Skip to main content

Application of 3D Visualization Technology in Perihilar Surgery

  • Chapter
  • First Online:
Biliary Tract Surgery
  • 531 Accesses

Abstract

The Perihilar area is a complex region where bile ducts, portal veins, hepatic arteries, lymphatics, and nerves intertwine often in an unpredictable way. Anatomical variation is common and the spatial relationships between the vessels are difficult to predict. Imaging techniques greatly assist the surgeon in visualizing the individual anatomy, improving operative precision, patient safety, and shortening duration of surgery. This chapter outlines the characteristic anatomical variation and spatial relationships between the portal veins, hepatic arteries, and bile duct. It categorizes: perihilar diseases and discusses their impact on the hilum, atrophy, and hypertrophy of the liver lobes. We discuss the nature of invasive disease and concomitant difficulties during surgery. We also outline the treatment of disease, and the value of imaging technologies, modeling hepatic lobe segmentation and related vasculature to enable simulated surgery, and for precise preoperative and intraoperative guidance. The chapter closes with a description of the 3D imaging software systems, from image acquisition, and data migration to 3D modelling of the perihilar region and the liver.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Al Mahjoub A, Menahem B, Fohlen A, et al. Preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma: is percutaneous transhepatic biliary drainage safer and more effective than endoscopic biliary drainage? A meta-analysis. J Vasc Interv Radiol. 2017;28(4):576–82.

    Article  PubMed  Google Scholar 

  • Ali MA, Chuang JF, Yong CC, et al. Extended central hepatectomy with preservation of segment 6 for patients with centrally located hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int. 2015;14(1):63–8.

    Article  PubMed  Google Scholar 

  • Atri M, Bret PM, Fraser-Hill MA. Intrahepatic portal venous variations: prevalence with US. Radiology. 1992;184(1):157–8.

    Article  CAS  PubMed  Google Scholar 

  • Belghiti J, Ogata S. Preoperative optimization of the liver for resection in patients with hilar cholangiocarcinoma. HPB (Oxford). 2005;7(4):252–3.

    Article  Google Scholar 

  • Biliary Surgery Group of Surgery Branch of Chinese Medical Association. Guidelines for diagnosis and treatment of hilar cholangiocarcinoma (2013 Edition). Chin J Surg. 2013a;51(10):865–71.

    Google Scholar 

  • Biliary Surgery Group of Surgery Branch of Chinese Medical Association. Guidelines for the diagnosis and treatment of bile duct injury (2013 Edition). Chin J Digest Surg. 2013b;12(2):81–95.

    Google Scholar 

  • Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet. 1975;140(2):170–8.

    CAS  PubMed  Google Scholar 

  • Bismuth H, Majno PE. Biliary strictures: classification based on the principles of surgical treatment. World J Surg. 2001;25(10):1241–4.

    Article  CAS  PubMed  Google Scholar 

  • Chaib E, Kanas AF, Galvao FH, et al. Bile duct confluence: anatomic variations and its classification. Surg Radiol Anat. 2014;36(2):105–9.

    Article  PubMed  Google Scholar 

  • Chedid MF, Capaverde LH, Pretto GG, et al. Replaced right hepatic artery originated from the proximal segment of the common hepatic artery and crossing behind the portal vein: a dangerous anomaly in hepatic resection and liver transplantation. Am Surg. 2012;78(12):E501–3.

    Article  PubMed  Google Scholar 

  • Chen W, Ke K, Chen YL. Combined portal vein resection in the treatment of hilar cholangiocarcinoma: a systematic review and meta-analysis. Eur J Surg Oncol. 2014;40(5):489–95.

    Article  CAS  PubMed  Google Scholar 

  • Cho A, Okazumi S, Yoshinaga Y, et al. Relationship between left biliary duct system and left portal vein: evaluation with three-dimensional portocholangiography. Radiology. 2003;228(1):246–50.

    Article  PubMed  Google Scholar 

  • da Fonseca-Neto OC, de Albuquerque-Neto MC, de Miranda AL. Surgical management of cystic dilatation bile ducts in adults. Arq Bras Cir Dig. 2015;28(1):17–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dong J-h, Zheng S-s, Xiao-ping C. Consensus on evaluation of Hepatic functional reserve before hepatectomy (2011 edition). Chin J Digest Surg. 2011;10(1):20–5.

