PLANNING OF LIVER SURGERY USING 3-DIMENSIONAL IMAGING TECHNIQUES

In the simplified Couinaud classification, in which the liver is divid ed into eight segments, each supplied by a central vasculo-biliary she ath, little attention is given to the high prevalence of anatomical va riations which occur, especially in the right hemiliver. Using volumet ric acquisition techniques, such as magnetic resonance imaging or spir al computed tomography scanning, detailed insight into the individual segmental anatomy can now be obtained in a non-invasive manner. The si gnificance of this anatomical insight lies in the planning of anatomic al resections, whereby the relationship between tumour and individual segmental anatomy can be depicted in a three-dimensional format. As su ch, three dimensional (3D) liver imaging helps to design an individual ised resection, tailored to the topographical relationship between ind ividual segmental anatomy and tumour tissue present. Three dimensional liver imaging is of most practical value if a resection of one or mor e segments or sectors is considered, especially in the right hemiliver . In these cases, 3D liver imaging can demonstrate the precise locatio n of the scissuras to the surgeon pre-operatively.