Application Of Three-Dimensional Visualization Technology And 3D Printing Technology In Hepatic Surgery

Objective: Evaluate the application value of three-dimensional visualization technology and 3D printing technology in preoperative assessment and surgical planning for hepatectomy of hepatic surgery disease.This study applied a three dimensional visualization technology to surgical treatment of liver lesions.We wish to evaluate the application value of three-dimensional visualization technology in preoperative assessment and surgical planning for hepatectomy of live benign and malignant lesions.Lay the foundation for individualized accurate hepatectomy of hepatic benign and malignant lesions.Applied a 3D printing technology in surgery treatment for hepatic lesions.We introduce a advance technology to provide a new solusion for surgical treatment of hepatic lesions.Evaluate the application value of 3D printing technology in preoperative assessment and surgical planning.Methords: Part one: 103 patients with liver malignant lesions underwent hepatectomy in our hospital between September 2015 and March 2018 were enrolled and randomly divided into three-dimensional visualization assessment group(group A)and the traditional imaging CT assessment group(group B),patients of group A underwent preoperative assessment by three dimensional visualization system(IQQA-3D Liver)and patients of group B underwent preoperative assessment by CT.The liver volume and resection margin were measured by 3D.Operations were performed according to surgical planning.Outcomes of hepatectomy and follow-up results were compared.Part two: 88 patients with liver benign lesions underwent hepatectomy in our hospital between September 2015 and March 2018 wereenrolled and randomly divided into three-dimensional visualization assessment group(group A)and the traditional imaging assessment group(group B).Patients of group A underwent preoperative assessment by three dimensional visualization technology and patients of group B underwent preoperative assessment by CT.The liver volume were estimated by 3D and 2D.Operations were performed according to surgical planning made by 3D and 2D.Outcomes of hepatectomy and follow-up results were compared.Part three: 8patients with hepaticlesions underwent preoperative assessment by 3D printed models and underwent hepatectomy between September 2015 and March 2018.3D liver models were printed according to the three-dimensional visualization models.Surgical planning were made by 3D printed liver models,operations were performed according to surgical planning.Outcomes of hepatectomy and follow-up results were observed.Results: 48 patients of group A underwent preoperative assessment by three dimensional visualization system,3D visualization can clearly show the anatomical structures of the liver and lesion features,and accurately estimate the liver volume and resection margin.Patient of two groups underwent hepatectomy according to the surgical planning by 3D or 2D.A strong positive correlation was evident between simulation-predicted liver resection volume and actual resection volume(R=0.977,P<0.01),a correlation was also evident between predicted and actual margins(R=0.816,P<0.01).Compared with patients in group B,those in group A had a faster operation time(188.7±54.3minutes vs 258±49.1minutes,P < 0.05),less intraoperative blood loss(301.2±143.5ml vs 462.6±151.5ml,P<0.05),and lower requirement for intraoperative blood transfusion(190.1±130.7ml vs 287.4±125.6ml,P<0.05).There was a dominance in group A for serum level of albumin and bilirubin.The incidence of postoperative complications in group B was higher than that in group A and the recurrence rate was similar in postoperative 6 to 25 months follow-up.(mean18.2months).Part two: Patients of two groups underwent preoperative assessment by the three-dimensional visualization system or the traditional imaging CT.Operations were performed according to surgical planning made by 3D and 2D.A positive correlation was evident between simulation-predicted liver resection volume and actual resection volume(R=0.916,P<0.01),3D assessment liver resection volume of patients with liver hemangioma were bigger than the actual liver resection volume,the reason might be that the blood inside the hemangioma lost during the operation.There was no recurrence in patients with liver benign lesions.Compared with patients in group B,those in group A had less intraoperative blood loss(286.4±142.3ml vs 407.5±166.4ml,P < 0.05)and lower requirement for intraoperative blood transfusion(180.8ml±109.2 vs 333.2±145.6ml,P<0.05),there was no significant different in operation time between group A and group B.There was a dominance in group A for serum level of albumin and bilirubin.Part three: The 3D printing models were printed successfully,which illustrated the positional relationship between the liver,lesions,and hepatic blood vessels more clear than 3D virtual models.We optimized operation schemes through simulation operations performed on liver models printed by 3D printer.The printed liver model was used for preoperative planning,as well as intraoperative navigation.Surgical procedures of the patients were consistent with their preoperative surgery performed on printed liver model.The Intraoperative real situation was consistent with the preoperative planning.One patient with hepatocellular carcinoma(HCC)combined with portal vein tumor thrombus died because of relapse and distant metastasis 8 months later after operation.Conclusion: It was convenient to apply three-dimensional visualization technology in accurate preoperative assessment and surgical planning for hepatectomy of hepatic disease.The application of three-dimensional visualization technology improves the efficacy and safety of hepatectomy.3D printing technology facilitates the realization of individualized operation scheme for liver lesions.3D printing technology facilitates the realization of precision hepatectomy.