title: Surgical impact of computerized 3D CT-based visualizations in living donor liver transplantation.
abstract: For living donor liver transplantation (LDLT), accurate diagnostic evaluation is essential. Problems arise in assessment of the vascular, bile duct anatomy, liver graft volume, and vascular territories involved. Requirements for the realization of decision-support and enhanced precision in the planning of surgery in LDLT engineering fields are a three-dimensional (3D) visualization system that improves anatomic assessment, allows for interactive surgery planning, and acts as an intraoperative guide. Thirteen LDLT candidates and three LDLT recipients were assessed by "multislice" computer-tomographic examinations. Image processing for 3D visualization included segmentation and calculation of centre lines. A hierarchical mathematical model representing the vascular and biliary tree was created, which allowed calculation of individual vascular territories. Precision of 3D computed tomography (CT)-based visualizations was superior to diagnostic modalities used currently. In addition to detection of decisive anatomic variants, computerized interactive insertion of splitting lines allowed for better planning of the surgical approach and image-guided surgery. 3D CT-based visualization in LDLT facilitates diagnostic evaluation with high accuracy. Multiple examinations, especially with regard to invasive diagnostics, may be avoided. Surgical strategy was directly influenced by the detection of vascular and biliary variants.
authors.affiliation: Department of Visceral, Transplantation, Vascular- and Thoracic Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Harms
authors.forename: Holger
authors.initials: H
authors.lastname: Bourquain
authors.forename: Michael
authors.initials: M
authors.lastname: Bartels
authors.forename: Heinz-Otto
authors.initials: HO
authors.lastname: Peitgen
authors.forename: Thomas
authors.initials: T
authors.lastname: Schulz
authors.forename: Thomas
authors.initials: T
authors.lastname: Kahn
authors.forename: Jan
authors.initials: J
authors.lastname: Hauss
authors.forename: Josef
authors.initials: J
authors.lastname: Fangmann
mesh_terms: D003287:Contrast Media; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000033:anatomy & histology / Q000502:physiology; D008102:Liver Circulation / Q000502:physiology; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011856:Radiographic Image Enhancement; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media