Aplicabilidad de la nueva generación de modelado 3D en cirugía hepatobiliar

Resum

Introduction: Hepatobiliary surgery is the treatment of choice in a large number of patients diagnosed with hepatic tumor pathology. Due to its great complexity, it is essential to master the anatomical variability of the liver and the surgical technique applied to each patient. With the advance of new technologies and the development of new generation 3D, surgical planning can find an important benefit by providing greater precision, both in the approach and in the liver resection used, acting as a guide and in an individualized manner. Aims: To validate the accuracy of the 3D model obtained from original images of each patient for preoperative planning and to support the teaching of students and members of the surgical team in complex hepatobiliary surgery. Methods: A retrospective multicenter analysis of patients using the latest generation of 3D modeling in the preoperative planning of hepatobiliary surgery was performed in two cohorts of patients: 1) complex hepatobiliary surgery and 2) perihilar cholangiocarcinoma. Results: In a first study of complex hepatobiliary surgery, 35 patients from 8 different hospital centers were included. Imaging tests obtained by CT and MRI compared with 3D printed achieved a high similarity in terms of vascular caliber measurements (0.22±1.8 mm) as well as the distance between the tumor and the vessel (0.31±0.24 mm). Bland-Altman plots also demonstrated agreement between 3D printed and surgical specimen with resection margin distance (1.15±1.52 mm). Practitioners highlighted 3D printed with a positive rate of 0.89 (CI:95%; 0.73-0.95) As for students, a higher success rate was achieved with 3D printed (median: 0.9, IQR:0.8-1) compared to CT/MRI or 3D digital imaging (P= 0.01). In the cohort of perihilar cholangiocarcinomas, 37 patients underwent liver surgery and 4 were considered inoperable when studying the findings found on 3D reconstruction. The mean difference between 2D reconstruction and intraoperative findings of tumor size was (3.60 mm, limits of agreement from 14.97 to 22.15 mm) greater than with 3D reconstruction (2.52 mm, limits of agreement from 9.21 to 4.17 mm). Using the Likert-type scale, respondents detailed a better understanding of all parameters related to tumor staging, size, extent and vascular relationships with the use of 3D modeling, with the exception of lymph node involvement. A clear improvement in the interpretation of vascular and biliary anatomy was also reported, with mean Likert scores of 4.72(0.46) and 4.77(0.42) respectively. In general, surgeons and nurses strongly agreed with the statement: “planning with the 3D model is much better than with 2D images”, with mean Likert scores of 4.72 and 5, respectively. Conclusion: The state-of-the-art 3D modeling is a great tool for decision making and preoperative planning in complex hepatobiliary surgery, as well as for teaching patients and students. Surgeons and nurses see this new tool as a support material that enhances communication and understanding within the operating room.