The impact of 3-dimensional reconstructions on operation planning in liversurgery

Background: Operation planning in liver surgery depends on the precise unde rstanding of the 3-dimensional (D) relation of the tumor to the intrahepati c vascular trees. To our knowledge, the impact of anatomical 3-D reconstruc tions on precision in operation planning has not yet been studied. Hypothesis: Three-dimensional reconstruction leads to an improvement of the ability to localize the tumor and an increased precision in operation plan ning in liver surgery. Design: We developed a new interactive computer-based quantitative 3-D oper ation planning system for liver surgery, which is being introduced to the c linical routine. To evaluate whether 3-D reconstruction leads to improved o peration planning, we conducted a clinical trial. The data sets of 7 virtua l patients were presented to a total of 81 surgeons in different levels of training. The tumors had to be assigned to a liver segment and subsequently drawn together with the operation proposal into a given liver model. The p recision of the assignment to a liver segment according to Couinaud classif ication and the operation proposal were measured quantitatively for each su rgeon and stratified concerning 2-D and different types of 3-D presentation s. Results: The ability of correct tumor assignment to a liver segment was sig nificantly correlated to the level of training (P<.05). Compared with 2-D c omputed tomography scans, 3-D reconstruction leads to a significant increas e of precision in turner localization by 37%. The target area of the resect ion proposal was improved by up to 31%. Conclusion: Three-dimensional reconstruction leads to a significant improve ment of tumor localization ability and to an increased precision of operati on planning in liver surgery.