Value of preoperative simulation in the treatment of transjugular intrahepatic portosystemic shunt_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WEI Xin , HU Hong , ZHONG Liming , YOU Jian

Department of Interventional Radiology, Nanchong Central Hospital, Second Clinic Institute of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding?author：

WEI Xin, Email: wxzyy1998@sina.com

Keywords：

portal hypertension; transjugular intrahepatic portosystemic shunt; three-dimensional reconstruction; simulation

DOI：

10.7507/1007-9424.201908053

Video：

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Objective To evaluate the value of individualized preoperative simulation in transjugular intrahepatic portosystemic shunt (TIPS).Methods Thin slice scan data of 39 patients with supine upper abdomen were obtained, three dimensional structures of bone, liver, portal vein, inferior vena cava and hepatic vein in CT scan area were reconstructed in Mimics software. According to the size of interventional instruments, a virtual RUPS-100 puncture kit and an VIATORR stent were established in 3D MAX software. Computer simulations were performed to evaluate the route from the hepatic vein puncture portal vein and stent release position. The coincidence of simulation parameters with actual surgical results was compared.Results ① The time of preoperative simulation was controllable. The total simulation time was 70–110 minutes (after summing up the previous experience). Preoperative simulation in daily work would not affect the progress of treatment. ② There were 4 cases of puncturing bifurcation of portal vein, 22 cases of puncturing left branch and 13 cases of puncturing right branch during operation (24 cases of puncturing left branch and 15 cases of puncturing right branch by preoperative simulation plan). The overall coincidence rate was 89.7% (35/39). ③ Preoperative simulations were performed using 8 mm×6 cm/2 cm size VIATORR stents, and the stents used in the actual operation were the same as the simulation results. ④ Preoperative simulation and post-operative retrospective simulation could shortened the teaching and training time and enhanced the understanding of surgical intention and key steps.Conclusion Preoperative simulation based on patient's individualized three-dimensional model and virtual interventional device could guided the actual operation of TIPS more accurately, and had practical value for improving the success rate of operation and training young doctors.

Citation： WEI Xin, HU Hong, ZHONG Liming, YOU Jian. Value of preoperative simulation in the treatment of transjugular intrahepatic portosystemic shunt. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(12): 1424-1428. doi: 10.7507/1007-9424.201908053 Copy

