Liver Surgery Planning

Operation planning that has taken place preoperatively is also available to the surgeon intraoperatively. Adapted views of the individual patient's anatomy can be displayed on a monitor during the operation. | © dkfz.de

In cases of orthopedic surgery and neurosurgery involving rigid anatomical structures, computer-assisted systems have become an integral part of preoperative planning and play a central role during the surgery. In visceral surgery, computer-assisted surgical planning systems have hardly made inroads into clinical routine up to now due to the enormous anatomical variation among patients as well as the exceptional technical challenges to imaging and image analysis.

This project involves the development of techniques for suitably processing the information contained in two-dimensional radiological tomographic images for the purpose of producing a three-dimensional representation. This additionally makes available to the radiologist and surgeon important quantitative information such as the volume of organs and tumors, measurements that rarely exist in clinical routine. The focus in this case is on the planning of liver tumor resections, of living donor liver transplantations and of pancreas tumor resections.

Three-dimensional reconstruction of an individual liver. The blood supply through the portal vein (light blue), the hepatic veins (dark blue), arteries (red), gall bladder (green) and three tumors (red), including safety margins (yellow), are shown. | © dkfz.de

Preoperatively performed planning entails the representation of tumor localization in the context of the surrounding vascular systems. Image data derived from various examination techniques or points in time can be merged, thus enabling a combined representation of veins, arteries and bile ducts. Resection proposals, calculated based on the location of tumors relative to vessels, approximate the supply or drainage areas of the vessels to be severed. The remaining organ volumes that result are an important indicator for determining the patient's operability.

These new techniques entail numerous advantages for surgeons. Most importantly, the resulting new information improves operation planning while facilitating surgery itself. In the final instance, this means for patients a high likelihood of a safer operation.

Project manager