| Research backgroundLiver cancer is one of the most common malignant tumor in our country,liver resection is an effective way to obtain the long-term survival.As the main blood vessel into the liver,the portal vein has many anatomical variations,which affect the formulation and implementation of the surgical plan.Therefore,it is extremely important for surgeons to understand the morphology of the portal vein for safe operation.Professor Fang Chihua’s research team has been using the 3d abdominal medicine visualization system with independent intellectual property rights in clinical practice for nearly 20 years,and can construct 3d models for preoperative planning based on easily accessible 2d images of living human body such as CT and MRI.This technology realizes the visual,three-dimensional and visual observation of the portal veins inside and outside the liver,which makes up for the deficiency of two-dimensional images such as ultrasound,CT and MRI.Supported by the National Major Scientific Research Instrument Development Project(81627805),this project collected the clinical data of 1076 cases of liver enhanced CT without affecting portal vein disfigurement and 7 cases of liver cancer patients with portal vein variation and underwent laparoscopic hepatectomy with augmented reality navigation.Firstly,the variation types of portal vein were studied by 3d visualization technology,and its significance in clinical practice of hepatobiliary surgery was analyzed.Secondly,the application value of the self-developed augmented reality navigation laparoscopic liver resection system in three-dimensional laparoscopic liver resection with portal vein variation was preliminarily explored,providing an effective and feasible method for the safe implementation of surgery.1.Three dimensional visual typing of the main portal veinObjective:1.Based on large sample data,the application of 3 d visualization technology the study on the anatomical variations of the portal vein type;2.Morphological measurement of normal portal vein was performed to provide theoretical data reference for accurate liver surgery.Methods:The original imaging data of 1076 patients undergoing enhanced upper abdominal CT examination in Zhujiang Hospital,Southern Medical University from June 2019 to June 2021 were collected.Using self-developed abdomen medical 3 d visualization on computer system(MI-3 DVS)based on abdominal enhanced CT image data portal vein of three-dimensional reconstruction,furst and second class branch of portal vein vascular branch line and variation of classifying and statistics,and to measure the normal type of portal vein morphology data,such as the Angle and length(about).Results:Among 1076 patients,there were 585 males and 491 females,with a median age of 53(28-68)years and 43(23-62)years,respectively.The 3d visualization system of abdominal medicine(MI-3DVS)can reconstruct the liver and portal vein vessels accurately.3 d model clearly shows the portal vein anatomy course situation,the analysis of the branch of portal vein go line classification,can be divided into 8 to portal vein.Normal type:914 cases(84.9%);Type Ⅰvariation:61 cases(5.6%);Type Ⅱ variations:64 cases(6.0%);Type Ⅲ variation:27 cases(2.5%);Type Ⅳ variation:3 cases(0.3%);Ⅴ type variation:1 case(0.1%);Type Ⅵvariation:3 cases(0.3%);Type Ⅶ:3 cases(0.3%).914 cases of normal type were divided into male and female groups.The Angle between the left and right branches of portal vein and the length and Angle between the main and primary branches were measured respectively.The results showed no statistical difference:the Angle between the two groups was 117.86±18.29°,122.62±19.97°(P>0.05);The trunk lengths of portal vein were 52.39±8.49mm and 50.45±8.21mm(P>0.05),respectively.The length of right branch of portal vein was 22.12±5.68mm and 21.30±5.51mm(P>0.05),respectively.The length of left branch of portal vein was 27.84±6.46mm and 27.01±6.77mm(P>0.05),respectively.Conclusion:1.Portal vein variation was complex and varied Seven portal vein variations were found by 3D reconstruction with MI-3DVS,with a total variation rate of 15.1%,among which types Ⅳ,Ⅴ,Ⅵ and Ⅶ were rare.2.Fully understanding individual portal vein vascular types and measuring portal vein length and Angle before surgery are conducive to the accurate implementation of liver surgery in the context of precision medicine.2.Application of augmented reality navigation in laparoscopic hepatectomy with portal vein variationObjective:A preliminary exploration of augmented reality navigation laparoscopic liver resection system application value in portal vein variation of liver resection.Methods:Clinical data of patients with portal vein variation and 3d laparoscopic hepatocellular carcinoma resection guided by augmented reality technology were retrospectively collected from June 2020 to January 2022 in department 1 of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University.There were 7 patients who met the inclusion and exclusion criteria,including 1 patient with type Ⅰ variation.3 cases with type Ⅱ variation;3 cases with type Ⅲ variation;There were 6 males and 1 female with a median age of 51(44-53)years.Preoperative enhanced CT examination was improved,and 3d visualization model was built to carry out individualized liver segmentation,volume calculation and preoperative planning.The self-developed laparoscopic hepatectomy navigation system(LHNS)based on augmented reality technology was used to navigate 3d laparoscopic hepatectomy by real-time fusion of preoperative 3D model,real surgical field and ICG fluorescence imaging.Preoperative data,surgical indicators,postoperative complications and postoperative hospital stay were collected.SPSS 25.0 statistical software was used for statistical analysis of clinical data.ResultsAll 7 patients successfully underwent 3d laparoscopic hepatectomy with augmented reality navigation technology,and the median intraoperative blood loss was 200(50-300)mL.The median operation time of 5 h(4～7);Postoperative hospital stay(6～8)d;The preoperative median hemoglobin was 120(117-151)g/L,and no intraoperative blood transfusion was reported.The hemoglobin was 124(111-136)g/L on the 1st day after surgery,and there was no statistically significant difference in hemoglobin indexes before and after surgery(P>0.05).The median postoperative hospital stay was 8 days.1 case of postoperative pleural effusion,recovered to symptomatic treatment,no perioperative deaths.ConclusionAugmented reality technology helps surgeons to identify portal vein variation in real-time during surgery,which is conducive to the accurate implementation of liver resection,and provides a safe and feasible method for liver resection with portal vein variation,which has important clinical application value. |
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