1.	Fulton N, Buethe J, Gollamudi J, et al. Simulation-based training may improve resident skill in ultrasound-guided Biopsy. AJR Am J Roentgenol, 2016, 207(6): 1329-1333.
2.	Powell DK, Jamison DK, Silberzweig JE. An endovascular simulation exercise among radiology residents: comparison of simulation performance with and without practice. Clin Imaging, 2015, 39(6): 1080-1085.
3.	Sun Z, Jansen S. Personalized 3D printed coronary models in coronary stenting. Quant Imaging Med Surg, 2019, 9(8): 1356-1367.
4.	Nayahangan LJ, Van Herzeele I, Konge L, et al. Achieving consensus to define Curricular content for simulation based education in vascular surgery: A Europe Wide Needs Assessment Initiative. Eur J Vasc Endovasc Surg, 2019, 58(2): 284-291.
5.	匡銘, 湯地, 王曄, 等. 三維手術模擬系統在肝癌患者精準肝切除中的應用. 中國普外基礎與臨床雜志, 2011, 18(7): 682-687.
6.	Roguin A, Beyar R. Real case virtual reality training prior to carotid artery stenting. Catheter Cardiovasc Interv, 2010, 75(2): 279-282.
7.	Maertens H, Vermassen F, Aggarwal R, et al. Endovascular training using a simulation based curriculum is less expensive than training in the hybrid angiosuite. Eur J Vasc Endovasc Surg, 2018, 56(4): 583-590.
8.	魏欣, 鐘立明, 謝曉東, 等. 虛擬血管內介入器械三維模型的建立及其臨床價值. 中華放射學雜志, 2012, 46(4): 359-362.
9.	魏欣, 鐘立明, 游箭, 等. 虛擬動脈及介入器械三維模型的建立及其臨床價值. 實用放射學雜志, 2014, 30(6): 995-998.
10.	林科燦, 劉景豐, 曾金華, 等. 基于肝臟三維圖像的肝段自動劃分及虛擬解剖性肝切除. 中國普外基礎與臨床雜志, 2011, 18(7): 694-967.
11.	Chivot C, Robert B, Bouzerar R, et al. 3D C-Arm cone beam CT for targeting the portal vein during TIPS: Initial clinical experience. Eur J Radiol, 2018, 106(1): 20-25.
12.	David A, Liberge R, Meyer J, et al. Ultrasonographic guidance for portal vein access during transjugular intrahepatic portosystemic shunt (TIPS) placement. Diagn Interv Imaging, 2019, 100(7): 445-453.
13.	Rossle M, Siegerstetter V, Euringer W, et al. The use of a polytetrafluoroethylene-covered stent graft for transjugular intrahepatic portosystemic shunt (TIPS): Long-term follow-up of 100 patients. Acta Radiol, 2006, 47(7): 660-666.
14.	Srinivasa RN, Srinivasa RN, Chick JFB, et al. Transjugular intrahepatic portosystemic shunt reduction using the GORE VIATORR controlled expansion endoprosthesis: hemodynamics of reducing an established 10-mm TIPS to 8-mm in diameter. Cardiovasc Intervent Radiol, 2018, 41(3): 518-521.
15.	Ferral H, Gomez-Reyes E, Fimmel CJ. Post-transjugular intrahepatic portosystemic shunt follow-up and management in the VIATORR Era. Tech Vasc Interv Radiol, 2016, 19(1): 82-88.
16.	付焱, 張超, 杜恩輔, 等. 覆膜支架與裸支架 TIPS 比較治療門脈高壓癥療效的 Meta 分析. 中國循證醫學雜志, 2018, 18(1): 35-42.
17.	韓國宏, 徐克. 規范經頸靜脈肝內門體分流術, 推動多中心研究. 中華放射學雜志, 2017, 51(5): 321-323.
18.	Jomier J, Bullitt E, Van Horn M, et al. 3D/2D model-to-image registration applied to TIPS surgery. Med Image Comput Comput Assist Interv, 2006, 9(2): 662-669.
19.	Javan R, Zeman MN. A prototype educational model for hepatobiliary interventions: unveiling the role of graphic designers in medical 3D printing. J Digit Imaging, 2018, 31(1): 133-143.
20.	Ho H, Sorrell K, Peng L, et al. Hemodynamic analysis for transjugular intrahepatic portosystemic shunt (TIPS) in the liver based on a CT-image. IEEE Trans Med Imaging, 2013, 32(1): 92-98.
21.	Wang M, Zhou H, Huang Y, et al. Hydrodynamics Analysis and CFD Simulation of Portal Venous System by TIPS and LS. Hepatogastroenterology, 2015, 62(140): 1016-1022.
22.	孔祥雪, 聶蘭英, 肖菊姣, 等. 新型肝臟管道模型的數字化制造研究. 中國臨床解剖學雜, 2014, 32(3): 256-258.
23.	Fu R, Mahemut D, Tiyipujiang R, et al. Effect studies of Uyghur sand therapy on the hemodynamics of the knee-joint arteries. Biomed Mater Eng, 2014, 24(6): 2381-2388.
24.	張韜, 郭紅斌, 李偉浩, 等. 基于個體化逆向工程和雙向流固耦合模型的 B 型主動脈夾層數值模擬血流分析. 中華醫學雜志, 2019, 99(2): 142-147.
25.	陳蘭, 陳春林, 劉萍, 等. 基于磁共振成像的女性盆腔臟器數字化三維模型的構建. 婦產與遺傳(電子版), 2019, 8(4): 17-21.

