Background

In recent years, the development of digital imaging technology has had a significant influence in liver surgery. The ability to obtain a 3-dimensional (3D) visualization of the liver anatomy has provided surgery with virtual reality of simulation 3D computer models, 3D printing models and more recently holograms and augmented reality (when virtual reality knowledge is superimposed onto reality). In addition, the utilization of real-time fluorescent imaging techniques based on indocyanine green (ICG) uptake allows clinicians to precisely delineate the liver anatomy and/or tumors within the parenchyma, applying the knowledge obtained preoperatively through digital imaging. The combination of both has transformed the abstract thinking until now based on 2D imaging into a 3D preoperative conception (virtual reality), enhanced with real-time visualization of the fluorescent liver structures, effectively facilitating intraoperative navigated liver surgery (augmented reality).

Data sources

A literature search was performed from inception until January 2021 in MEDLINE (PubMed), Embase, Cochrane library and database for systematic reviews (CDSR), Google Scholar, and National Institute for Health and Clinical Excellence (NICE) databases.

Results

Fifty-one pertinent articles were retrieved and included. The different types of digital imaging technologies and the real-time navigated liver surgery were estimated and compared.

Conclusions

ICG fluorescent imaging techniques can contribute essentially to the real-time definition of liver segments; as a result, precise hepatic resection can be guided by the presence of fluorescence. Furthermore, 3D models can help essentially to further advancing of precision in hepatic surgery by permitting estimation of liver volume and functional liver remnant, delineation of resection lines along the liver segments and evaluation of tumor margins. In liver transplantation and especially in living donor liver transplantation (LDLT), 3D printed models of the donor's liver and models of the recipient's hilar anatomy can contribute further to improving the results. In particular, pediatric LDLT abdominal cavity models can help to manage the largest challenge of this procedure, namely large-for-size syndrome.

中文翻译：

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导航肝脏手术：最新技术和未来展望

背景

近年来，数字成像技术的发展对肝脏外科手术产生了重大影响。获得肝脏解剖结构的 3 维 (3D) 可视化的能力为手术提供了模拟 3D 计算机模型、3D 打印模型的虚拟现实以及最近的全息图和增强现实（当虚拟现实知识叠加到现实上时）。此外，利用基于实时荧光成像技术吲哚菁绿 (ICG) 摄取使临床医生能够应用术前通过数字成像获得的知识，精确描绘肝组织和/或实质内的肿瘤。两者的结合将迄今为止基于 2D 成像的抽象思维转变为 3D 术前概念（虚拟现实），增强了荧光肝脏结构的实时可视化，有效促进了术中导航肝脏手术（增强现实）。

数据源

从开始到 2021 年 1 月，我们在 MEDLINE (PubMed)、Embase、Cochrane 图书馆和系统评价数据库 (CDSR)、谷歌学术和美国国家健康与临床卓越研究所 (NICE) 数据库中进行了文献检索。

结果

检索并收录了 51 篇相关文章。对不同类型的数字成像技术和实时导航肝脏手术进行了估计和比较。

结论

ICG 荧光成像技术可以对肝段的实时定义做出重要贡献；因此，可以通过荧光的存在来指导精确的肝切除。此外，3D 模型可以通过允许估计肝脏体积和功能性肝脏残余、描绘沿肝段的切除线和评估肿瘤边缘，从根本上帮助进一步提高肝脏手术的精确度。在肝移植，尤其是活体肝移植 (LDLT) 中，供体肝脏的 3D 打印模型和受者肝门解剖模型可以进一步改善结果。特别是，儿科 LDLT 腹腔模型可以帮助管理该程序的最大挑战，即大尺寸综合征。