Current trends in three-dimensional visualization and real-time navigation as well as robot-assisted technologies in hepatobiliary surgery

Table 1 Three-dimensional visualization and robot-assisted surgery in recent years

	Surgical site	Sample size	Patient type of disease	Imaging systems	Incidence of complications (%)	Summary of technology	Ref.
3D visualization	Bile duct department	1	Extrahepatic cholangiocarcinoma combined with paracolic bile duct	Synapse Vincent	0	Accuracy and reliability	Miyamoto et al[15], 2014
	Hepatic portal	47	Type-III cholangiocarcinoma of the porta hepatis	MI-3DVS		Safety, effectiveness, and feasibility	Zeng et al[16], 2016
	Liver	120	Hepatocellular carcinoma, bile duct cancer, liver transplantation	Synapse Vincent	10.8	Time savings	Nakayama et al[13], 2017
	Pancreas	64	Pancreatic cancer, biliary tract cancer, neuroendocrine tumors, IPMN	Synapse Vincent	14	Safety, effectiveness, and feasibility	Miyamoto et al[100], 2018
	Pancreas	44	Pancreatic cancer	MVT		Safety, effectiveness, and feasibility	Lin et al[17], 2020
Robot-assisted	Major and minor liver resections	40	Hemangioma, HCC, hydatid cyst, cholangiocarcinoma	da Vinci Surgical System	12.5	Safety and feasibility	Troisi et al[37], 2013
	Major liver resection	25	Fatty liver, hepatic hemangioma, giant adenoma, HCC, secondary liver carcinoma	da Vinci Surgical System	9.3	Safety and feasibility	Spampinato et al[33], 2014
	Wedge resection of the liver	20	HCC, secondary liver carcinoma, hepatic hemangioma, liver stones	da Vinci Surgical System	9.5	Safety and feasibility	Felli et al[47], 2015
	Cholecystectomy	38	Benign biliary disease	da Vinci Surgical System	0	Safety and effectiveness	Gustafson et al[51], 2016
	Cholecystectomy	1833	Benign gallbladder disease	da Vinci Surgical System, Zeus system, AESPO	9.3	No superiority over laparoscopy	Han et al[101], 2018
	Major and minor liver resections	1312	Liver tumors	da Vinci Surgical System	17.8	No superiority over laparoscopy	Zhang et al[2], 2020

MVT: A three-dimensional multi-touch visualization table introduced by Sectra in 2010 at the Radiological Society of North America. IPMN: Intraductal papillary mucinous neoplasm; HCC: Hepatocellular carcinoma; 3D: Three-dimensional.

Table 2 Advantages and current limitations of existing three-dimensional printing

Advantages	Limitations
(1) Realistic spatially dissected views	(1) Time-consuming production
(2) Intuitive real-time navigation for rapid identification and location	(2) Rigid model with poor soft tissue compliance
(3) Improved surgical safety	(3) Fragility
(4) Less time consumed and fewer complications	(4) High cost
(5) Novel educational techniques	(5) Issues of specificity, safety, and sustainability of implantable 3D-printed products

3D: Three-dimensional.

Table 3 Comparison of optical and electromagnetic tracking navigation

Item	Optical tracking	Electromagnetic tracking
Tracking accuracy	High	Low
Robustness relative to environmental conditions	High	Low
Visible line of sight	Need for	No need for
Tracking of rigid objects	Suitable for	Unsuitable for
Electromagnetic field	No need for	Need for
Interference from magnetic field	Nothing	Notable
Common uses in the surgeries:
Neurosurgery	+
Orthopedic	+
Endoscopic abdominal		+

Table 4 Advantages and limitations of three-dimensional visualization, robot-assisted surgery, and electromagnetic tracking navigation

	Advantages	Limitations
3D visualization	Realistic spatially dissected views	Complex and time-consuming reconstruction process
	Accurate 3D preoperative images	Possible loss of raw data due to operational errors
	Possibility of complicated surgery	Distortion in reconstructed images
	Optimization of preoperative assessment	Poor accuracy of reconstructed images
	Time-saving simulation	Complex algorithms and imperfect display techniques
	Less time consumed and fewer complications	Registration of mutable organs
	Novel educational techniques	High cost
Robot-assisted	Better micro-invasiveness	Inefficient surgical resources
	Smaller equipment for wider scope	Lack of tactile feedback
	Larger and clearer 3D views	Limitations in the choice of anatomical methods
	Micro-invasiveness	Restrictions on the placement of casing needles
	Improved venous drainage	Time-consuming operation
	More accurate resolution and greater magnification	Prolonged Pringle operation in the hilar region
	Filtering of natural tremor	Potential bleeding tendency of the clamping and squeezing technique
	Better ergonomics of the operator	High cost
Electromagnetic tracking real-time navigation	No requirement for any other invasive operations	Magnetic field interference and tracking errors
	No line of sight restrictions	Low tracking accuracy and robustness relative to environmental conditions
	Real-time intraoperative tracking and navigation	Low stability of electromagnetic navigation system
	Display of intraoperative fine anatomy	High cost
	Improved safety of surgical operations	Registration of mutable organs
	Identification of lesions that are not visually detectable	Accuracy of navigation issues
	Simultaneous sharing of intraoperative information	Time-consuming reconstruction image overlay
	Increased hand-eye coordination for doctors	Low resolution and distortion of the reconstructed image
		Insufficient communication between technicians and surgeons
		Tedious operation

3D: Three-dimensional.