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Uses of a dedicated 3D reconstruction software with augmented and mixed reality in planning and performing advanced liver surgery and living donor liver transplantation(with videos)

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Hepatobiliary & Pancreatic Diseases International 2022年第5期21卷 455-461页

作者： Deniz Balci Elvan Onur Kirimker Dimitri Aristotle Raptis Yujia Gao alfred wei chieh kow Department of Surgery Medical Park Goztepe Hastanesi Organ Nakli Merkezi Nisan SokBahce se hir UniversityNo.23 Merdivenkoy KadıkoyIstanbulTurkiye Department of Surgery Ankara UniversityAnkaraTurkiye Clinical Service of HPB Surgery and Liver Transplantation NHS Foundation TrustRoyal Free London HospitalLondonUK Division of Surgery&Interventional Science University College LondonLondonUK Division of Hepatobiliary&Pancreatic Surgery Department of SurgeryNational University of SingaporeSingapore Liver Transplant Program National University Center for Organ Transplantation(NUCOT)National University Health SystemSingapore

The development of digital intelligent diagnostic and treatment technology has opened countless new opportunities for liver surgery from the era of digital anatomy to a new era of digital diagnostics,virtual surgery simulation and using the created scenarios in real-time surgery using mixed reality.In this article,we described our experience on developing a dedicated 3 dimensional visualization and reconstruction software for surgeons to be used in advanced liver surgery and living donor liver transplantation.Furthermore,we shared the recent developments in the field by explaining the outreach of the software from virtual reality to augmented reality and mixed reality.

关键词： Living donor liver transplantation 3D reconstruction software 3D volumetry Precision medicine Augmented reality Mixed reality

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Pedicled omental patch as a bridging procedure for iatrogenic bile duct injury

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World Journal of Gastroenterology 2017年第36期23卷 6741-6746页

作者： Jun Jie Ng alfred wei chieh kow Department of Surgery National University HospitalSingapore 119074 Singapore

Iatrogenic bile duct injuries during cholecystectomy can present as fulminant intra-abdominal sepsis which precludes immediate repair or biliary reconstruction.We report the case of a 29-year-old female patient who sustained a bile duct injury after an open cholecystectomy in a neighboring country.She presented to our institution 22 d after initial surgery with septic shock and multiple intra-abdominal collections.Endoscopic retrograde cholangiography revealed a large common hepatic duct defect corresponding to a Strasberg type D bile duct injury.Definitive reconstruction such as a hepaticojejunostomy cannot be performed due to the presence of dense adhesions with infected and friable tissues.She underwent a combination of endoscopic biliary stenting and pedicled omental patch repair of the bile duct to control bile leak and sepsis as a bridging procedure to definite hepaticojejunostomy three months later.

关键词： Cholecystectomy Endoscopic retrograde cholangiopancreatography Case reports Bile ducts Abdominal abscess

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Comparative study and systematic review of laparoscopic liver resection for hepatocellular carcinoma

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World Journal of Hepatology 2015年第27期7卷 2765-2773页

作者： wei Qi Leong Iyer Shridhar Ganpathi alfred wei chieh kow Krishnakumar Madhavan Stephen Kin Yong Chang Division of Hepatobiliary and Pancreatic Surgery Department of Surgery National University Health System Singapore

