Perspectives of computer assisted resection planning and navigation for hepatic resections in the elderly
KeywordsLiver Resection Navigation System Surgical Planning Liver Surgery Major Liver Resection
Recent advances in image-based computer assistance in the last ten years allow computerized preoperative simulations, giving a lot of advantages in the preoperative surgical planning of resections1. Preoperative simulation represents the prerequisite for navigated liver surgery. The aim of this study is to describe elementary technical aspects of a navigated approach to liver resections showing the advantages of navigation-system especially in the elderly.
Materials and methods
The main advantages shown in old patients were: the possibility to extend major liver resections while calculating exactly the rest-volume of the liver, to give a more precise localization of vessels and biliary structures, to allow the recognition of anatomical variants, to drive multiple resection sparing as more parenchyma as possible avoiding re-resection. The navigation system seems to be very useful and applicable in old patients, reducing the risk of liver failure  and allowing us to also operate on a tumour no more to be localized after neoadjuvant chemotherapy .
The navigation system allowed us to exactly reproduce in the operatory theatre, on the patient, the previously computer-planned operation. In selected cases, this information may have a considerable influence on operative planning , especially with regard to the extent of resection or the need for vascular reconstruction. This seems to be particularly important in extended left hepatectomies or in repeat hepatectomy when intrahepatic vascular anatomy may be altered.
- 1.Lang H, Radtke A, Hindennach M, Schroeder T, Bourquain H, Schenk A, Oldhafer KJ, Prause G, Peitigen HO, Broelsch CE: Virtuelle hepatobiliare Chirurgie-computer-unterstutzte Resektionsplanung an der dreidimensional rekostruierten. Leber.Z.Gastroenterol. 2007, 45: 965-70. 10.1055/s-2007-963210.CrossRefGoogle Scholar
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