Nihon Geka Gakkai Zasshi
· 2017 Jan · PMID 30176137
Preoperative simulation and intraoperative navigation using three-dimensional (3D) analysis has been established and is indispensable in liver surgery. However, 3D analysis has not been developed in pancreatic surgery. R...Preoperative simulation and intraoperative navigation using three-dimensional (3D) analysis has been established and is indispensable in liver surgery. However, 3D analysis has not been developed in pancreatic surgery. Recently, we have been able to perform 3D analysis of the pancreas and make 3D models of it with surrounding vascular structures and tumors using a 3D printer. Preoperative computed tomography (CT) images were reconstructed in a 3D configuration, including the pancreatic parenchyma, tumors, pancreatic duct, bile duct, portal venous system, and hepatic and superior mesenteric arteries. Pancreas models with internal structures in color were made of soft resin with a 3D printer. The 3D printed models were made in cases when patients were to undergo laparoscopic distal pancreatectomy and pancreatoduodenectomy with anomalies of the hepatic arteries, i.e., the replaced right hepatic artery. Preoperatively, the surgeons simulated surgical plans using the 3D model and acquired real images of surgical procedures. Intraoperatively, the surgeons performed pancreatic resection with navigation using the 3D pancreas model in a sterilization bag. Simulation and navigation using 3D analysis and 3D printed pancreas models can be useful in pancreatic surgery, in cases of laparoscopic surgery, and in patients with vascular anomalies.
Nihon Geka Gakkai Zasshi
· 2017 Jan · PMID 30176136
In the last five years, many hospitals in Japan have created three-dimensional (3D) images from computed tomography (CT) data from patients who have undergone liver resection to share the images of liver structures with...In the last five years, many hospitals in Japan have created three-dimensional (3D) images from computed tomography (CT) data from patients who have undergone liver resection to share the images of liver structures with the surgical team and analyze the liver volume based on portal perfusion. However, using the previous software packages, the 3D liver model was fixed and rigid. Therefore, we developed novel 3D simulation software, called Liversim, to visualize real-time malformations of the liver. There were no marked differences during the process of liver resection between Liversim and actual surgery. Virtual liver resection showing real-time malformations of the liver using Liversim is useful for the safe performance of liver resections.
Kawaguchi Y, Hasegawa K, Sakamoto Y
… +1 more, Kokudo N
Nihon Geka Gakkai Zasshi
· 2017 Jan · PMID 30176135
Recent developments in multidetector-row computed tomography (CT) provide precise information on liver anatomy. In the early 2000s, liver simulation based on three-dimensional (3D)-CT enabled estimation of total liver vo...Recent developments in multidetector-row computed tomography (CT) provide precise information on liver anatomy. In the early 2000s, liver simulation based on three-dimensional (3D)-CT enabled estimation of total liver volume and liver volume flown from the portal vein or drained by the hepatic vein, facilitating liver resection planning. Additionally, 3D-CT simulation is useful for graft selection in living-donor liver transplantation. From April 2012, the simulation technique has been covered by the Japanese national health insurance system. Compared with the dissemination of liver simulation, liver surgery navigation is still in the developing stage. Recently, our group has clinically applied real-time virtual sonography, which synchronizes preoperative CT and supports tumor identification. The drawback of the system is the synchronization accuracy of both images. Another intraoperative navigation technique available is fluorescence imaging using indocyanine green (ICG) as a fluorescence source. ICG-fluorescence imaging enables the identification of liver malignancies, the bile duct, portal segment, and veno-occlusive regions in real time. However, deeply located (>10 mm) structures cannot be visualized because near-infrared light lacks tissue-penetration ability. Further technological advances are expected to improve liver surgery navigation and enhance the safety of liver surgery.
