 min for hepatectomy in patients with cirrhosis caused by hepatitis B virus. Hepatol Res, 2007, 37(5): 346-352.
12.	Okamura Y, Ito T, Sugiura T, et al. Anatomic versus nonanatomic hepatectomy for a solitary hepatocellular carcinoma: a case-controlled study with propensity score matching. J Gastrointest Surg, 2014, 18(11): 1994-2002.
13.	Cucchetti A, Cescon M, Trevisani F, et al. Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients. World J Gastroenterol, 2012, 18(44): 6398-6408.
14.	孟祥軍, 米其武, 梁鑄林, 等. CT 三維重建在腹腔鏡腎部分切除術中的應用價值. 中國內鏡雜志, 2014, 20(2): 189-192.
15.	Zein NN, Hanouneh IA, Bishop PD, et al. Three-dimensional print of a liver for preoperative planning in living donor liver transplantation. Liver Transpl, 2013, 19(12): 1304-1310.
16.	Yang X, Qiu Y, Huang B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: a study of 31 cases. Am J Transplant, 2017, [Epub ahead of print].
17.	范應方, 向飛, 蔡偉,等. 基于三維可視化技術的右半肝門靜脈 3D 分型及分段. 南方醫科大學學報, 2016, 36(1): 26-31.
18.	Fang CH, Li XF, Li Z, et al. Application of a medical image processing system in liver transplantation. Hepatobiliary Pancreat Dis Int, 2010, 9(4): 370-375.
19.	Ishizawa T, Gumbs AA, Kokudo N, et al. Laparoscopic segmentectomy of the liver: from segment Ⅰ to Ⅷ. Ann Surg, 2012, 256(6): 959-964.
20.	閆峻. 三維重建在精準肝切除術中的應用進展. 世界最新醫學信息文摘, 2017, 47(17): 15-16.
21.	Tan Y, Zhang W, Jiang L, et al. Efficacy and safety of anatomic resection versus nonanatomic resection in patients with hepatocellular carcinoma: A systemic review and meta-analysis. PLoS One, 2017, 12(10): e0186930.
22.	Kamiyama T, Nakanishi K, Yokoo H, et al. The impact of anatomical resection for hepatocellular carcinoma that meets the Milan criteria. J Surg Oncol, 2010, 101(1): 54-60.
23.	Yamazaki O, Matsuyama M, Horii K, et al. Comparison of the outcomes between anatomical resection and limited resection for single hepatocellular carcinomas no larger than 5 cm in diameter: a single-center study. J Hepatobiliary Pancreat Sci, 2010, 17(3): 349-358.
24.	Cucchetti A, Qiao GL, Cescon M, et al. Anatomic versus nonanatomic resection in cirrhotic patients with early hepatocellular carcinoma. Surgery, 2014, 155(3): 512-521.
25.	Kudo A, Tanaka S, Ban D, et al. Anatomic resection reduces the recurrence of solitary hepatocellular carcinoma ≤5 cm without macrovascular invasion. Am J Surg, 2014, 207(6): 863-869.
26.	Cucchetti A, Cescon M, Ercolani G, et al. A comprehensive meta-regression analysis on outcome of anatomic resection versus nonanatomic resection for hepatocellular carcinoma. Ann Surg Oncol, 2012, 19(12): 3697-3705.
27.	Hu JX, Dai WD, Miao XY, et al. Bisegmentectomy Ⅶ, Ⅷ for hepatocellular carcinoma in cirrhotic livers. Hepatogastroenterology, 2007, 54(77): 1311-1314.
28.	Kang CM, Choi GH, Kim DH, et al. Revisiting the role of nonanatomic resection of small. J Surg Res, 2010, 160(1): 81-89.
29.	Yamashita Y, Taketomi A, Itoh S, et al. Longterm favorable results of limited hepatic resections for patients with hepatocellular carcinoma: 20 years of experience. J Am Coll Surg, 2007, 205(1): 19-26.

1. Yan LN. Operative techniques in liver resection. New York: Springer, 2014.
2. 許戈良, 劉文斌, 李建生, 等. 位于 7 或 8 段肝癌手術切除效果分析. 中華外科雜志, 2012 50(6): 498-501.
3. Tian F, Wu JX, Rong WQ, et al. Three-dimensional morphometric analysis for hepatectomy of centrally located hepatocellular carcinoma: a pilot study. World J Gastroenterol, 2015, 21(15): 4607-4619.
4. 彭馳涵, 李川, 文天夫, 等. 原發性肝癌行 ALPPS 的適應證與禁忌證初探 (附 15 例報道). 中國普外基礎與臨床雜志, 2015, 22(10): 1183-1186.
5. Cai YL, Song PP, Tang W, et al. An updated systematic review of the evolution of ALPPS and evaluation of its advantages and disadvantages in accordance with current evidence. Medicine (Baltimore), 2016, 95(24): e3941.
