Ann Hepatobiliary Pancreat Surg.  2021 May;25(2):265-269. 10.14701/ahbps.2021.25.2.265.

Application of three-dimensional printing for intraoperative guidance during liver resection of a hepatocellular carcinoma with sophisticated location

• Rhu J
• Kim MS
• Kim S
• Choi GS
• Kim JM
• Joh JW

• KMID: 2516249
• DOI: http://doi.org/10.14701/ahbps.2021.25.2.265

Abstract

While 3D printing is adapted usefully in certain field of surgery, its application in liver surgery was limited. Here, we introduce our experience for using 3D printing for intraoperative guidance during liver resection in a case for HCC with an intrahepatic metastasis at a sophisticated location. A 50 years old male patient was diagnosed 4.7 cm-sized hepatocellular carcinoma located on segment 3 with and an intrahepatic metastasis located on segment 8 which was between right anterior portal vein, middle hepatic vein and right hepatic vein. Since radiofrequency ablation appeared to be inappropriate, surgical resection was planned. However, the patient had a cirrhotic liver and left liver was estimated to be 47% according to volume measurement. Therefore, we planned a two-step procedure by performing left hemihepatectomy preserving the middle hepatic vein and additionally removing the intrahepatic metastasis by tumorectomy. For better guidance, we made a 3D printed model tailored for using it as a guidance during operation, and the accuracy of 3D-printed model helped the surgical team perform a safe operation. The patient underwent adjuvant proton beam therapy on the site of tumorectomy and did not experience recurrence.

Keyword

Hepatocellular carcinoma; 3D printing; 3D printer

Figure

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  Fig. 1 Preoperative 3D modeling of the liver. (A) A 4.7 cm-sized hepatocellular carcinoma (arrowhead) was located on segment 3 and intrahepatic metastasis (arrow) located between the right anterior portal vein, middle hepatic vein and right hepatic vein. Preoperative magnetic resonance imaging shows (B) the main mass on segment 3 and (C) segment 8 right above right anterior portal vein.

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  Fig. 2 Three-dimensional print-ing of the model. (A) The re-gion of interest was set between the middle hepatic vein and 3 cm right side to the midline. (B) The liver parenchyma was removed to allow visualization of the inner vascular structure and intrahepatic metastasis. (C) The 3D model was edited (D) and printed using a 3D printer.

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  Fig. 3 Intraoperative finding during surgery. After left hemi-hepatectomy, (A) the 3D printed model was compared directly side by side as a guide. (B) After dissecting the liver parenchyma between the right anterior glisso-nean pedicle and middle hepa-tic vein, intrahepatic metastasis (arrow) was identified. (C) The 3D model was compared to the actual field with the intrahepa-tic metastasis exposed. (D) The intrahepatic metastasis was re-moved and (E) the main mass was removed with the left hemi-liver with a 3 cm margin.

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