BACKGROUND: Liver surgery has gone through the phases of wedge liver resection, regular resection of hepatic lobes, irregular and local resection, extracorporeal hepatectomy, hemi-extracorporeal hepatectomy and Da Vin...BACKGROUND: Liver surgery has gone through the phases of wedge liver resection, regular resection of hepatic lobes, irregular and local resection, extracorporeal hepatectomy, hemi-extracorporeal hepatectomy and Da Vinci surgical system-assisted hepatectomy. Taking advantage of modern technologies, liver surgery is stepping into an age of precise liver resection. This review aimed to analyze the comprehensive application of modern technologies in precise liver resection. DATA SOURCE: PubMed search was carried out for English-language articles relevant to precise liver resection, liver anatomy, hepatic blood inflow blockage, parenchyma transection, and down-staging treatment. RESULTS: The 3D image system can imitate the liver operation procedures, conduct risk assessment, help to identify the operation feasibility and confirm the operation scheme. In addition, some techniques including puncture and injection of methylene blue into the target Glisson sheath help to precisely determine the resection. Alternative methods such as Pringle maneuver are helpful for hepatic blood inflow blockage in precise liver resection. Moreover, the use of exquisite equipment for liver parenchyma transection, such as cavitron ultrasonic surgical aspirator, ultrasonic scalpel, Ligasure and Tissue Link is also helpful to reduce hemorrhage in liver resection, or even operate exsanguinous liver resection without blocking hepatic blood flow. Furthermore, various down-staging therapies including transcatheter arterial chemoembolization and radio-frequency ablation were appropriate for unresectable cancer, which reverse the advanced tumor back to early phase by local or systemic treatment so that hepatectomy or liver transplantation is possible.CONCLUSIONS: Modern technologies mentioned in this paper are the key tool for achieving precise liver resection and can effectively lead to maximum preservation of anatomical structural integrity and functions of the remnant liver. In addition, large randomized trials are needed to evaluate the usefulness of these technologies in patients with hepatocellular carcinoma who have undergone precise liver resection.展开更多
Precision liver surgery has advanced significantly with the improvements of technology,and led to a significant decrease in mortality and complication rates.We argued for the necessity of a paradigm shift in liver sur...Precision liver surgery has advanced significantly with the improvements of technology,and led to a significant decrease in mortality and complication rates.We argued for the necessity of a paradigm shift in liver surgery,and advocated“precision liver resection”as a surgical concept for the first time in 2006.The aim of precision liver surgery involves personalized surgery planning based on individual patient status.The core of the precision liver surgery is to be visualizable,quantifiable,and controllable also known as three essential elements.Since precision paradigm is essential in modern surgery,characterized by multi-objective optimization accommodating therapeutic effectiveness,surgical safety,and minimal invasiveness,it had expanded to different surgery,such as neurosurgery and gastrointestinal surgery.Techniques such as three-dimensional(3D)reconstruction,intraoperative navigation systems,and indocyanine green(ICG)fluorescence imaging facilitate precise identification and removal of liver tumors while preserving healthy liver tissue.These advancements not only promote the certainty,predictability,and controllability in surgical practice,and achieve the balance of these three essential elements.As technological progress continues,precision liver surgery holds the promise of safer and more effective treatments.Precision medicine aims to balance operative risk against survival benefit by removing targeted lesions,protecting liver function,minimizing surgical trauma.The ultimate aim of precision medicine is the maximization of patient benefit(Fig.1).展开更多
The liver contains a complex structure of blood vessels and bile ducts,and the vascular structure is highly variable.The anatomical segmentation of the liver is still controversial,and the Couinaud segmentation method...The liver contains a complex structure of blood vessels and bile ducts,and the vascular structure is highly variable.The anatomical segmentation of the liver is still controversial,and the Couinaud segmentation method based on the portal vein is more widely used in clinical practice.The treatment of liver tumors and other lesions is closely related to the liver anatomy.The mechanism of liver tumor invasion and metastasis is complex,and it is currently believed that tumor invasion mainly spreads along the portal vein.Anatomic liver resection is an important surgical method for liver diseases,especially liver tumors.This article reviews the vascular structure of the liver,the development of anatomical hepatectomy,blood flow control,surgical planning,intraoperative navigation,minimally invasive surgery,and precise hepatectomy.Anatomic liver resection is a part of precision liver surgery,which is becoming increasingly more precise in terms of surgical evaluation,surgical planning,and surgical operation.New technologies will facilitate precision surgery with less trauma and greater benefits for patients.With the development and advancement of technology,image-based surgical planning and intraoperative surgical navigation will become more widely used in precision liver surgery.展开更多
