Comparative Analysis Of Preoperative Planning Of Hepatoblastoma Using Computer-aided Three-dimensional And Two-dimensional Imaging

Objective: Three-dimensional(3D)reconstructed computer-aided surgical system has been widely applied in the preoperative planning of adult liver surgery.However,few studies have investigated on the preoperative planning of pediatric hepatoblastoma using computer-aided 3D and two-dimensional(2D)imaging surgical system currently.It is therefore that the present study aimed to compare and analyze the application effects of images under different dimensions on the preoperative planning of pediatric hepatoblastoma.Methods: A total of 25 hepatoblastoma children(16 males and 9 females)who accepted surgical resection in the Pediatric Surgery Department of the Affiliated Hospital of Qingdao University from January 2016 to October 2019.All children underwent pathological biopsy guided by B-ultrasound before surgery and were confirmed hepatoblastoma with the pathological results.Each child was initiated a surgical resection proposal by a surgeon team based on 2D CT images.Computer-assisted 3D imaging of the same child was performed subsequently.After observation of the 3D reconstructed images,an in-depth analysis was made to revise the surgical planning.The 3D-assisted surgery planning was then simulated to perform the resection using a computer-assisted surgery system.The total volume of both liver and tumor were calculated by simulating surgical resection,and the pre-resected volume of liver and the residual were also simulated.Formulation of surgical resection plan was based on the location and number of the liver tumors,and the 3D spatial positional relationship with the surrounding duct system and the compensation of the residual liver.Comparative analysis: The difference between computer-aided 3D imaging and 2D imaging was analyzed comparatively,including the influence in hepatoblastoma surgical planning.Results: Tumors of all the 25 children in this group were successfully removed as per the 3D assisted surgical planning.Eleven of them underwent right hemihepatectomy,three performed extended right hemihepatectomy,two accepted segments V and VI resection,three cases had mesohepatectomy,four underwent left hemihepatectomy,and 2 had extended left hemihepatectomy.Compared with 2D CT images,3D reconstructed computer-aided surgical system could clearly present the liver contour,the direction of the intrahepatic duct system,the tumor size,and the location of the spacial structure.Preoperative simulated excision and all-around stereoscopic analysis were available.Following in-depth analysis using the 3D reconstructed computer-aided surgical system,the resection scopes of 10 cases were readjusted and the surgical methods were modified,which was 40% of the former surgical planning.The average hospital stay of all children was 11 ± 2 days.And the average surgery time was 147 ± 18 min with intraoperative blood loss 225 ± 48 ml.One case was given 200 ml of red blood cell transfusion for intraoperative bleeding,and another case had bile leakage postoperatively.All patients were followed up by telephone,and all survived free of complications and local metastasis.Conclusions: Compared with 2D images,the 3D reconstructed computer-aided surgical system could clearly display the hepatic anatomical features,the direction of all intrahepatic duct systems,and the 3D spacial position relationship.Moreover,preoperative simulated surgical resection presented more benefits to the preoperative planning of pediatric hepatoblastoma allowing to revise the surgical planning designed with 2D imaging.