Clinical Application Study For Real-time Multimodal Fusion Image Guided Three-dimensional Laparoscopic Hepatectomy

BackgroundPrimary liver cancer is the most common subtype of hepatic malignant tumors in China,laparoscopic hepatectomy has became the major surgical option for radical resection of primary lesions recently.Compared with conventional two-dimensional laparoscopy,nevertheless three-dimensional laparoscopy possesses better stereoscopic effects and vertical effects,lacking of tactile feedbacks,operating space and limited fields of surgical vision are still exist as its main drawbacks which hinder its extensive application in daily surgery practice.In order to overcome as-mentioned drawbacks of laparoscopic surgery,multimodal images such as intraoperative B-type ultrasound image,three-dimensional visualization image,indocyanine green fluorescence image have applied to achieve precise diagnosis and resection of liver tumors.Meanwhile,images which with different dimensions and modals applied to practical surgery procedures for indirect images guided surgery have problems as spatiotemporal disparity and lacking of accuracy with which is important to perform a surgery successful,spatiotemporal difference of those images lead distraction of surgeons in addition.Therefore,our team introduce an augmented reality visualization method based on surgery videos to develop a multimodal fusion image guided three-dimensional laparoscopic hepatectomy navigation system,which combined three-dimensional images and indocyanine green florescence images to guide three-dimensional laparoscopic hepatectomy to achieve the transition of concept in addition to technique from indirect style to direct style,all those achievements obtained have beneficial in respects below:identify location of tumors and detailed vasculature arrangement around the lesion,decrease bleeding due to intraoperative vascular injury,improve the safety and accuracy of surgery ultimately.On the basis of three-dimensional visualization guided anatomical hepatectomy,we combined indocyanine green florescence images with it to realize a real sense of anatomical,functional,radical three-dimensional laparoscopic hepatectomy.Objective1.Study the clinical application value of proposed multimodal fusion image guided three-dimensional laparoscopic hepatectomy.2.Compare the therapeutic effects of proposed multimodal fusion image guided three-dimensional laparoscopic hepatectomy with conventional three-dimensional laparoscopic hepatectomy applied to liver tumors treatment.MethodWe recollected clinicopathological characteristic data a total of 75 patients who underwent three-dimensional laparoscopic hepatectomy for malignant liver tumors at Zhu Jiang Hospital,Southern Medical University between January 2018 and June 2019.Patients in Group A(n=39)underwent three-dimensional laparoscopic hepatectomy using the proposed system.In this group,the system was operated to project the preoperative three-dimensional model to the surgical field,and combined with ICG molecular fluorescence imaging navigation three-dimensional laparoscopic hepatectomy.No surgical navigation technology was applied in Group B(n=36).The preoperative data(i.e.age,gender,hepatitis B virus surface antigen,cirrhosis,liver function Child grade,tumor size and number),surgical indicators(operation types,operation time,intraoperative blood loss and blood transfusion rate),postoperative complications and postoperative length of stay between the two groups were compared and analyzed.All statistical analyses were performed using SPSS 25.0 P<0.05 was considered as indicative of statistical significance.ResultThere was no significant difference in preoperative data between the two groups(P>0.05).The Group A had a significant less blood loss(250.0(100.0～300.0)ml vs 300.0(225.0～400.0)ml,P<0.001),lower intraoperative blood transfusion rate(12.8%vs.36.1%;P=0.029),and shorter postoperative hospital stay(8.0±2.4 days vs.10.5±3.7 days;P=0.001)than the Group B.There was no statistical difference in operative time and the overall complication rate between the two groups.No liver failure and death occurred after operation between the two groups.ConclusionThis proposed multimodal fusion image guided three-dimensional laparoscopic hepatectomy assist surgeons to identify critical surgery points as vital intrahepatic anatomical structures,tumor locations and extent of liver resection which aid to achieve anatomical,functional,radical hepatectomy.