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Novel 3-dimensional virtual hepatectomy simulation combined with real-time deformation

World Journal of Gastroenterology 2015年第34期21卷 9982-9992页

作者： Yukio Oshiro Hiroaki Yano Jun Mitani Sangtae kim jaejeong kim Kiyoshi Fukunaga Nobuhiro Ohkohchi Department of Surgery Division of Gastroenterological and Hepatobiliary Surgery and Organ TransplantationFaculty of MedicineUniversity of Tsukuba Department of Computer Science Graduate School of System Information EngineeringUniversity of Tsukuba School of Informatics College of Media Arts Science and TechnologyFaculty of Library Information and Media ScienceUniversity of Tsukuba

AIM:To develop a novel 3-dimensional(3D) virtual hepatectomy simulation software,Liversim,to visualize the real-time deformation of the liver.METHODS:We developed a novel real-time virtual hepatectomy simulation software program called Liversim. The software provides 4 basic functions:viewing 3D models from arbitrary directions,changing the colors and opacities of the models,deforming the models based on user interaction,and incising the liver parenchyma and intrahepatic vessels based on user operations. From April 2010 through 2013,99 patients underwent virtual hepatectomies that used the conventional software program SYNAPSE VINCENT preoperatively. Between April 2012 and October 2013,11 patients received virtual hepatectomies using the novel software program Liversim; these hepatectomies were performed both preoperatively and at the same that the actual hepatectomy was performed in an operating room. The perioperative outcomes were analyzed between the patients for whom SYNAPSE VINCENT was used and those for whom Liversim wasused. Furthermore,medical students and surgical residents were asked to complete questionnaires regarding the new software.RESULTS:There were no obvious discrepancies(i.e.,the emergence of branches in the portal vein or hepatic vein or the depth and direction of the resection line) between our simulation and the actual surgery during the resection process. The median operating time was 304 min(range,110 to 846) in the VINCENT group and 397 min(range,232 to 497) in the Liversim group(P = 0.30). The median amount of intraoperative bleeding was 510 m L(range,18 to 5120) in the VINCENT group and 470 m L(range,130 to 1600) in the Liversim group(P = 0.44). The median postoperative stay was 12 d(range,6 to 100) in the VINCENT group and 13 d(range,9 to 21) in the Liversim group(P = 0.36). There were no significant differences in the preoperative outcomes between the two groups. Liversim was not found to be clinically inferior to SYNAPSE VINCENT. Both students and surgical residents reported that th

关键词： Liver Surgery Simulation Virtual hepatectomy Real-

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Conversion hepatectomy for hepatocellular carcinoma with main portal vein tumour thrombus after lenvatinib treatment: A case report

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World Journal of Hepatology 2021年第3期13卷 384-392页

作者： Kazuhiro Takahashi jaejeong kim Amane Takahashi Shinji Hashimoto Manami Doi Kinji Furuya Ryosuke Hashimoto Yohei Owada Koichi Ogawa Yusuke Ohara Yoshimasa Akashi Katsuji Hisakura Tsuyoshi Enomoto Osamu Shimomura Masayuki Noguchi Tatsuya Oda Department of Gastrointestinal and Hepatobiliary Pancreatic Surgery University of TsukubaTsukuba 3058575IbarakiJapan Department of Gastroenterological Surgery Saitama Cancer CenterSaitama 3620806SaitamaJapan Department of Diagnostic Pathology University of TsukubaTsukuba 3058575IbarakiJapan

BACKGROUND Hepatocellular carcinoma(HCC)accompanied by portal vein tumour thrombus(PVTT)presents an aggressive disease course,worsening liver function reserve,and a high recurrence rate.Clinical practice guidelines recommend systemic therapy as the first-line option for HCC with portal invasion.However,to achieve longer survival in these patients,the treatment strategy should be concluded with removal of the tumour by locoregional therapy.We experienced a case of initially unresectable HCC with main PVTT converted to radical hepatectomy after lenvatinib treatment.CASE SUMMARY A 59-year-old male with chronic hepatitis C infection visited our clinic as a regular post-surgery follow-up.Contrast-enhanced abdominal computed tomography revealed a liver mass diffusely located at the lateral segment with a massive PVTT extending from the umbilical portion to the main and contralateral third-order portal branches.With the diagnosis of unresectable HCC with Vp4(main trunk/contralateral branch)PVTT,lenvatinib was started at 12 mg/d.The computed tomography taken 3 mo after starting lenvatinib showed regression of the PVTT,which had retreated to the contralateral first-order portal branch.He tolerated the full dose without major adverse effects.With cessation of lenvatinib for 7 d,radical left lobectomy and PVTT thrombectomy were conducted.The patient’s postoperative course was uneventful.Microscopically,the primary lesion showed fibrotic changes,with moderately to poorly differentiated tumour cells surrounded by granulation tissues in some areas.The majority of the PVTT showed necrosis.He was alive without recurrence for 8 mo.CONCLUSION This is the first case of HCC with Vp4 PVTT in which radical conversion hepatectomy was succeeded after lenvatinib treatment.

关键词： Hepatocellular carcinoma Lenvatinib Portal vein tumour thrombus Conversion hepatectomy Case report

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