AIM: To compare the surgical outcomes between laparoscopic liver resection(LLR) and open liver resection(OLR) as a curative treatment in patients with hepatocellular carcinoma(HCC). METHODS: A Pub Med database search was performed systematically to identify comparative studies of LLR vs OLR for HCC from 2000 to 2014. An extensive text word search was conducted, using combinations of search headings such as "laparoscopy", "hepatectomy", and "hepatocellular carcinoma". A comparative study was also performed in our institution where we analysed surgical outcomes of 152 patients who underwent liver resection between January 2005 to December 2012, of which 42 underwent laparoscopic or hand-assisted laparoscopic resection and 110 underwent open resection. RESULTS: Analysis of our own series and a review of 17 high-quality studies showed that LLR was superior to OLR in terms of short-term outcomes, as patients in the laparoscopic arm were found to have less intraoperative blood loss, less blood transfusions, and a shorter length of hospital stay. In our own series, both LLR and OLR groups were found to have similar overall survival(OS) rates, but disease-free survival(DFS) rates were higher in the laparoscopic arm. CONCLUSION: LLR is associated with better short-term outcomes compared to OLR as a curative treatment for HCC. Long-term oncologic outcomes with regards to OS and DFS rates were found to be comparable in both groups. LLR is hence a safe and viable option for curative resection of HCC.

关键词： Hepatocellular carcinoma Laparoscopy Open liver re

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Dynamic phenotypic heterogeneity and the evolution of multiple RNA subtypes in hepatocellular carcinoma:the PLANET study

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National Science Review 2022年第3期9卷 96-109页

作者： weiwei Zhai Hannah Lai Neslihan Arife Kaya Jianbin Chen Hechuan Yang Bingxin Lu Jia Qi Lim Siming Ma Sin Chi Chew Khi Pin Chua Jacob Josiah Santiago Alvarez Pauline Jieqi Chen Mei Mei Chang Lingyan Wu Brian K.P.Goh Alexander Yaw-Fui Chung Chung Yip Chan Peng Chung Cheow Ser Yee Lee Juinn Huar Kam alfred wei-chieh kow Iyer Shridhar Ganpathi Rawisak Chanwat Jidapa Thammasiri Boon Koon Yoong Diana Bee-Lan Ong Vanessa H.de Villa Rouchelle D.Dela Cruz Tracy Jiezhen Loh wei Keat Wan Zeng Zeng Anders Jacobsen Skanderup Yin Huei Pang Krishnakumar Madhavan Tony Kiat-Hon Lim Glenn Bonney wei Qiang Leow Valerie Chew Yock Young Dan Wai Leong Tam Han Chong Toh Roger Sik-Yin Foo Pierce Kah-Hoe Chow Division of Pathology National Cancer Institute Department of Surgery Faculty of Medicine University of Malaya Department of Surgery and Center for Liver Disease Management and Transplantation The Medical City 13. Department of Laboratories The Medical City Department of Pathology Singapore General Hospital Institute for Infocomm Research ASTAR Department of Pathology National University Health System Translational Immunology Institute (TII) Sing Health Duke-NUS Academic Medical Centre Division of Gastroenterology and Hepatology University Medicine Cluster National University Hospital Department of Biochemistry Yong Loo Lin School of Medicine National University of Singapore Genome Institute of Singapore Agency for Science Technology and Research Cancer Science Institute of Singapore National University of Singapore Division of Medical Oncology National Cancer Center Singapore Cardiovascular Research Institute National University of Singapore National University Healthcare System Singhealth-Duke-NUS Academic Surgery Program Duke-NUS Graduate Medical School Institute of Molecular and Cell Biology Agency for Science Technology and Research Key Laboratory of Zoological Systematics and Evolution Institute of Zoology Chinese Academy of Sciences Center for Excellence in Animal Evolution and Genetics Chinese Academy of Sciences School of Biological Sciences Nanyang Technological University Division of Biosciences Faculty of Life Sciences Division of Surgery and Surgical Oncology National Cancer Centre Department of Hepato-Pancreato-Biliary and Transplant Surgery Singapore General Hospital Division of Hepatobiliary and Pancreatic Surgery Department of Surgery University Surgical Cluster National University Health System Hepato-Pancreato-Biliary Surgery Unit Department of Surgery National Cancer Institute

