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| Navigated liver surgery: State of the art and future perspectives |
| Paschalis Gavriilidis a , ∗, Bjorn Edwin b , Egidijus Pelanis b , Ernest Hidalgo c , Nicola de’Angelis d , Riccardo Memeo e , Luca Aldrighetti f , Robert P Sutcliffe a |
a Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, B15 2TH, UK
b The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
c Department of Hepato-Pancreatico-Biliary Surgery and Transplantation, Hospital Universitari Vall d’Hebron, Barcelona, Spain
d Department of Digestive Surgery, University Hospital Henri Mondor (AP-HP), 94010 Créteil and University of Paris Est, Créteil, France
e Department of Hepatobiliary and Pancreatic Surgery, Miulli Hospital, Acquaviva delle Fonti, Bari 70021, Italy
f Division of Hepatobiliary Surgery, San Raffaele Hospital, Via Olgettina 60, Milan 20132, Italy
∗ Corresponding author.
E-mail address: pgavrielidis@yahoo.com (P. Gavriilidis).
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Abstract Background: In recent years, the development of digital imaging technology has had a significant influence in liver surgery. The ability to obtain a 3-dimensional (3D) visualization of the liver anatomy has provided surgery with virtual reality of simulation 3D computer models, 3D printing models and more recently holograms and augmented reality (when virtual reality knowledge is superimposed onto reality). In addition, the utilization of real-time fluorescent imaging techniques based on indocyanine green (ICG) uptake allows clinicians to precisely delineate the liver anatomy and/or tumors within the parenchyma, applying the knowledge obtained preoperatively through digital imaging. The combination of both has transformed the abstract thinking until now based on 2D imaging into a 3D preoperative conception (virtual reality), enhanced with real-time visualization of the fluorescent liver structures, effectively facilitating intraoperative navigated liver surgery (augmented reality).
Data sources: A literature search was performed from inception until January 2021 in MEDLINE (PubMed), Embase, Cochrane library and database for systematic reviews (CDSR), Google Scholar, and National Insti- tute for Health and Clinical Excellence (NICE) databases.
Results: Fifty-one pertinent articles were retrieved and included. The different types of digital imaging technologies and the real-time navigated liver surgery were estimated and compared.
Conclusions: ICG fluorescent imaging techniques can contribute essentially to the real-time definition of liver segments; as a result, precise hepatic resection can be guided by the presence of fluorescence. Furthermore, 3D models can help essentially to further advancing of precision in hepatic surgery by permitting estimation of liver volume and functional liver remnant, delineation of resection lines along the liver segments and evaluation of tumor margins. In liver transplantation and especially in living donor liver transplantation (LDLT), 3D printed models of the donor’s liver and models of the recipient’s hilar anatomy can contribute further to improving the results. In particular, pediatric LDLT abdominal cavity models can help to manage the largest challenge of this procedure, namely large-for-size syndrome.
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2022, Vol. 21 
