Role of 3D reconstructive imaging

Abstract

Since its introduction to hepatobiliary surgery, three-dimensional (3D) imaging has assumed a growing importance for the visualization of abdominal diseases. The main clinical applications include preoperative simulation for oncologic liver resection [1, 2], and living-donor liver transplantation [3, 4]. The advantages of 3D imaging are the exact visualization of vessels in areas with complex and variable vascular anatomy, determining possible resection margins, and predicting operative risks. Although hepatectomy is increasingly carried out, it is still one of the most difficult operative procedures because of the anatomical complexity and hepatic vascular variability [5]. Moreover, patients with hilar cholangiocarcinoma often have obstructive jaundice, and the impaired hepatic function restricts the volume of liver resection. In addition, a positive resection margin should be avoided in order to achieve a potential cure of the disease. Thus, exact preoperative information on the detailed topography and precise liver resection volume should be obtained for curative and harmless hepatectomy. Concerning hilar cholangiocarcinoma, a successful management requires the following three steps: accurate preoperative estimation of both the tumor extent and anatomical variations, appropriate planning and simulation of the operative procedures, and implementing the planned procedures securely [6-8].