Intra-tumor heterogeneity(ITH) is a key challenge in cancer treatment, but previous studies have focused mainly on the genomic alterations without exploring phenotypic(transcriptomic and immune)heterogeneity. Using one of the largest prospective surgical cohorts for hepatocellular carcinoma(HCC)with multi-region sampling, we sequenced whole genomes and paired transcriptomes from 67 HCC patients(331 samples). We found that while genomic ITH was rather constant across stages, phenotypic ITH had a very different trajectory and quickly diversified in stage Ⅱ patients. Most strikingly, 30% of patients were found to contain more than one transcriptomic subtype within a single tumor. Such phenotypic ITH was found to be much more informative in predicting patient survival than genomic ITH and explains the poor efficacy of single-target systemic therapies in HCC. Taken together, we not only revealed an unprecedentedly dynamic landscape of phenotypic heterogeneity in HCC, but also highlighted the importance of studying phenotypic evolution across cancer types.

关键词： NADH oxidase H2O2 production oxidative phosphorylation

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Liver resection versus liver transplantation for hepatocellular carcinoma within Milan criteria:a meta-analysis of 18,421 patients

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Hepatobiliary Surgery and Nutrition 2022年第1期11卷 78-93,I0009-I0013页

作者： Jin Hean Koh Darren Jun Hao Tan Yuki Ong Wen Hui Lim Cheng Han Ng Phoebe Wen Lin Tay Jie Ning Yong Mark D.Muthiah Eunice X.Tan Ning Qi Pang Beom Kyung Kim Nicholas Syn alfred kow Brian K.P.Goh Daniel Q.Huang Yong Loo Lin School of Medicine National University of SingaporeSingaporeSingapore Division of Gastroenterology and Hepatology Department of MedicineNational University HospitalSingaporeSingapore National University Centre for Organ Transplantation National University Health SystemSingaporeSingapore Division of Hepatobiliary&Pancreatic Surgery Department of SurgeryNational University HospitalSingaporeSingapore Department of Internal Medicine Yonsei University College of MedicineSeoulRepublic of Korea Yonsei Liver Center Severance HospitalYonsei University Health SystemSeoulRepublic of Korea Biostatistics and Modelling Domain Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingaporeSingapore Department of Hepato-Pancreato-Biliary and Transplant Surgery Division of SurgerySingapore General HospitalSingaporeSingapore Liver Transplant Service SingHealth Duke-NUS Transplant CentreSingaporeSingapore

Background:Outcomes after liver resection(LR)and liver transplantation(LT)for hepatocellular carcinoma(HCC)are heterogenous and may vary by region,over time periods and disease burden.We aimed to compare overall survival(OS)and disease-free survival(DFS)between LT versus LR for HCC within the Milan criteria.Methods:Two authors independently searched Medline and Embase databases for studies comparing survival after LT and LR for patients with HCC meeting the Milan criteria.Meta-analyses and meta-regression were conducted using random-effects models.Results:We screened 2,278 studies and included 35 studies with 18,421 patients.LR was associated with poorer OS[hazard ratio(HR)=1.44;95%confidence interval(CI):1.14-1.81;P<0.01]and DFS(HR=2.71;95%CI:2.23-3.28;P<0.01)compared to LT,with similar findings among intention-to-treat(ITT)studies.In uninodular disease,OS in LR was comparable to LT(P=0.13)but DFS remained poorer(HR=2.95;95%CI:2.30-3.79;P<0.01).By region,LR had poorer OS versus LT in North America and Europe(P≤0.01),but not Asia(P=0.25).LR had inferior survival versus LT in studies completed before 2010(P=0.01),but not after 2010(P=0.12).Cohorts that underwent enhanced surveillance had comparable OS after LT and LR(P=0.33),but cohorts undergoing usual surveillance had worse OS after LR(HR=1.95;95%CI:1.24-3.07;P<0.01).Conclusions:Mortality after LR for HCC is nearly 50%higher compared to LT.Survival between LR and LT were similar in uninodular disease.The risk of recurrence after LR is threefold that of LT.

关键词： Hepatocellular carcinoma(HCC) liver resection(LR) liver transplant survival recurrence

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