    Google Scholar 

  • Dong J, Yang S, Zeng J, et al. Precision in liver surgery. Semin Liver Dis. 2013a;33(3):189–203.

    Article  PubMed  Google Scholar 

  • Dong J-H, Zheng X-H, Xia H-T. Cystic dilation of bile duct: new clinical classification and treatment strategy. Chin J Digest Surg. 2013b;12(5):370–7.

    Google Scholar 

  • Dreizin D, Bodanapally UK, Neerchal N, et al. Volumetric analysis of pelvic hematomas after blunt trauma using semi-automated seeded region growing segmentation: a method validation study. Abdom Radiol (NY). 2016;41(11):2203–8.

    Article  Google Scholar 

  • Endo I, Shimada H, Sugita M, et al. Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma. Surgery. 2007;142(5):666–75.

    Article  PubMed  Google Scholar 

  • Fang C-H, Zhong S-Z, Wu K-C. Three-dimensional reconstruction of hepatic duct system by MRI and CT. World Chin J Digest. 2004;12(1):216–7.

    Google Scholar 

  • Fang CH, Xie AW, Chen ML, et al. Application of a visible simulation surgery technique in preoperation planning for intrahepatic calculi. World J Surg. 2010;34(2):327–35.

    Article  PubMed  Google Scholar 

  • Fang CH, Liu J, Fan YF, et al. Outcomes of hepatectomy for hepatolithiasis based on 3-dimensional reconstruction technique. J Am Coll Surg. 2013;217(2):280–8.

    Article  PubMed  Google Scholar 

  • Fang C-H, Fang C-S, Cai W. Establishment and value of three-dimensional visualization diagnosis platform in the treatment of hepatolithiasis. Chin J Surg. 2015;35(9):974–8.

    Google Scholar 

  • Farges O, Regimbeau JM, Fuks D, et al. Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma. Br J Surg. 2013;100(2):274–83.

    Article  CAS  PubMed  Google Scholar 

  • Germain T, Favelier S, Cercueil JP, et al. Liver segmentation: practical tips. Diagn Interv Imaging. 2014;95(11):1003–16.

    Article  CAS  PubMed  Google Scholar 

  • Gluszek S, Kot M, Balchanowski N, et al. Iatrogenic bile duct injuries--clinical problems. Pol Przegl Chir. 2014;86(1):17–25.

    Article  PubMed  Google Scholar 

  • Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994;220(1):50–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hirose T, Igami T, Ebata T, et al. Surgical and radiological studies on the length of the hepatic ducts. World J Surg. 2015;39(12):2983–9.

    Article  PubMed  Google Scholar 

  • Honma S, Matsuda W, Kudo M. Right hepatic artery traveling anteriorly to the common bile duct. Anat Sci Int. 2013;88(2):93–6.

    Article  PubMed  Google Scholar 

  • Huang Z-Q, Huang X-Q, Zhou NI-X. Perihepatic hilar surgery: concept and practice. Chin J Digest Surg. 2002;1(3):153–9.

    Google Scholar 

  • Jiang Y, Zhang S-D. Hilar exploration and biliary operation. J Surg Concepts Pract. 2001;6(3):133–4.

    Google Scholar 

  • Kawarada Y, Das BC, Taoka H. Anatomy of the hepatic hilar area: the plate system. J Hepato-Biliary-Pancreat Surg. 2000;7(6):580–6.

    Article  CAS  Google Scholar 

  • Kawasaki S, Imamura H, Kobayashi A, et al. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg. 2003;238(1):84–92.

    PubMed  PubMed Central  Google Scholar 

  • Kennedy TJ, Yopp A, Qin Y, et al. Role of preoperative biliary drainage of liver remnant prior to extended liver resection for hilar cholangiocarcinoma. HPB (Oxford). 2009;11(5):445–51.

    Article  Google Scholar 

  • Kitami M, Takase K, Murakami G, et al. Types and frequencies of biliary tract variations associated with a major portal venous anomaly: analysis with multi-detector row CT cholangiography. Radiology. 2006;238(1):156–66.

    Article  PubMed  Google Scholar 

  • Kobayashi K, Matsui O, Yoshikawa J, Kadoya M, Kawamori Y, Takashima T. Right hepatic arterial supply to the posterior aspect of segment IV of the liver: analysis by CT during hepatic arteriography. Abdom Imaging. 1999;24:591–593.19.

