Successful duct-to-duct biliary reconstruction after right hemihepatectomy. Operative planning using virtual 3D reconstructed images.
Accurate knowledge of partial anatomy is essential in hepatic surgery but is difficult to acquire. We describe the potential impact of a new technique for constructing three-dimensional virtual images of the portal vein, hepatic artery, and bile ducts and present a representative case. An 80-year-old man was suspected of having papillary cholangiocarcinoma arising in S8 of the liver and extending to the hepatic hilum intraluminaly. Right hemihepatectomy with bile duct resection was planned. However, it was uncertain whether duct-to-duct biliary reconstruction would be possible based on the appearance of the confluence of the right and left hepatic ducts on cholangiogram and conventional computed tomograph. Virtual three-dimensional images of the liver were constructed and revealed vascular and biliary anatomy. They showed that the upper margin of bile duct excision would be 19 mm from the umbilical point of the left portal vein, and that the site of the left branch of the caudate lobe bile duct could be preserved. Based on this information, we performed a sphincter-preserving biliary operation safely without complications. Planning complex biliary surgery may be improved by the use of virtual three-dimensional images of the liver. This approach is especially useful in candidates for postoperative regional chemotherapy.
Endo
Itaru
I
Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan 236-0004. endoit@med.yokohama-cu.ac.jp
Shimada
Hiroshi
H
Takeda
Kazuhisa
K
Fujii
Yoshiro
Y
Yoshida
Kenichi
K
Morioka
Daisuke
D
Sadatoshi
Sugae
S
Togo
Shinji
S
Bourquain
Holger
H
Peitgen
Heinz O
HO
D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery; D001652:Bile Ducts / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery; D002758:Cholangiography; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000473:pathology; D006500:Hepatic Duct, Common / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D010347:Patient Care Planning; D011169:Portal Vein / Q000473:pathology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012449:Safety; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface