Zhao D, Zhang KJ, Fang TS, Yan X, Jin X, Liang ZM, Tang JX, Xie LJ. Topological approach of liver segmentation based on 3D visualization technology in surgical planning for split liver transplantation. World J Gastrointest Surg 2022; 14(10): 1141-1149 [PMID: 36386399 DOI: 10.4240/wjgs.v14.i10.1141]
Corresponding Author of This Article
Dong Zhao, MD, Professor, Department of Liver Surgery and Organ Transplantation Center, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, No. 29 Bulan Road, Longgang District, Shenzhen 518000, Guangdong Province, China. zdong1233@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dong Zhao, Kang-Jun Zhang, Tai-Shi Fang, Xu Yan, Xin Jin, Zi-Ming Liang, Jian-Xin Tang, Lin-Jie Xie, Department of Liver Surgery and Organ Transplantation Center, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, Shenzhen 518000, Guangdong Province, China
Author contributions: Zhao D conceived and designed, and made contributions to administrative support; Zhang KJ, Fang TS and Tang JX made contributions to providing research materials or patients; Liang ZM, Yan X, Jin X and Xie LJ collected and compiled data; Zhao D, Zhang KJ and Fang TS conducted data analysis and interpretation; All authors wrote the manuscript and contributed to the final approval of manuscript.
Supported byThe Third People's Hospital of Shenzhen Scientific Research Project, No. G2021008 and No. G2022008; Shenzhen Key Medical Discipline Construction Fund, No. SZXK079; Shenzhen Science and Technology Research and Development Fund, No. JCYJ20190809165813331 and No. JCYJ20210324131809027.
Institutional review board statement: The study was reviewed and approved by the Third People's Hospital of Shenzhen Institutional Review Board (Approval No. 2022-133).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong Zhao, MD, Professor, Department of Liver Surgery and Organ Transplantation Center, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, No. 29 Bulan Road, Longgang District, Shenzhen 518000, Guangdong Province, China. zdong1233@126.com
Received: August 23, 2022 Peer-review started: August 23, 2022 First decision: September 26, 2022 Revised: September 28, 2022 Accepted: October 17, 2022 Article in press: October 17, 2022 Published online: October 27, 2022 Processing time: 63 Days and 3.1 Hours
ARTICLE HIGHLIGHTS
Research background
Split liver transplantation (SLT) is complex, and the commonly used surgical technique is the left-lateral segment and right tri-segment splits, which is implemented based on Couinaud liver segmentation. The right tri-segment liver surface may have different degrees of ischemic changes after SLT, which was related to the destruction of the local portal vein blood flow topology.
Research motivation
To our best knowledge, opinions diverge on the management of ischemia in surface tissues of the liver segment following SLT and there was no a consensus of pre-operative evaluation and predictive strategy for hepatic segmental necrosis after SLT worldwide.
Research objectives
Herein, we sought to investigate the application of the topological approach of liver segmentation based on 3D visualization technology in the surgical planning of SLT.
Research methods
A retrospective analysis was performed on 10 recipients and 5 donors who underwent SLT from January 2020 to January 2021. All the donor livers were subjected to 3D modeling and evaluation before surgery, based on which the liver splitting procedure was simulated by the Couinaud liver segmentation and blood flow topology liver segmentation (BFTLS) methods respectively, and the volume of the liver was calculated. Clinical data were analyzed, including the hepatic vasculature and expected volume of split grafts evaluated by 3D models, the actual liver volume, and the ischemia state of hepatic section in actual surgery.
Research results
The donor liver was split into a left-lateral segment and right tri-segment in 4 cases, while 1 case was split by left and right half liver splitting. According to Couinaud liver segmentation and BFTLS methods, the volume of the left lateral segment was 359.00 ± 101.57 mL and 367.75 ± 99.73 mL, respectively. The volume of segment IV (the portion of ischemic liver lobes) allocated to the right tri-segment was 136.31 ± 86.10 mL as determined using the topological approach to liver segmentation. Yet, during the actual operations, ischemia of the right tri-segment section was observed in 4 cases, including 1 case of necrosis of the surfaces cut and bile leakage.
Research conclusions
The application of the topological approach of liver segmentation based on 3D visualization technology may be useful to predict the range of ischemia in the liver section and provide a basis for determining whether the ischemic liver tissue should be removed during the surgery.
Research perspectives
However, the follow-up studies with large samples are still warranted due to the relatively small number of cases.