    Article  CAS  PubMed  Google Scholar 

  • Kokudo T, Hasegawa K, Sugawara Y, et al. Pitfall of right lateral sector graft procurement: supraportal right posterior hepatic artery. Transplantation. 2013;96(12):e89–91.

    Article  PubMed  Google Scholar 

  • Kuhns LR, Borlaza G. Normal roentgen variant: aberrant right hepatic artery on computed tomography. Radiology. 1980;135(2):392.

    Article  CAS  PubMed  Google Scholar 

  • Lau W-Y, Zhang S-X, Jiang H-C. Expert consensus on accurate diagnosis and treatment of complex liver tumor by 3D visualization. Chin J Pract Surg. 2017a;1:53–9.

    Google Scholar 

  • Lau Y-Y, Zhang S-X, Jiang H-C. Expert consensus on accurate diagnosis and treatment of hilar cholangiocarcinoma with three-dimensional visualization. Chin J Pract Surg. 2017b;1:48–52.

    Google Scholar 

  • Li C-Y, Ni Q-H, Wang J. Diagnosis and treatment of complicated intrahepatic bile duct stone: an efficacy analysis of 60 cases. Chin J Pract Surg. 2016;36(3):316–8.

    Google Scholar 

  • Lopez-Andujar R, Moya A, Montalva E, et al. Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers. Liver Transpl. 2007;13(10):1401–4.

    Article  PubMed  Google Scholar 

  • Lu DS, Reber HA, Krasny RM, et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol. 1997;168(6):1439–43.

    Article  CAS  PubMed  Google Scholar 

  • Marescaux J, Clement JM, Tassetti V, et al. Virtual reality applied to hepatic surgery simulation: the next revolution. Ann Surg. 1998;228(5):627–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mariolis-Sapsakos T, Kalles V, Papatheodorou K, et al. Anatomic variations of the right hepatic duct: results and surgical implications from a cadaveric study. Anat Res Int. 2012;2012:838179.

    PubMed  PubMed Central  Google Scholar 

  • Matsumura H. The significance of the morphology of the dorsal pancreatic artery in determining the presence of the accessory right hepatic artery passing behind the portal vein. Kaibogaku Zasshi. 1998;73(5):517–27.

    CAS  PubMed  Google Scholar 

  • Matsuyama R, Mori R, Ota Y, et al. Significance of vascular resection and reconstruction in surgery for hilar cholangiocarcinoma: with special reference to hepatic arterial resection and reconstruction. Ann Surg Oncol. 2016;23(Suppl 4):475–84.

    Article  PubMed  Google Scholar 

  • Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg. 1966a;112(3):337–47.

    Article  CAS  PubMed  Google Scholar 

  • Michels NA. Newer anatomy of the liver and its variantblood supply and collateral circulation. Am J Surg. 1966b;112:337–47.

    Article  CAS  PubMed  Google Scholar 

  • Miyayama S, Matsui O, Taki K, Minami T, Ryu Y, Ito C, et al. Arterial blood supply to the posterior aspect of segment IV of the liver from the caudate branch: demonstration at CT after iodized oil injection. Radiology. 2005;237:1110–1114.18.

    Article  PubMed  Google Scholar 

  • Miyazaki M, Ohtsuka M, Miyakawa S, et al. Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3(rd.) English edition. J Hepatobiliary Pancreat Sci. 2015;22(3):181–96.

    Article  PubMed  Google Scholar 

  • Moole H, Bechtold M, Puli SR. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review. World J Surg Oncol. 2016;14(1):182.

    Article  PubMed  PubMed Central  Google Scholar 

  • Neuhaus P, Jonas S, Bechstein WO, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230(6):808–18. discussion 819

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ni Q-h, Zhang Y-h, Chen W. Application of multi-slice spiral CT and three-dimensional reconstruction in diagnosis and treatment of hilar cholangiocarcinoma. J Hepatopancreatobiliary Surg. 2015;27(1):84–5.

    Google Scholar 

  • Ni Q, Wang H, Liang X, et al. Successful parenchyma-sparing anatomical surgery by 3-dimensional reconstruction of hilar cholangiocarcinoma combined with anatomic variation. J Coll Physicians Surg Pak. 2016;26(6 Suppl):S13–5.

    PubMed  Google Scholar 

  • Ni Q, Wang H, Zhang Y, et al. MDCT assessment of resectability in hilar cholangiocarcinoma. Abdom Radiol (NY). 2017;42(3):851–60.

