Application Of Computer Assisted Surgery System In Right Hepatic Portal Vein Analysis And Pediatric Liver Tumor Surgery

Part1 Analysis of the right portal vein based on Dong’s liver segmentation and it’ s clinical significanceObjective The digital mode of liver and blood vessels were reconstructed using Hisense CAS,by which we can clearly observe the position and shape of the hepatic vessels and their branches from different angles,and the system can automatically measure the volume of the liver.To investigate the anatomy of the 4th grade portal vein of right liver and to measure liver volume using Computer Assisted Surgical System(Hisense CAS).Perform preoperative surgical simulation to evaluate the feasibility of surgery,the size of resection range and the compensability of the residual liver volume after surgery,so as to guide accurate liver resection,achieving individualized anatomical hepatectomy and provide reference for anatomy teaching.Methods Thin-layer computed tomography(CT)imaging of 810 cases from different age groups were reconstructed using Hisense CAS.investigating the anatomy of the system of right liver portal vein and measurement of liver volume based on Dong’s liver segments.Results Hisense CAS can clearly show the 4th grade of right liver portal vein and measure liver volume automatically.Type A(8 segments type)43.83%(355/810).The right anterior portal vein presented two main branches,and the right posterior portal vein presented two main branches,Type A was further classified into 2 types: cranio-caudal type 23.83%(193/810)and ventro-dorsal type 20.00%(162/810).Type B(9 segments type)30.86%(250/810).The right anterior portal vein are three bifurcation,dominate Ⅴ,Ⅸ and Ⅷ paragraphs.Type C 8.77%(71/810),Right posterior portal vein does not divide into main branches like type A or type B,which separate into a number of branches from an arcuate trunk.type C was further classified into type C-a and type C-b,The right anterior portal vein of type C-a presented two main branches,The right anterior portal vein of type C-b presented three main branches,type C-b 2.47%(20/810),type C-a 6.30 %(51/810),among the type C-a cranio-caudal type 3.70%(30/810)and ventro-dorsal type 2.60%(21/810).Type D 16.54%(134/810),among the type D quadrifurcation of the right anterior portal vein accounted for 1.73%(14/810),multiple bifurcations of the right anterior portal vein accounted for 1.60%(13/810),the right anterior portal vein is from the left trunk accounted for 11.36%(92/810),this type was further classified into 5 types: cranio-caudal type 4.32%(35/810);ventro-dorsal type 3.58%(29/810);trifurcation of the right anterior portal vein accounted for 1.98%(16/810);multiple bifurcations of the right anterior portal vein accounted for 1.11%(9/810);quadrifurcation of the right anterior portal vein accounted for 0.37%(3/810).the 6 segment of the hepatic segment from the right anterior portal vein accounted for 1.85%(15/810): among this type cranio-caudal type accounted for 0.99%(8/810);ventro-dorsal type accounted for0.37%(3/810);trifurcation of the right anterior portal vein accounted for 0.49%(4/810).Conclusion There are many variations in the 4th grade portal vein of right liver and the volume of the different liver segment dominated by the right intrahepatic portal vein are various.Three-dimensional reconstruction and analysis of the large amount of portal vein lay a foundation for further study on the classification of portal vein in anatomy teaching.In clinical practice,preoperative surgical simulation can be conducted,According to preoperative surgical simulation develop individualized operation scheme for different patients.During the operation,the digital liver model of the patient can be pulled out from the device at any time,and the rotation,magnification and reduction of the digital model as well as the switching with two-dimensional pictures can be controlled by gesture transformation to clearly reproduce the anatomy of the liver and blood vessels,so that better guide the precision hepatectomy.Part 2 Application of computer assisted surgical system in Pediatric right hepatic hepatoblastoma surgeryObjective The Hisense computer-assisted surgery system(Hisense CAS)was used to threedimensional reconstruction for upper abdomen enhanced CT image in children with right hepatic hepatoblastoma,digtial model of liver was obtained.Analyse the relationship between liver tumors and portal veins,To explore the value of Hisense CAS in the operation of right hepatic hepatoblastoma in children.Methods Clinical data of 18 cases with right hepatic hepatoblastoma from January 2016 to February 2019 in the affiliated hospital of Qingdao University were analyzed,reconstruction of the liver and vasculature of the child using Hisense CAS,Accurately analyze the positional relationship and invasion degree of tumors and peripheral vessels by studying the shape and variation of intravascular vessels.We can take Simulate surgery on this software to develop the best surgical plan,The tumor volume,surgical procedure,operation time,blood loss and complications were analyzed.Results According to the three-dimensional reconstruction,There were 7 cases with tumor involving the right main trunk of the portal vein,5 cases involving the right anterior branch of the portal vein,and 6 cases involving the right posterior branch of the portal vein,The average tumor volume was 215 ml,the operation time was 100 min-210 min,average 148 min,the median blood loss was 45 ml,and the minimum amount of bleeding was 4 ml.All 18 children were successfully operated and discharged.Conclusions The three-dimensional liver model reconstructed by Hisense CAS in the liver and intrahepatic vasculature can be rotated from all angles,clearly showing the relationship between tumor and portal vein,and personalized by preoperative surgery simulation.Through preoperative surgical simulation,a personalized surgical plan was developed to guide the precise hepatectomy of children.