The impact of virtual operation planning on liver surgery

The increasing complexity of hepato-biliary surgery, including major hepatic resections and living donor liver transplantation (LDLT), has lead to an increasing demand for sophisticated imaging modalities. Standard operation planning for hepatic resections and preoperative donor and recipient work-up for LDLT is based on two-dimensional computed tomography (CT) images and magnetic resonance imaging. However, even modern multidetector CT scanners are not able to perform routinely three-dimensional (3D) visualization needed for operation planning in liver surgery or LDLT. As a consequence, special-purpose computer-based operation planning systems have been developed that leverage the possibilities of modern image processing to improve surgical planning. The advances in technology enable surgeons to analyse and to visualize the anatomy of the human liver including the vascular structures within the human liver and define the exact volumetric data of the liver tissue to be resected or preserved. Furthermore, 3D visualization of the vessel architecture within the human liver allows a reliable estimation of the amount of liver tissue that could be at risk after resection because of inadequate hepatovenous drainage. Because of its clinical usefulness and real-time visualization capabilities we already use an operation planning system in selected patients prior to liver resection and before donor hepatectomy for LDLT as a standard.