    Article  Google Scholar 

  • Noie T, Sugawara Y, Imamura H, et al. Selective versus total drainage for biliary obstruction in the hepatic hilus: an experimental study. Surgery. 2001;130(1):74–81.

    Article  CAS  PubMed  Google Scholar 

  • Ohkubo M, Nagino M, Kamiya J, et al. Surgical anatomy of the bile ducts at the hepatic hilum as applied to living donor liver transplantation. Ann Surg. 2004;239(1):82–6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ozden I, Kamiya J, Nagino M, et al. Clinicoanatomical study on the infraportal bile ducts of segment 3. World J Surg. 2002;26(12):1441–5.

    Article  PubMed  Google Scholar 

  • Park HS, Lee JM, Choi JY, et al. Preoperative evaluation of bile duct cancer: MRI combined with MR cholangiopancreatography versus MDCT with direct cholangiography. AJR Am J Roentgenol. 2008;190(2):396–405.

    Article  PubMed  Google Scholar 

  • Rau HG, Schauer R, Helmberger T, et al. Impact of virtual reality imaging on hepatic liver tumor resection: calculation of risk. Langenbeck’s Arch Surg. 2000;385(3):162–70.

    Article  CAS  Google Scholar 

  • Sakamoto E, Nimura Y, Hayakawa N, et al. The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg. 1998;227(3):405–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Saluja SS, Nayeem M, Sharma BC, et al. Management of choledochal cysts and their complications. Am Surg. 2012;78(3):284–90.

    Article  PubMed  Google Scholar 

  • Schmidt SC, Langrehr JM, Hintze RE, et al. Long-term results and risk factors influencing outcome of major bile duct injuries following cholecystectomy. Br J Surg. 2005;92(1):76–82.

    Article  CAS  PubMed  Google Scholar 

  • Seyama Y, Kubota K, Sano K, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg. 2003;238(1):73–83.

    PubMed  PubMed Central  Google Scholar 

  • Shimizu H, Sawada S, Kimura F, et al. Clinical significance of biliary vascular anatomy of the right liver for hilar cholangiocarcinoma applied to left hemihepatectomy. Ann Surg. 2009;249(3):435–9.

    Article  PubMed  Google Scholar 

  • Shimizu H, Hosokawa I, Ohtsuka M, et al. Clinical significance of anatomical variant of the left hepatic artery for perihilar cholangiocarcinoma applied to right-sided hepatectomy. World J Surg. 2014;38(12):3210–4.

    Article  PubMed  Google Scholar 

  • Sinanan MN. Acute cholangitis. Infect Dis Clin N Am. 1992;6(3):571–99.

    Article  CAS  Google Scholar 

  • Soares KC, Kamel I, Cosgrove DP, et al. Hilar cholangiocarcinoma: diagnosis, treatment options, and management. Hepatobiliary Surg Nutr. 2014;3(1):18–34.

    PubMed  PubMed Central  Google Scholar 

  • Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995;180(1):101–25.

    CAS  PubMed  Google Scholar 

  • Takahashi Y, Nagino M, Nishio H, et al. Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma. Br J Surg. 2010;97(12):1860–6.

    Article  CAS  PubMed  Google Scholar 

  • Takeishi K, Shirabe K, Yoshida Y, et al. Correlation between portal vein anatomy and bile duct variation in 407 living liver donors. Am J Transplant. 2015;15(1):155–60.

    Article  CAS  PubMed  Google Scholar 

  • Takeshita N, Ota T, Yamamoto M. Forty-year experience with flow-diversion surgery for patients with congenital choledochal cysts with pancreaticobiliary maljunction at a single institution. Ann Surg. 2011;254(6):1050–3.

    Article  PubMed  Google Scholar 

  • Tao H-S. Application of 3D visualization technology in diagnosis and treatment of central liver cancer: Southern Medical University; 2016.

    Google Scholar 

  • Tirumani SH, Shanbhogue AK, Vikram R, et al. Imaging of the porta hepatis: spectrum of disease. Radiographics. 2014;34(1):73–92.

    Article  PubMed  Google Scholar 

  • Todani T, Watanabe Y, Narusue M, et al. Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg. 1977;134(2):263–9.

