Abstract
Background
Liver volumetry is a critical component of safe hepatic surgery, in order to minimize the risk of postoperative liver failure. Liver volumes can be calculated routinely using the time-consuming gold standard method of manual volumetry. The current work sought to evaluate an alternative automatic technique based on a novel 3D virtual planning software, and to compare it to the manual technique.
Methods
A prospective study of patients undergoing liver resection was conducted. Every patient had a pre and 2-day postoperative CT-scan. For each patient, total, remnant and resected volumes were calculated manually and automatically. Planes of resection were verified by a hepatobiliary surgeon and compared with postoperative volumes. Paired t-tests and correlation coefficients were calculated.
Results
A major hepatectomy was carried out in 36/43 patients. The automatic TLV (1,759 mL) and the manual TLV (1,832 mL) were significantly different (p < 0.001), but extremely highly correlated (r = 0.989). The percentages of preoperative RLV (manual 58.5 %, automatic 58.9 %) were similar, with an excellent correlation of 0.917. The preoperative RLV were matched with the 2-day postoperative RLV showing a significant difference (p = 0.0301). The resected volumes using both techniques (871 and 832 mL) were compared with the resected specimen volume (670 mL), showing a significant difference (p < 0.001) but a high degree of correlation (r = 0.874).
Conclusion
The 3D virtual surgical planning software is accurate and reliable in determining the total liver and future remnant liver volumes. This technique demonstrates a good correlation with the manual technique. Future work will be required to confirm these findings and to evaluate the clinical value of the three-dimensional planning platform.
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Acknowledgments
This project was co-funded by the IRCAD and the European Community in the scope of the FP7 PASSPORT Project.
Disclosures
G Martel and the HPB and Liver Transplantation Unit, CHUM St-Luc, University of Montreal, are supported in part by a clinical and research bursary from Covidien Canada. R Lapointe has received honoraria from Sanofi Canada, Roche Canada, and BMS Canada; has received institution grants from Sanofi Canada, and Roche Canada. A Bégin, A Belblidia, and F Vandenbroucke-Menu have no conflicts of interest or financial ties to disclose. L Lepanto, L Soler, D Mutter, J Marescaux have no conflicts of interest or financial ties to disclose.
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Bégin, A., Martel, G., Lapointe, R. et al. Accuracy of preoperative automatic measurement of the liver volume by CT-scan combined to a 3D virtual surgical planning software (3DVSP). Surg Endosc 28, 3408–3412 (2014). https://doi.org/10.1007/s00464-014-3611-x
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DOI: https://doi.org/10.1007/s00464-014-3611-x