6. 嚴律南. 肝葉切除術中的半肝血流阻斷法. 中國普外基礎與臨床雜志, 1995, 2(1): 54-55.
7. 嚴律南. 肝門板及其在肝膽外科的應用. 中國普外基礎與臨床雜志, 1998, 5(4): 239-239.
8. 嚴律南, 曾勇, 林琦遠, 等. 半肝血流阻斷的臨床應用. 中國現代普通外科進展, 1998, 1(1): 36-38.
9. 嚴律南, 盧實春, 陳曉理, 等. 用生物泵行體外靜脈轉流下的肝葉切除術. 中華肝膽外科雜志, 2000, 6(1): 37-38.
10. 嚴律南, 袁朝新, 張肇達, 等. 應用半肝血流阻斷行肝葉切除術 29 例報告. 中華外科雜志, 1994, 32(1): 35-36.
11. Wen T, Chen Z, Yan L, et al. Continuous normothermic hemihepatic vascular inflow occlusion over 60 min for hepatectomy in patients with cirrhosis caused by hepatitis B virus. Hepatol Res, 2007, 37(5): 346-352.
12. Okamura Y, Ito T, Sugiura T, et al. Anatomic versus nonanatomic hepatectomy for a solitary hepatocellular carcinoma: a case-controlled study with propensity score matching. J Gastrointest Surg, 2014, 18(11): 1994-2002.
13. Cucchetti A, Cescon M, Trevisani F, et al. Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients. World J Gastroenterol, 2012, 18(44): 6398-6408.
14. 孟祥軍, 米其武, 梁鑄林, 等. CT 三維重建在腹腔鏡腎部分切除術中的應用價值. 中國內鏡雜志, 2014, 20(2): 189-192.
15. Zein NN, Hanouneh IA, Bishop PD, et al. Three-dimensional print of a liver for preoperative planning in living donor liver transplantation. Liver Transpl, 2013, 19(12): 1304-1310.
16. Yang X, Qiu Y, Huang B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: a study of 31 cases. Am J Transplant, 2017, [Epub ahead of print].
17. 范應方, 向飛, 蔡偉,等. 基于三維可視化技術的右半肝門靜脈 3D 分型及分段. 南方醫科大學學報, 2016, 36(1): 26-31.
18. Fang CH, Li XF, Li Z, et al. Application of a medical image processing system in liver transplantation. Hepatobiliary Pancreat Dis Int, 2010, 9(4): 370-375.
19. Ishizawa T, Gumbs AA, Kokudo N, et al. Laparoscopic segmentectomy of the liver: from segment Ⅰ to Ⅷ. Ann Surg, 2012, 256(6): 959-964.
20. 閆峻. 三維重建在精準肝切除術中的應用進展. 世界最新醫學信息文摘, 2017, 47(17): 15-16.
21. Tan Y, Zhang W, Jiang L, et al. Efficacy and safety of anatomic resection versus nonanatomic resection in patients with hepatocellular carcinoma: A systemic review and meta-analysis. PLoS One, 2017, 12(10): e0186930.
22. Kamiyama T, Nakanishi K, Yokoo H, et al. The impact of anatomical resection for hepatocellular carcinoma that meets the Milan criteria. J Surg Oncol, 2010, 101(1): 54-60.
23. Yamazaki O, Matsuyama M, Horii K, et al. Comparison of the outcomes between anatomical resection and limited resection for single hepatocellular carcinomas no larger than 5 cm in diameter: a single-center study. J Hepatobiliary Pancreat Sci, 2010, 17(3): 349-358.
24. Cucchetti A, Qiao GL, Cescon M, et al. Anatomic versus nonanatomic resection in cirrhotic patients with early hepatocellular carcinoma. Surgery, 2014, 155(3): 512-521.
25. Kudo A, Tanaka S, Ban D, et al. Anatomic resection reduces the recurrence of solitary hepatocellular carcinoma ≤5 cm without macrovascular invasion. Am J Surg, 2014, 207(6): 863-869.
26. Cucchetti A, Cescon M, Ercolani G, et al. A comprehensive meta-regression analysis on outcome of anatomic resection versus nonanatomic resection for hepatocellular carcinoma. Ann Surg Oncol, 2012, 19(12): 3697-3705.
27. Hu JX, Dai WD, Miao XY, et al. Bisegmentectomy Ⅶ, Ⅷ for hepatocellular carcinoma in cirrhotic livers. Hepatogastroenterology, 2007, 54(77): 1311-1314.
28. Kang CM, Choi GH, Kim DH, et al. Revisiting the role of nonanatomic resection of small. J Surg Res, 2010, 160(1): 81-89.
29. Yamashita Y, Taketomi A, Itoh S, et al. Longterm favorable results of limited hepatic resections for patients with hepatocellular carcinoma: 20 years of experience. J Am Coll Surg, 2007, 205(1): 19-26.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of three-dimensional printing technology to precise hepatectomy

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