Published online Oct 27, 2022. doi: 10.4240/wjgs.v14.i10.1141
Peer-review started: August 23, 2022
First decision: September 26, 2022
Revised: September 28, 2022
Accepted: October 17, 2022
Article in press: October 17, 2022
Published online: October 27, 2022
Split liver transplantation (SLT) is complex, and the commonly used surgical technique is the left-lateral segment and right tri-segment splits, which is implemented based on Couinaud liver segmentation. The right tri-segment liver surface may have different degrees of ischemic changes after SLT, which was related to the destruction of the local portal vein blood flow topology.
To our best knowledge, opinions diverge on the management of ischemia in surface tissues of the liver segment following SLT and there was no a consensus of pre-operative evaluation and predictive strategy for hepatic segmental necrosis after SLT worldwide.
Herein, we sought to investigate the application of the topological approach of liver segmentation based on 3D visualization technology in the surgical planning of SLT.
A retrospective analysis was performed on 10 recipients and 5 donors who underwent SLT from January 2020 to January 2021. All the donor livers were subjected to 3D modeling and evaluation before surgery, based on which the liver splitting procedure was simulated by the Couinaud liver segmentation and blood flow topology liver segmentation (BFTLS) methods respectively, and the volume of the liver was calculated. Clinical data were analyzed, including the hepatic vasculature and expected volume of split grafts evaluated by 3D models, the actual liver volume, and the ischemia state of hepatic section in actual surgery.
The donor liver was split into a left-lateral segment and right tri-segment in 4 cases, while 1 case was split by left and right half liver splitting. According to Couinaud liver segmentation and BFTLS methods, the volume of the left lateral segment was 359.00 ± 101.57 mL and 367.75 ± 99.73 mL, respectively. The volume of segment IV (the portion of ischemic liver lobes) allocated to the right tri-segment was 136.31 ± 86.10 mL as determined using the topological approach to liver segmentation. Yet, during the actual operations, ischemia of the right tri-segment section was observed in 4 cases, including 1 case of necrosis of the surfaces cut and bile leakage.
The application of the topological approach of liver segmentation based on 3D visualization technology may be useful to predict the range of ischemia in the liver section and provide a basis for determining whether the ischemic liver tissue should be removed during the surgery.
However, the follow-up studies with large samples are still warranted due to the relatively small number of cases.