Nihon Geka Gakkai Zasshi
· 2017 Jan · PMID 30176134
For advanced right colon cancer, we perform lymph node dissection exposing the so-called surgical trunk. For the resection of advanced distal sigmoid/rectal cancer, we routinely perform lymph node dissection around the r...For advanced right colon cancer, we perform lymph node dissection exposing the so-called surgical trunk. For the resection of advanced distal sigmoid/rectal cancer, we routinely perform lymph node dissection around the root of the inferior mesenteric artery, preserving the left colic artery. To perform either of these procedures safely, it is important to know the precise vascular anatomy with individual variations. However, there are major issues in laparoscopic surgery, such as a lack of tactile sensation and limited visual field. To overcome these issues and identify the vascular anatomy of each patient accurately, we have applied integrated three-dimensional computed tomography (3D-CT) imaging as a preoperative simulation and for intraoperative navigation since July 2000. Integrated 3D-CT imaging appears to be useful, especially for cancer located around the left flexure of the transverse colon, where major variations in vascular anatomy occur. Using the no-touch technique appropriately with the precise determination of laparoscopic surgical anatomy based on simulation and navigation by integrated 3D-CT imaging for each patient, systematic lymphadenectomy in addition to lateral lymph node dissection with tailor-made vascular laparoscopic dissection for the treatment of advanced lower rectal cancer appears to be feasible and a more meticulous approach compared with conventional open surgery.
Nihon Geka Gakkai Zasshi
· 2017 Jan · PMID 30176133
Preoperative simulation of vascular anatomy has been widely accepted in order to reduce surgical complications and improve postoperative outcomes. In esophagectomy, preservation of the bronchial artery (BA) was shown to...Preoperative simulation of vascular anatomy has been widely accepted in order to reduce surgical complications and improve postoperative outcomes. In esophagectomy, preservation of the bronchial artery (BA) was shown to reduce postoperative pulmonary complications. However, some anomalous BA branching patterns have been reported and these can make BA preservation difficult during surgery. Recently, the clinical utility of preoperative three-dimensional computed tomography angiography (3D-CTA) has been reported as a form of preoperative anatomical simulation. Consequently, the BA was safely preserved and efficient lymph node (LN) dissection was achieved. In surgery for gastric cancer, tracing the inner dissectable layer is necessary for LN dissection. Particularly in laparoscopic total gastrectomy with spleen preservation, there is considerable variation in the vascular anatomy of the splenic artery, splenic vein, and short gastric artery. Therefore, preoperative 3D-CTA could improve the safety of this procedure. Recently, the number of dissected LNs has been shown to be increased after introduction of 3D-CTA in laparoscopic surgery for both esophageal and gastric cancer, which showed that preoperative anatomical simulation could achieve more radical LN dissection. As a future perspective, intraoperative navigation systems could become more practical guides for endoscopic surgery for upper gastrointestinal cancer.
Nihon Geka Gakkai Zasshi
· 2017 Jan · PMID 30176132
Pulmonary segmentectomy-level variations in the three-dimensional (3D) architecture of the bronchi and pulmonary vessels are much wider than those at the lobectomy level. Presurgical simulation with sharing of necessary...Pulmonary segmentectomy-level variations in the three-dimensional (3D) architecture of the bronchi and pulmonary vessels are much wider than those at the lobectomy level. Presurgical simulation with sharing of necessary information is believed to reduce the surgical time and number of detachment procedures required. For such simulations, the author’s group developed homemade software that: 1) reconstructs the shapes of the bronchi, vessels, lung, and tumors as simplified 3D images such as sequentially connected cylinders with branches and membranes from digital-imaging data on a personal computer screen; 2) allows surgeons to input data on the initial and terminal points, diameters of cylinders, etc. continuously by moving computed tomography (CT) images up and down; and 3) permits these data to be read by modeler shareware on the Internet. Although conventional 3D images from CT data are reconstructed by a volume-rendering method, those of the software developed by the author’s group are made using a surface-rendering method. This article explains the present status of and future trends in the actual processes of simulated surgery including segmentectomy and navigation, applications of newly developed operative procedures, and results of data analysis of more than 500 cases.
Nihon Geka Gakkai Zasshi
· 2017 Jan · PMID 30176131
Because of its low invasiveness, endovascular aneurysmal repair was established as a new method of treatment for aortic aneurysms, revolutionizing the treatment of this condition. With the continuing development of techn...Because of its low invasiveness, endovascular aneurysmal repair was established as a new method of treatment for aortic aneurysms, revolutionizing the treatment of this condition. With the continuing development of technology and devices, endovascular aneurysmal repair has become safer than before. Innovations in imaging support systems including navigation systems have contributed greatly to the development of endovascular procedures, making transcatheter aortic valve implantation a safe surgical option. We discuss such innovations and the future development of imaging support systems for safe cardiovascular surgery.