Intraoperative three-dimensional fluoroscopic cholangiography.
Precise intraoperative assessment of the architecture of the biliary tree could reduce lesions to intra- or extrahepatic bile ducts. The aim of this study was to test feasibility of intraoperative three-dimensional imaging during liver resections. Isocentric C-arm fluoroscopy acquires three-dimensional images during a 190 degrees orbital rotation. The bile ducts were displayed three-dimensionally by realtime rotational projections or multiplanar reconstructions. The technique was established ex vivo in a preserved cadaveric human liver. Intraoperative three-dimensional cholangiography was performed in five patients with centrally located liver malignancies. Complete data acquisition in 3 patients depicted precise anatomical details of the architecture of the biliary tree up to third order divisions. Biliary imaging can be improved by the application of real-time intraoperative three-dimensional cholangiography. For the development of computer-aided navigation in hepatobiliary procedures, this technique could be an important prerequisite for defining landmarks of the liver in a three-dimensional space.
Beldi
Guido
G
Department of Visceral and Transplant Surgery, University of Bern, Switzerland. guido.beldi@insel.ch
Styner
Martin
M
Schindera
Sebastian
S
Inderbitzin
Daniel
D
Candinas
Daniel
D
D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D002276:Carcinoid Tumor / Q000000981:diagnostic imaging / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000601:surgery; D002758:Cholangiography; D003537:Cystadenoma / Q000000981:diagnostic imaging / Q000601:surgery; D005240:Feasibility Studies; D005471:Fluoroscopy; D006498:Hepatectomy; D006801:Humans; D021621:Imaging, Three-Dimensional; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D025321:Surgery, Computer-Assisted