Chinese expert consensus on laparoscopic hepatic segmentectomy and subsegmentectomy navigated by augmented-and mixed-reality technology combined with indocyanine green fluorescence imaging

Augmented-and mixed-reality technologies have pioneered the realization of real-time fusion and interactive projection for laparoscopic surgeries.Indocyanine green fluorescence imaging technology has enabled anatomical,functional,and radical hepatectomy through tumor identification and localization of target hepatic segments,driving a transformative shift in themanagement of hepatic surgical diseases,moving away from traditional,empirical diagnostic and treatment approaches toward digital,intelligent ones.The Hepatic Surgery Group of the Surgery Branch of the Chinese Medical Association,Digital Medicine Branch of the Chinese Medical Association,Digital Intelligent Surgery Committee of the Chinese Society of ResearchHospitals,and Liver Cancer Committee of the Chinese Medical Doctor Association organized the relevant experts in China to formulate this consensus.This consensus provides a comprehensive outline of the principles,advantages,processes,and key considerations associated with the application of augmented reality and mixed-reality technology combined with indocyanine green fluorescence imaging technology for hepatic segmental and subsegmental resection.The purpose is to streamline and standardize the application of these technologies.

Value of a virtual hepatic segment model in assisting in the ultrasonic localization of intrahepatic lesions

Background During scanning of the right hypochondrium and right intercostal regions with an ultrasonic transducer,several ultrasonic images of oblique sections are obtained.It is still a challenge for ultrasonography to divide these nonconventional sections into an accurate hepatic segmentation pattern.The aim of this research was to investigate the value of the virtual hepatic segment model （VHSM） in assisting the ultrasonic localization of space-occupying hepatic lesions.Methods VHSM was constructed via 3D reconstruction according to the first Chinese visible human dataset.Preoperative ultrasonography,contrast-enhanced CT scan and VHSM techniques were performed in 100 patients with spaceoccupying focal lesions in the liver parenchyma for segmental localization.The results of these three techniques were compared with the operative findings.Results VHSM was successfully detected on 2D sectional images by 3D reconstruction through surface rendering and volume rendering.The model could simulate ultrasonic directions to conduct a virtual dissection on any section plane,and fine liver segmentation could be displayed in any virtual plane.In 100 patients,there were 112 liver space-occupying focal lesions distributed in 148 liver segmentations.Regarding the positioning accuracies for lesions of different sizes and the lesion segmental distribution accuracies estimated using the three methods mentioned above,ultrasonography exhibited a significantly lower accuracy than VHSM for the segmental localization of lesions （P ＜0.05）,and contrast-enhanced CT was not significantly different from ultrasonography plus VHSM （P ＞0.05）.Conclusion VHSM increased the accuracy of ultrasonic localization of space-occupying hepatic lesions,particularly in hepatic hypovascular regions.

Segmental Embolization by Ethanol Iodized Oil Emulsion for Hepatocellular Carcinoma

The hemodynamic changes of portal vein before and after intra arterial infusion of ethanol iodized oil emulsion (EIOE) were studied in 4 healthy dogs. Segmental transcatheter arterial embolization (TAE) using EIOE was performed in 55 patients with hepatocellular carcinoma (HCC). Twenty patients subsequently underwent surgery. It was concluded that segmental TAE might lead to double embolization of both hepatic arteries and portal veins. It is a more effective therapeutic method for HCC localized in one or a few segments, as compared with conventional TAE.