Computer-based Surgery Planning for Living Liver Donation

The aim of this project is computer-based planning of a partial organ resection for three dimensional visualisation of anatomical structures and volumetric estimations. Using quantitative parameters for the estimation of the operation risk, the selection of patients can be further objectified. Another important effect of this project is support for surgical interventions by predefinition of different operation scenarios. All preoperative analysis results are based on tomographic images acquired during the clinical routine. In the end, the integration of planning results into the operation theater as well as into the clinical workflow is part of this project. Surgical strategy is determined by the exact location of the tumor, the respective donor liver part, and the proximity of supporting and draining vessels. Depending on the acquired images, the portal, hepatic, arterial and biliary systems may be analyzed. Therefore, fundamentals for the qualitative and quantitative analysis of images have been developed and implemented since the beginning of the project. The qualitative aspects are, e.g., the three dimensional visualisation of vessel structures, tumors, the security margin and the organ itself. These were evaluated for use in the clinical routine. Preoperatively, the operation strategy is planned by segmenting the important anatomical structures and defining the different vessel systems using a special operation planning software. The visualisation and volumetric results can be visualised and adapted during surgical intervention with the help of a beamer and a touchscreen monitor installed above the patient. In living donor liver transplantation (LDLT) the most important factor is to ensure that the anatomy of the donor patient allows surgical splitting of the liver. Also, a volumetric analysis of the donor liver is of interest to achieving less complicated surgery. Actually, all LDLTs performed in our Surgical Clinic are supported by this operation planning system.