    Article  CAS  PubMed  Google Scholar 

  • Unno M, Okumoto T, Katayose Y, et al. Preoperative assessment of hilar cholangiocarcinoma by multidetector row computed tomography. J Hepato-Biliary-Pancreat Surg. 2007;14(5):434–40.

    Article  Google Scholar 

  • Varotti G, Gondolesi GE, Goldman J, et al. Anatomic variations in right liver living donors. J Am Coll Surg. 2004;198(4):577–82.

    Article  PubMed  Google Scholar 

  • Wang J. Diagnosis and treatment of complicated intrahepatic bile duct stones. Chin J Pract Surg. 2016;36(3):292–5.

    Google Scholar 

  • Wang J. Application of perihepatic portal surgery in reoperation of complex intrahepatic bile duct stones. J Hepatobiliary Surg. 2017a;25(3):161–3.

    CAS  Google Scholar 

  • Wang J. Treatment of restenosis after repair of high bile duct injury by peri hilar surgery. Chin J General Surg. 2017b;32(8)

    Google Scholar 

  • Wang J, Chen W. Application of bilioenterostomy in the treatment of hilar bile duct stricture. Chin J Pract Surg. 2014;34(10):921–4.

    CAS  Google Scholar 

  • Wang J, Chen W. Application of perihilar surgical techniques in biliary tract surgery. Chin J Digest Surg. 2015;14(4):284–7.

    CAS  Google Scholar 

  • Wang H, Wang J. Analysis of post-operative effect of 29 patients with iatrogenic bile duct injury. J Surg Concepts Pract. 2011;16(4):355–8.

    Google Scholar 

  • Wang L, Yu WF. Obstructive jaundice and perioperative management. Acta Anaesthesiol Taiwanica. 2014;52(1):22–9.

    Article  Google Scholar 

  • Wang S, He X, Li Z, Peng Z, Tam NL, Sun C, et al. Characterization of the middle hepatic artery and its relevance to living donor liver transplantation. Liver Transpl. 2010;16:736–41.

    PubMed  Google Scholar 

  • Weiglein AH. Variations and topography of the arteries in the lesser omentum in humans. Clin Anat. 1996;9(3):143–50.

    Article  CAS  PubMed  Google Scholar 

  • Wigmore SJ, Redhead DN, Yan XJ, et al. Virtual hepatic resection using three-dimensional reconstruction of helical computed tomography angioportograms. Ann Surg. 2001;233(2):221–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wu CC, Ho WL, Chen JT, et al. Mesohepatectomy for centrally located hepatocellular carcinoma: an appraisal of a rare procedure. J Am Coll Surg. 1999;188(5):508–15.

    Article  CAS  PubMed  Google Scholar 

  • Xiang CH, Dong JH. The basis of precisely surgical therapy for hilar cholangiocarcinoma-the imaging evaluation of advance degree of cancer before operation. Contemp Med. 2009;15(26):68–71.

    Google Scholar 

  • Yan J, Feng H, Wang H, et al. Hepatic artery classification based on three-dimensional CT. Br J Surg. 2020a;107(7):906–16. https://doi.org/10.1002/bjs.11458.

    Article  CAS  PubMed  Google Scholar 

  • Yan J, Feng H, Wang H, Yuan F, Yang C, Liang X, et al. Hepatic artery classification based on three-dimensional CT. Br J Surg. 2020b;107:906–16.

    Article  CAS  PubMed  Google Scholar 

  • Yoshioka Y, Ebata T, Yokoyama Y, et al. “Supraportal” right posterior hepatic artery: an anatomic trap in hepatobiliary and transplant surgery. World J Surg. 2011;35(6):1340–4.

    Article  PubMed  Google Scholar 

  • Yu WB, Rao A, Vu V, et al. Management of centrally located hepatocellular carcinoma: update 2016. World J Hepatol. 2017;9(13):627–34.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zhu XY, Fang CH, Bao SS, et al. Reconstruction of the liver based on 64-slice spiral CT scanning data[J]. J South Med Univ. 2008;28(3):345–7.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Wang, J., Yan, J., Fang, C. (2021). Application of 3D Visualization Technology in Perihilar Surgery. In: Fang, C., Lau, W.Y. (eds) Biliary Tract Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-33-6769-2_17

Download citation

  • DOI: https://doi.org/10.1007/978-981-33-6769-2_17

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-33-6768-5

  • Online ISBN: 978-981-33-6769-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics