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The Impact of 3-Dimensional Reconstructions on Operation Planning in Liver Surgery
Wolfram Lamadé, MD;
Gerald Glombitza, PhD;
Lars Fischer, MD;
Peter Chiu, MS;
Carlos E. Cárdenas Sr, MSc;
M. Thorn, MSc;
Hans-Peter Meinzer, PhD;
Lars Grenacher, MD;
Harald Bauer, MD;
Thomas Lehnert, MD;
Christian Herfarth, MD
Arch Surg. 2000;135:1256-1261.
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.
Hypothesis Three-dimensional reconstruction leads to an improvement of the ability to localize the tumor and an increased precision in operation planning in liver surgery.
Design 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%.
Conclusion Three-dimensional reconstruction leads to a significant improvement of tumor localization ability and to an increased precision of operation planning in liver surgery.
From the Departments of Surgery (Drs Lamadé, Fischer, Lehnert, and Herfarth and Mr Chiu), Radiology (Dr Grenacher), and Anesthesiology (Dr Bauer), University of Heidelberg, Heidelberg, Germany; and the Department of Medical and Biological Informatics, German Cancer Research Center, Heidelberg (Drs Glombitza and Meinzer and Messrs Cárdenas and Thorn).
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