Modelling and 3D printing for complex liver surgery
Dr. Miguel Ángel Ciavarelli, Dr. Ignacio Ciavarelli & Dr. M. Ciavarelli
Hospital Eva Perón - San Martín, Argentina
✔ Clearly defining metastatic foci
✔ Reducing surgical complications
✔ Avoid unnecessary vascular or biliary lesions
✔ Direct and decide on oncological treatment with greater precision
A 47-year-old male patient presented with intestinal obstruction. A CT scan revealed the presence of a tumour in the terminal ileum, regional adenopathies and bilobar liver metastases.
The patient underwent emergency right hemicolectomy and resection of the terminal ileum. Pathological anatomy gave a diagnosis corresponding to neuroendocrine tumours.
In relation to the liver metastases, MRI and PET-Gallium were requested to evaluate the locoregional and distant disease. The studies showed metastatic lesions in segments II, III, IVb, V, VI and VII. The case was presented to the committee of the oncological and hepato-bilio-pancreatic surgery sector and it was decided to treat them surgically.
3D anatomical model
◾ FDM techonology - Material: PLA
◾ Resolution: 0.2 mm - Finish: Multiple colors
Surgical plan design and results
The surgical strategy was to perform liver surgery in two stages:
Left lobe metastasectomies and embolisation of the right branch of the portal vein, aiming for lobe hypertrophy. All procedures were performed without complications.
To be defined after the results of the first stage.
45 days after surgery new MRI and CT images were acquired. From these, a digital 3D model was created and 3D printed.
The 3D models made it possible to clearly see both the diagnosed anomalies and the anatomical changes in the patient after the first stage of surgery:
They showed an anti-clockwise rotation of the biliary pedicle.
Decreased size of the metastatic lesions in the right lobe, with mild hypotrophy of the right lobe.
Large hypertrophy of the left lobe, with total absence of portal flow from the embolised lobe, showing the effectiveness of the first stage of the procedure.
Hepatic artery with its branches in good condition.
Volume of the left lobe: 176cm3, without the presence of new metastases or hypertrophied remnant metastases.
With all this information, the biomodels helped the surgical team to direct and decide the oncological treatment with greater precision.
"Their usefulness far exceeded our expectations. It allowed us to create a three-dimensional image of the liver, to see the anatomical changes to elaborate the future surgical therapeutic strategy and to define the postoperative oncological conduct", says Dr. Ignacio Ciavarelli in reference to the use of 3D models.
You may be interested in: "Liver tumour with 3D models: a GPS inside the operating theatre" to find out how 3D models guided the surgery of Dr. Nari, surgeon at the Tránsito Cáceres de Allende Hospital (Córdoba, Argentina).
Planning with 3D models is of real importance in cases with liver tumours due to the vascular complexity of the organ in question and how these structures are modified in a pathological environment. They allow the lesions to be placed on a real scale and define the volumes of both healthy segments and tumour areas, helping to define appropriate treatments and surgical tactics.
Given the good experience with 3D biomodels, the oncological and hepatobiliopancreatic surgery sector of the Eva Perón Hospital decided to incorporate 3D reconstructions into its pre-surgical studies in order to improve tactics and reduce patient morbidity and mortality.