Kelly Paul, Fung Albert, Qu Joy, Greig Paul, Tait Gordon, Jenkinson Jodie, McGilvray Ian, Agur Anne
Division of General Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Canada.
J Vis Surg. 2017 Apr 2;3:43. doi: 10.21037/jovs.2017.03.08. eCollection 2017.
Visualizing the complex anatomy of vascular and biliary structures of the liver on a case-by-case basis has been challenging. A living donor liver transplant (LDLT) right hepatectomy case, with focus on the porta hepatis, was used to demonstrate an innovative method to visualize anatomy with the purpose of refining preoperative planning and teaching of complex surgical procedures. The production of an animation-enhanced video consisted of many stages including the integration of pre-surgical planning; case-specific footage and 3D models of the liver and associated vasculature, reconstructed from contrast-enhanced CTs. Reconstructions of the biliary system were modeled from intraoperative cholangiograms. The distribution of the donor portal veins, hepatic arteries and bile ducts was defined from the porta hepatis intrahepatically to the point of surgical division. Each step of the surgery was enhanced with 3D animation to provide sequential and seamless visualization from pre-surgical planning to outcome. Use of visualization techniques such as transparency and overlays allows viewers not only to see the operative field, but also the origin and course of segmental branches and their spatial relationships. This novel educational approach enables integrating case-based operative footage with advanced editing techniques for visualizing not only the surgical procedure, but also complex anatomy such as vascular and biliary structures. The surgical team has found this approach to be beneficial for preoperative planning and clinical teaching, especially for complex cases. Each animation-enhanced video case is posted to the open-access Toronto Video Atlas of Surgery (TVASurg), an education resource with a global clinical and patient user base. The novel educational system described in this paper enables integrating operative footage with 3D animation and cinematic editing techniques for seamless sequential organization from pre-surgical planning to outcome.
逐例可视化肝脏血管和胆管结构的复杂解剖一直具有挑战性。以一例活体供肝肝移植（LDLT）右半肝切除术为例，重点关注肝门，展示了一种创新的解剖可视化方法，目的是完善术前规划并用于复杂手术操作的教学。制作动画增强视频包括多个阶段，包括整合术前规划；从增强CT重建的肝脏及相关脉管系统的病例特异性影像和三维模型。胆管系统的重建基于术中胆管造影建模。从肝门向肝内手术分割点确定供体门静脉、肝动脉和胆管的分布。手术的每一步都通过三维动画进行增强，以提供从术前规划到手术结果的连续无缝可视化。使用透明度和叠加等可视化技术，使观众不仅能看到手术视野，还能看到节段分支的起源、走行及其空间关系。这种新颖的教育方法能够将基于病例的手术影像与先进的编辑技术相结合，不仅能可视化手术过程，还能可视化血管和胆管结构等复杂解剖。手术团队发现这种方法对术前规划和临床教学有益，尤其是对于复杂病例。每个动画增强视频病例都发布到开放获取的多伦多手术视频图谱（TVASurg），这是一个拥有全球临床和患者用户群体的教育资源。本文描述的新颖教育系统能够将手术影像与三维动画和电影编辑技术相结合，实现从术前规划到手术结果的无缝连续组织。