基金supported by grants from the National Natural Science Foundation of China (81172095, 81171135 and 81200324)Bureau of Health Medical Scientific Research Foundation of Hainan Province (Qiongwei 2012 PT-70)China Postdoctoral Science Foundation funded project (2012m521875)
文摘BACKGROUND: Liver surgery has gone through the phases of wedge liver resection, regular resection of hepatic lobes, irregular and local resection, extracorporeal hepatectomy, hemi-extracorporeal hepatectomy and Da Vinci surgical system-assisted hepatectomy. Taking advantage of modern technologies, liver surgery is stepping into an age of precise liver resection. This review aimed to analyze the comprehensive application of modern technologies in precise liver resection. DATA SOURCE: PubMed search was carried out for English-language articles relevant to precise liver resection, liver anatomy, hepatic blood inflow blockage, parenchyma transection, and down-staging treatment. RESULTS: The 3D image system can imitate the liver operation procedures, conduct risk assessment, help to identify the operation feasibility and confirm the operation scheme. In addition, some techniques including puncture and injection of methylene blue into the target Glisson sheath help to precisely determine the resection. Alternative methods such as Pringle maneuver are helpful for hepatic blood inflow blockage in precise liver resection. Moreover, the use of exquisite equipment for liver parenchyma transection, such as cavitron ultrasonic surgical aspirator, ultrasonic scalpel, Ligasure and Tissue Link is also helpful to reduce hemorrhage in liver resection, or even operate exsanguinous liver resection without blocking hepatic blood flow. Furthermore, various down-staging therapies including transcatheter arterial chemoembolization and radio-frequency ablation were appropriate for unresectable cancer, which reverse the advanced tumor back to early phase by local or systemic treatment so that hepatectomy or liver transplantation is possible.CONCLUSIONS: Modern technologies mentioned in this paper are the key tool for achieving precise liver resection and can effectively lead to maximum preservation of anatomical structural integrity and functions of the remnant liver. In addition, large randomized trials are needed to evaluate the usefulness of these technologies in patients with hepatocellular carcinoma who have undergone precise liver resection.
基金supported by the Beijing Research Ward Excellence Program,BRWEP(BRWEP2024W032240108 for Wang S)National Natural Science Foundation of China(No.81972726 and 82273074 for Yang T+2 种基金No.81930119,No.82090050,and No.82090053 for Dong J)Shanghai Health and Hygiene Discipline Leader Project(No.2022XD001 for Yang T)Shanghai Outstanding Academic Leader Program(No.23XD1424900 for Yang T).
文摘Precision liver surgery has advanced significantly with the improvements of technology,and led to a significant decrease in mortality and complication rates.We argued for the necessity of a paradigm shift in liver surgery,and advocated“precision liver resection”as a surgical concept for the first time in 2006.The aim of precision liver surgery involves personalized surgery planning based on individual patient status.The core of the precision liver surgery is to be visualizable,quantifiable,and controllable also known as three essential elements.Since precision paradigm is essential in modern surgery,characterized by multi-objective optimization accommodating therapeutic effectiveness,surgical safety,and minimal invasiveness,it had expanded to different surgery,such as neurosurgery and gastrointestinal surgery.Techniques such as three-dimensional(3D)reconstruction,intraoperative navigation systems,and indocyanine green(ICG)fluorescence imaging facilitate precise identification and removal of liver tumors while preserving healthy liver tissue.These advancements not only promote the certainty,predictability,and controllability in surgical practice,and achieve the balance of these three essential elements.As technological progress continues,precision liver surgery holds the promise of safer and more effective treatments.Precision medicine aims to balance operative risk against survival benefit by removing targeted lesions,protecting liver function,minimizing surgical trauma.The ultimate aim of precision medicine is the maximization of patient benefit(Fig.1).
基金supported by the National Natural Science Foundation of China(grant numbers:82090052,82090050,81930119)the CAMS Innovation Fund for Medical Sciences(grant number:2019-I2M-5-056).
文摘The liver contains a complex structure of blood vessels and bile ducts,and the vascular structure is highly variable.The anatomical segmentation of the liver is still controversial,and the Couinaud segmentation method based on the portal vein is more widely used in clinical practice.The treatment of liver tumors and other lesions is closely related to the liver anatomy.The mechanism of liver tumor invasion and metastasis is complex,and it is currently believed that tumor invasion mainly spreads along the portal vein.Anatomic liver resection is an important surgical method for liver diseases,especially liver tumors.This article reviews the vascular structure of the liver,the development of anatomical hepatectomy,blood flow control,surgical planning,intraoperative navigation,minimally invasive surgery,and precise hepatectomy.Anatomic liver resection is a part of precision liver surgery,which is becoming increasingly more precise in terms of surgical evaluation,surgical planning,and surgical operation.New technologies will facilitate precision surgery with less trauma and greater benefits for patients.With the development and advancement of technology,image-based surgical planning and intraoperative surgical navigation will become more widely used in precision liver surgery.