1. Fulton N, Buethe J, Gollamudi J, et al. Simulation-based training may improve resident skill in ultrasound-guided Biopsy. AJR Am J Roentgenol, 2016, 207(6): 1329-1333.
2. Powell DK, Jamison DK, Silberzweig JE. An endovascular simulation exercise among radiology residents: comparison of simulation performance with and without practice. Clin Imaging, 2015, 39(6): 1080-1085.
3. Sun Z, Jansen S. Personalized 3D printed coronary models in coronary stenting. Quant Imaging Med Surg, 2019, 9(8): 1356-1367.
4. Nayahangan LJ, Van Herzeele I, Konge L, et al. Achieving consensus to define Curricular content for simulation based education in vascular surgery: A Europe Wide Needs Assessment Initiative. Eur J Vasc Endovasc Surg, 2019, 58(2): 284-291.
5. 匡銘, 湯地, 王曄, 等. 三維手術模擬系統在肝癌患者精準肝切除中的應用. 中國普外基礎與臨床雜志, 2011, 18(7): 682-687.
6. Roguin A, Beyar R. Real case virtual reality training prior to carotid artery stenting. Catheter Cardiovasc Interv, 2010, 75(2): 279-282.
7. Maertens H, Vermassen F, Aggarwal R, et al. Endovascular training using a simulation based curriculum is less expensive than training in the hybrid angiosuite. Eur J Vasc Endovasc Surg, 2018, 56(4): 583-590.
8. 魏欣, 鐘立明, 謝曉東, 等. 虛擬血管內介入器械三維模型的建立及其臨床價值. 中華放射學雜志, 2012, 46(4): 359-362.
9. 魏欣, 鐘立明, 游箭, 等. 虛擬動脈及介入器械三維模型的建立及其臨床價值. 實用放射學雜志, 2014, 30(6): 995-998.
10. 林科燦, 劉景豐, 曾金華, 等. 基于肝臟三維圖像的肝段自動劃分及虛擬解剖性肝切除. 中國普外基礎與臨床雜志, 2011, 18(7): 694-967.
11. Chivot C, Robert B, Bouzerar R, et al. 3D C-Arm cone beam CT for targeting the portal vein during TIPS: Initial clinical experience. Eur J Radiol, 2018, 106(1): 20-25.
12. David A, Liberge R, Meyer J, et al. Ultrasonographic guidance for portal vein access during transjugular intrahepatic portosystemic shunt (TIPS) placement. Diagn Interv Imaging, 2019, 100(7): 445-453.
13. Rossle M, Siegerstetter V, Euringer W, et al. The use of a polytetrafluoroethylene-covered stent graft for transjugular intrahepatic portosystemic shunt (TIPS): Long-term follow-up of 100 patients. Acta Radiol, 2006, 47(7): 660-666.
14. Srinivasa RN, Srinivasa RN, Chick JFB, et al. Transjugular intrahepatic portosystemic shunt reduction using the GORE VIATORR controlled expansion endoprosthesis: hemodynamics of reducing an established 10-mm TIPS to 8-mm in diameter. Cardiovasc Intervent Radiol, 2018, 41(3): 518-521.
15. Ferral H, Gomez-Reyes E, Fimmel CJ. Post-transjugular intrahepatic portosystemic shunt follow-up and management in the VIATORR Era. Tech Vasc Interv Radiol, 2016, 19(1): 82-88.
16. 付焱, 張超, 杜恩輔, 等. 覆膜支架與裸支架 TIPS 比較治療門脈高壓癥療效的 Meta 分析. 中國循證醫學雜志, 2018, 18(1): 35-42.
17. 韓國宏, 徐克. 規范經頸靜脈肝內門體分流術, 推動多中心研究. 中華放射學雜志, 2017, 51(5): 321-323.
18. Jomier J, Bullitt E, Van Horn M, et al. 3D/2D model-to-image registration applied to TIPS surgery. Med Image Comput Comput Assist Interv, 2006, 9(2): 662-669.
19. Javan R, Zeman MN. A prototype educational model for hepatobiliary interventions: unveiling the role of graphic designers in medical 3D printing. J Digit Imaging, 2018, 31(1): 133-143.
20. Ho H, Sorrell K, Peng L, et al. Hemodynamic analysis for transjugular intrahepatic portosystemic shunt (TIPS) in the liver based on a CT-image. IEEE Trans Med Imaging, 2013, 32(1): 92-98.
21. Wang M, Zhou H, Huang Y, et al. Hydrodynamics Analysis and CFD Simulation of Portal Venous System by TIPS and LS. Hepatogastroenterology, 2015, 62(140): 1016-1022.
22. 孔祥雪, 聶蘭英, 肖菊姣, 等. 新型肝臟管道模型的數字化制造研究. 中國臨床解剖學雜, 2014, 32(3): 256-258.
23. Fu R, Mahemut D, Tiyipujiang R, et al. Effect studies of Uyghur sand therapy on the hemodynamics of the knee-joint arteries. Biomed Mater Eng, 2014, 24(6): 2381-2388.
24. 張韜, 郭紅斌, 李偉浩, 等. 基于個體化逆向工程和雙向流固耦合模型的 B 型主動脈夾層數值模擬血流分析. 中華醫學雜志, 2019, 99(2): 142-147.
25. 陳蘭, 陳春林, 劉萍, 等. 基于磁共振成像的女性盆腔臟器數字化三維模型的構建. 婦產與遺傳(電子版), 2019, 8(4): 17-21.

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Value of preoperative simulation in the treatment of transjugular intrahepatic portosystemic shunt

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