Usefulness of Three-Dimensional Computed Tomography Simulation for Safe Laparoscopic Liver Anatomical Resection

Koji Kitamura, MD, PhD

Product Details
Product ID: ACS-5959
Year Produced: 2019
Length: 10 min.


To perform a safe anatomical liver resection with an extrahepatic Glissonean approach, it is helpful that visualization of the porta hepatis as well as the vessels appearing on the cut surface can be accomplished. Visualization of these anatomic structures is vital for successful laparoscopic surgery in the absence of touch and direction of dissection and is also useful for sharing the anatomical grasp within the surgical team. Our procedure outline for laparoscopic liver anatomical resection; LLAR is as follows: Preoperative 3D simulation images were generated using Synapse Vincent (Fujifilm medicals). It permits patient positioning and port placement. In the operation, we encircle and clamp the target Glissonean pedicle supplying the tumor extrahepatically at the hepatic hilum. We then, perform parenchymal transection along the ischemic demarcation line mainly using Cavitron ultrasonic surgical aspirator exposing landmark hepatic veins and the Glissonean stump. During the procedures the simulation images as well as the intraoperative ultra sound were often referred to verify anatomic structures nearby. Fifty to sixty cases of liver resection are performed in our institute per year, in which about twenty to thirty cases are performed by the laparoscopic surgery. We present preoperative 3D simulation images and LLAR surgical videos.