Simulation and navigation in liver surgery

Abstract

In the past, liver surgery relied heavily on the experience of surgeons, and it took many years to understand the anatomy of the liver and develop various techniques. However, owing to recent advances in image analysis systems and the spread of dye fluorescence methods, preoperative simulations and intraoperative navigations have become indispensable for performing safe and accurate hepatectomy. In this paper, we highlight the progress of simulation and navigation in the field of liver surgery and also details our efforts during this process. The main preoperative simulations used in liver surgery include a method of displaying a contrast-enhanced CT image in 3D on the screen and rendering it as an actual 3D model. The purpose of intraoperative navigation is to accurately identify the excision area, the position of the tumor, and the vessel to be ligated. The course of intrahepatic vessels varies greatly from case to case, and they cannot be visualized easily as they are covered by the thick hepatic parenchyma. Correct hepatectomy is possible by accurately aligning the understanding of the preoperative simulation with the actual liver through intraoperative navigation by various methods.