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World J Gastrointest Surg. Jan 27, 2019; 11(1): 1-10
Published online Jan 27, 2019. doi: 10.4240/wjgs.v11.i1.1
Up-to-date intraoperative computer assisted solutions for liver surgery
Apollon Zygomalas, Ioannis Kehagias
Apollon Zygomalas, Surgical Oncology, OLYMPION General Clinic of Patras, Patras 26442, Greece
Ioannis Kehagias, Department of Surgery, University Hospital of Patras, Patras 26500, Greece
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other co-authors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Apollon Zygomalas, MD, MSc, PhD, FACS, Surgeon, Surgical Oncology, OLYMPION General Clinic of Patras, Volou and Meilichou, Patras 26443, Greece. azygomalas@upatras.gr
Telephone: +30-2610-464100 Fax: +30-2610-464115
Received: August 29, 2018
Peer-review started: August 29, 2018
First decision: October 1, 2018
Revised: December 12, 2018
Accepted: December 29, 2018
Article in press: December 30, 2018
Published online: January 27, 2019
Processing time: 151 Days and 12.4 Hours
Abstract

Computer assisted surgical planning allowed for a better selection of patients, evaluation of operative strategy, appropriate volumetric measurements, identification of anatomical risks, definition of tumour resection margins and choice of surgical approach in liver oncologic resections and living donor liver transplantations. Although preoperative computer surgical analysis has been widely used in daily clinical practice, intraoperative computer assisted solutions for risk analysis and navigation in liver surgery are not widely available or still under clinical evaluation. Computer science technology can efficiently assist modern surgeons during complex liver operations, mainly by providing image guidance with individualized 2D images and 3D models of the various anatomical and pathological structures of interest. Intraoperative computer assisted liver surgery is particularly useful in complex parenchyma-sparing hepatectomies, for intraoperative risk analysis and for the effective treatment of colorectal metastases after neoadjuvant therapy or when they are multiple. In laparoscopic liver surgery, intraoperative computer aid is definitively more important as, apart from a restricted field of view, there is also loss of the fine haptic feedback. Intraoperative computer assisted developments face challenges that prevent their application in daily clinical practice. There is a vast variety of studies regarding intraoperative computer assisted liver surgery but there are no clear objective measurements in order to compare them and select the most effective solutions. An overview of up-to-date intraoperative computer assisted solutions for liver surgery will be discussed.

Keywords: Computer assisted surgery; Liver; Intraoperative; 3D models; Navigation; Image guidance; Augmented reality; Hepatic surgery; Hepatectomy

Core tip: Intraoperative computer assisted liver surgery is useful in complex parenchyma-sparing hepatectomies, for intraoperative risk analysis and for the treatment of colorectal metastases after neoadjuvant therapy or when they are multiple. In laparoscopic liver surgery, intraoperative computer aid is more important as, apart from a restricted field of view, there is also loss of the fine haptic feedback. Intraoperative computer assisted developments face challenges that prevent their application in daily clinical practice. There is a variety of studies regarding intraoperative computer assisted liver surgery but there are no clear objective measurements to compare them and select the most effective solutions.