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Liver tissue sparing resection using a novel planning tool

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Abstract

Purpose

Accurate preoperative prediction of liver function, volume, and vessel anatomy is essential in preventing postoperative liver failure, optimizing safety, and ensuring optimal outcome in patients undergoing hepatic surgery. We propose that preoperative resection planning provides useful anatomical and volumetric data, allowing for sparing of liver tissue in surgical resections. The purpose of the present study was to evaluate the use of a novel resection planning tool.

Methods

Thirteen patients undergoing hemihepatectomy were included. Preoperative resection planning was performed using the commercially available software Mint Liver. During resection planning, virtual resections were calculated based on Couinaud classification, Cantlie's line (standard), and individually by the operating surgeon (individual). Intraoperatively, volume and weight of the resected specimen were measured. A 14-day follow-up was conducted, and laboratory parameters were collected. Statistical analysis was performed, comparing virtual resection volumes (i.e., standard vs. individual) and secondarily virtual vs. actual resection volume.

Results

We found a significant difference (p = 0.001) in the comparison of standard vs. individual in all 13 cases, with an average 92.8 mL smaller resected volume, sparing 11.3% of liver parenchyma with virtual resection. No patients suffered from acute liver failure. Perioperative mortality was 0%.

Conclusion

Mint Liver is capable of acquiring exact anatomical and volumetric knowledge prior to hepatic resections. Liver parenchyma can be spared by preoperative assessment of the resection plan. We propose that this tool could be an important addition to preoperative patient evaluation, especially in complex liver surgery and living donor liver transplantation where precise volumetry is the decisive factor.

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Acknowledgements

The present study was conducted within the setting of Research Training Group 1126: Intelligent Surgery-Development of new computer-based methods for the future workplace in surgery, founded by the German Research Foundation.

Conflicts of interest

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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Frank Pianka, Bruno M. Schmied & Sascha A. Müller

  2. Division for Medical and Biological Informatics, German Cancer Research Center, Heidelberg, Germany

    Matthias Baumhauer, Daniel Stein & Hans-Peter Meinzer

  3. Department of Radiology, University of Heidelberg, Heidelberg, Germany

    Boris Radeleff

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  1. Frank Pianka
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  2. Matthias Baumhauer
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  7. Sascha A. Müller
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Correspondence to Bruno M. Schmied.

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Pianka, F., Baumhauer, M., Stein, D. et al. Liver tissue sparing resection using a novel planning tool. Langenbecks Arch Surg 396, 201–208 (2011). https://doi.org/10.1007/s00423-010-0734-y

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