Successful Duct-to-duct Biliary Reconstruction after Right Hemihepatectomy. Operative Planning Using Virtual 3D Reconstructed Images |
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Authors: | Itaru Endo Hiroshi Shimada Kazuhisa Takeda Yoshiro Fujii Kenichi Yoshida Daisuke Morioka Sugae Sadatoshi Shinji Togo Holger Bourquain Heinz O Peitgen |
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Institution: | (1) Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura Kanazawa-ku, Yokohama Japan, 236-0004;(2) MeVis, Bremen, Germany |
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Abstract: | Accurate knowledge of partial anatomy is essential in hepatic surgery but is difficult to acquire. We describe the potential
impact of a new technique for constructing three-dimensional virtual images of the portal vein, hepatic artery, and bile ducts
and present a representative case. An 80-year-old man was suspected of having papillary cholangiocarcinoma arising in S8 of
the liver and extending to the hepatic hilum intraluminaly. Right hemihepatectomy with bile duct resection was planned. However,
it was uncertain whether duct-to-duct biliary reconstruction would be possible based on the appearance of the confluence of
the right and left hepatic ducts on cholangiogram and conventional computed tomograph. Virtual three-dimensional images of
the liver were constructed and revealed vascular and biliary anatomy. They showed that the upper margin of bile duct excision
would be 19 mm from the umbilical point of the left portal vein, and that the site of the left branch of the caudate lobe
bile duct could be preserved. Based on this information, we performed a sphincter-preserving biliary operation safely without
complications. Planning complex biliary surgery may be improved by the use of virtual three-dimensional images of the liver.
This approach is especially useful in candidates for postoperative regional chemotherapy. |
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Keywords: | Liver resection 3D Duct-to-duct biliary reconstruction |
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