Planning of anatomical liver segmentectomy and subsegmentectomy with 3-dimensional simulation software

Am J Surg. 2013 Oct;206(4):530-8. doi: 10.1016/j.amjsurg.2013.01.041. Epub 2013 Jun 27.


Background: The aim of this study was to evaluate whether 3-dimensional (3D) simulation software is applicable to and useful for anatomic liver segmentectomy and subsegmentectomy.

Methods: A prospective study of 83 consecutive patients who underwent anatomic segmentectomy or subsegmentectomy using the puncture method was performed. All patients underwent 3D simulation analysis (SA) preoperatively for planning operative procedures. The clinical information acquired by 3D SA and the consistency of virtual and real hepatectomy were evaluated.

Results: The time needed for completing 3D SA was 18.3 ± .7 minutes. Three-dimensional SA proposed resection of multiple segments or subsegments in 29 patients (35%). It also helped complement the resection line in 26 patients (31%) who lacked a bold staining area on the liver surface. The volume of segment or subsegment calculated by 3D SA was correlated with the actual resected specimen (R(2) = .9942, P < .01). The bordering hepatic veins were clearly exposed in 71 patients (86%), in accordance with completed drawings by 3D SA.

Conclusions: Three-dimensional SA showed accurate completed drawings and assisted liver surgeons in planning and executing anatomic segmentectomy and subsegmentectomy.

Keywords: 3D simulation analysis; Anatomic segmentectomy; Hepatocellular carcinoma; Liver hepatectomy; Subsegmentectomy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / diagnostic imaging
  • Carcinoma, Hepatocellular / surgery
  • Female
  • Hepatectomy / methods*
  • Hepatic Veins / diagnostic imaging
  • Hepatic Veins / surgery
  • Humans
  • Imaging, Three-Dimensional*
  • Liver Neoplasms / diagnostic imaging
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Multidetector Computed Tomography
  • Portal Vein / diagnostic imaging
  • Portal Vein / surgery
  • Preoperative Care*
  • Prospective Studies
  • Radiographic Image Interpretation, Computer-Assisted*
  • Software
  • Surgery, Computer-Assisted*