The impact of 3-dimensional reconstructions on operation planning in liver surgery.
BACKGROUND
Operation planning in liver surgery depends on the precise understanding of the 3-dimensional (D) relation of the tumor to the intrahepatic vascular trees. To our knowledge, the impact of anatomical 3-D reconstructions on precision in operation planning has not yet been studied.


OBJECTIVE
Three-dimensional reconstruction leads to an improvement of the ability to localize the tumor and an increased precision in operation planning in liver surgery.


METHODS
We developed a new interactive computer-based quantitative 3-D operation planning system for liver surgery, which is being introduced to the clinical routine. To evaluate whether 3-D reconstruction leads to improved operation planning, we conducted a clinical trial. The data sets of 7 virtual patients were presented to a total of 81 surgeons in different levels of training. The tumors had to be assigned to a liver segment and subsequently drawn together with the operation proposal into a given liver model. The precision of the assignment to a liver segment according to Couinaud classification and the operation proposal were measured quantitatively for each surgeon and stratified concerning 2-D and different types of 3-D presentations.


RESULTS
The ability of correct tumor assignment to a liver segment was significantly correlated to the level of training (P<.05). Compared with 2-D computed tomography scans, 3-D reconstruction leads to a significant increase of precision in tumor localization by 37%. The target area of the resection proposal was improved by up to 31%.


CONCLUSIONS
Three-dimensional reconstruction leads to a significant improvement of tumor localization ability and to an increased precision of operation planning in liver surgery.
Lamadé
W
W
Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. wolfram.lamade@urz.uni-heidelberg.de
Glombitza
G
G
Fischer
L
L
Chiu
P
P
Cárdenas
C E
CE
Thorn
M
M
Meinzer
H P
HP
Grenacher
L
L
Bauer
H
H
Lehnert
T
T
Herfarth
C
C
D003198:Computer Simulation; D013502:General Surgery / Q000193:education; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008099:Liver / Q000098:blood supply / Q000473:pathology; D008113:Liver Neoplasms / Q000601:surgery*; D013813:Therapy, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface