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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_585_Библиотеки_им_академика_М_И_Перельмана.pdf
Chihua Fang
Wan Yee Lau
Editors
Biliary Tract
Surgery
Application of Digital Technology
123
Biliary Tract Surgery
Chihua Fang • Wan Yee Lau
Editors
Biliary Tract Surgery
Application ofDigital Technology
Editors
Chihua Fang
Hepatobiliary Surgery
Zhujiang Hospital of Southern
Medical University
Guangzhou
China
Translator
Sai Wen
Hepatobiliary Surgery
Zhujiang Hospital of Southern
Medical University
Guangzhou
China
Wan Yee Lau
Chinese University of Hong Kong
Princecss of Wales Hospital
Hong Kong
China
ISBN 978-981-33-6768-5 ISBN 978-981-33-6769-2 (eBook)
https://doi.org/10.1007/978-981-33-6769-2
Jointly published with People’s Medical Publishing House, PR of China
© People’s Medical Publishing House, PR of China 2021
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or
part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and
retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter
developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publishers, the authors, and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publishers nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
made. The publishers remain neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore
Foreword I
“Workers must rst sharpen their tools if they want to do well.” What is digitization? It is a
science and technology that can be used to deal with many different real things through inputting the number symbols of 0 and 1, after being processed by superb computer programming
technology. This cutting-edge science and technology is adopted in Biliary Tract Surgery:
Application of Digital Technology. In this book, digital 3D images, visualized diagnosis and
treatment, surgical navigation, 3D printing, and indocyanine green uorescent imaging are
used, which pioneers the diagnosis and treatment of biliary tract surgical diseases with precision and minimal invasiveness.
“Practice a thousand songs and then know the sound, observe a thousand swords and then
recognize the device.” On the occasion of the publication of this book, the “foreword” of this
monograph gave us the inscribed feeling: “It is important to know that bliss in the fairyland,
cultivation comes from hardship.” Together with this monograph, Digital Liver Surgery and
Digital Pancreatic Surgery, these three cutting-edge monographs on vital organ surgery in the
upper abdomen are the achievements of Prof. Fang’s team. Over the past 15 years, they have
undergone “rope sawing” and “water droplets through stone” and achieved the result of “the
fragrance of plum blossom coming from bitter cold.”
“If you want to be a thousand miles away, go to the next level.” The biliary tract is a group
of functionally specic systems with the smallest diameter among the four types of ducts in the
liver. It is more difcult to image and 3D reconstruct the biliary tract compared to the portal
vein, hepatic vein, and hepatic artery. Especially in the pre-cancerous stage, the biliary tract
has been twisted, deformed, dilated, and narrowed, and pathological changes of the adjacent
liver tissues such as necrosis, hyperplasia, brosis, atrophy, and hypertrophy may occur. With
ingenuity and dexterity, contemporary doctors must conceive ingeniously and climb high and
far, so that they can “be ignorant of oating clouds to cover their eyes and be at the highest
level” and strive to practice new mission and new deeds in the new era.
“After all the owers are collected into honey, for whom is the hard work and sweet for
whom.” Fang’s team has developed independent intellectual property rights: a 3D visualization
system software for abdominal medical images, a multifunctional virtual surgical instrument
simulation system, and a surgical platform. These software and devices assist the communication of professional workers for preoperative evaluation, plan formulation, and surgical operations. This technology has been promoted and applied in more than 500 hospitals in China.
This book is suitable for undergraduate and graduate students to study, reference, and use,
which is conducive to accelerating the growth of surgeons. I wrote the forward on the day the
book was completed.
ShizhenZhong
Academician of the Chinese Academy of Engineering
Director of the Institute of Clinical Anatomy, Southern Medical University
Guangzhou, China
October 10, 2020
v
Foreword II
Surgeons pursue the precise and quick implementation of hepatobiliary surgery, so as to relieve
the patient’s distress and promote rapid postoperative recovery. Whether the operation can be
performed precisely and accurately is determined not only by the exquisite surgical technique,
but also accurate understanding and judgment of the size, the range of invasion, the structure
of adjacent ducts, and the degree of invasion of tissues and organs. In the past, surgeons relied
on 2D imaging data to obtain abstract three-dimensional understanding of them and their experience. Due to the limitations and uncertainties of experience, it is difcult to obtain satisfactory diagnosis and treatment effects. Fine surgical anatomy is always the cornerstone of the
success of precise surgical operations. Today, in the era in which modern bioinformatics technology, surgery and anatomy, imaging, computer science, and molecular imaging technology
are highly integrated, the neness of anatomy and the precision of surgery can be visualized
before and during surgery, thereby reducing the blindness and risk of exploration, and unveiling the mystery of difcult hepatobiliary surgery. Biliary Tract Surgery: Application of Digital
Technology is loaded with such a background and stands out.
At the beginning of the twenty-rst century, Prof. Fang began to explore the development
path of interdisciplinary integration of hepatobiliary-pancreatic surgery and digital medicine
under the guidance of his tutor Academician Shizhen Zhong. He closely integrates clinical
reality and always adheres to the research aims of “using modern digital medical imaging
technology to solve the need for precise clinical surgical evaluation.” In order to break through
the bottlenecks in imaging the low-pressure biliary system, he applied for the national “863”
project. With the support of this project, he organized a multidisciplinary team involving professionals in surgery, anatomy, imaging, and informatics, developed a 3D visualization system
for abdominal medicine with independent intellectual property rights, and constructed the
theory and scientic diagnosis and treatment methods of 3D visualization of hepatobiliarypancreatic diseases. Through his personal practice and continuous review and exploration of
successful experience, he has published his research results regularly in inuential journals.
Immediately afterward, he has further condensed and sublimated these reports into a theoretical system and compiled monographs with brand-new concepts such as Digital Liver Surgery
and Digital Pancreatic Surgery.
This book, the third monograph compiled by Fang’s team, was reviewed by Academician
Shizhen Zhong, edited by Prof. Chihua Fang and Academician Wan Yee Lau. The rst part is
a general introduction. It separately elaborates the digital human biliary system tomographic
anatomy, biliary system cast anatomy, and individualized liver ducts, from aspects including
3D printing of biliary diseases, virtual simulation surgery, 3D laparoscopy, molecular imaging,
and endoscopic technology; it also involves the new theory of 3D visualization of biliary tract
diseases and constructed new technologies and methods of 3D visualization of biliary diseases
and 3D printing technology. The second part is a monograph, focusing on the clinical application of 3D visualization technology in biliary diseases, including the 3D visualization, diagnosis, and treatment of diseases such as gallbladder diseases, biliary stones, and biliary tumors,
and the forming of a 3D precision diagnosis and treatment system for biliary diseases such as
complex hepatolithiasis and hilar cholangiocarcinoma.
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“The sword’s edge is sharpened by itself, and the fragrance of winter plum comes from the
bitter cold.” The successful publication of this book has condensed the forward thinking and
hard work of the team led by Prof. Fang through long-term clinical practice. However, the
development process of digital clinical surgery toward a new scientic peak has only just
begun. How to better apply and develop this technology so that the 3D accurate assessment of
apparent morphology will leapfrog the development of the 3D accurate assessment of molecular pathology remains an important task before us. We look forward to the continuous efforts
of Fang’s team to cast a solid foundation stone and pave the way for the development of digital
hepatobiliary surgery in the new era and I hereby write this preface.
MengchaoWu
Academician of the Chinese Academy of Sciences
Professor of Surgery
Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
Shanghai, China
October 18, 2020
Foreword II
Foreword III
Not long ago, Prof. Fang gave me two books compiled by his team, Digital Liver Surgery and
Digital Pancreatic Surgery. After I read them, I felt refreshed. A distinctive feature of the mod-
ern medical science and technology in the twenty-rst century is the interdisciplinary mutual
penetration and integration of biological technology, informatics technology, imaging technology, and medical science and technology, which greatly enriches and changes thinking modes
and opens up people’s broad vision of understanding and transforms the world from a new
perspective. I have been a surgeon for half a century and have experienced the development of
surgery. I deeply feel that the development of surgery is inseparable from anatomy. Surgical
anatomy is the foundation of surgery. Fine surgical operations depend on ne surgical anatomy. In such a new era of interdisciplinary integration and mutual promotion of development,
the development of surgery has also entered the era of digital anatomy from the traditional
anatomy era. In the past, the preoperative and intraoperative judgment of disease was based on
the traditional two-dimensional imaging diagnosis and treatment. Now, we have entered a new
mode of 3D visualization and precise diagnosis and treatment. It has brought about a major
change in our traditional surgical technology. The monographs of Prof. Fang Chihua reect the
spirit of this era. In the early twenty-rst century, Fang’s team took the lead in climbing to the
peak of digital hepatobiliary and pancreatic surgery in China. Responding to the urgent clinical
needs, they innovatively studied the new theory and technologies of 3D visualization and precise diagnosis and treatment of hepatobiliary and pancreatic diseases, and applied them to
clinical practice, which has realized the digital anatomy, diagnostic programming, and visualization of hepatobiliary and pancreatic diseases, improved the accuracy of diagnosis of hepatobiliary and pancreatic diseases, and reduced surgical complications. I have also applied this
technology clinically and feel that digital medicine has played a signicant role in the advancement of surgery.
Recently, Fang’s team has compiled Biliary Tract Surgery: Application of Digital
Technology. The biliary tract connects the liver, pancreas, and digestive tract. It has its special
tissue structure, blood supply characteristics, and metabolic characteristics. It is difcult and
risky to operate. Due to the low-pressure characteristics of biliary uid mechanics, it is difcult to achieve 3D stereo imaging, especially difcult to present 3D imaging of blood vessels
simultaneously. Therefore, it has always been a bottleneck restricting accurate preoperative
assessment and accurate intraoperative operation. Many surgical decisions depend on explorations during operation, which leads to a certain degree of blindness in results; the high rate of
reoperation in biliary surgery is also related to this issue. Fang’s team grasped this core issue
and organized a multidisciplinary team to research on this issue. After more than 10 years of
research, they nally achieved breakthrough progress and successfully constructed a digital
three-dimensional visualization precision evaluation platform for biliary surgery and a preoperative virtual surgery platform. The construction and implementation of this platform freed
the hepatobiliary surgeons from the trouble of blind exploration during the operation, improved
the radical resection rate of biliary tumors and the surgical cure rate of hepatobiliary calculi,
and brought good news to the recovery of patients. All of this has been vividly and fully demonstrated in this book.
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What is particularly gratifying is that this monograph comprehensively elaborates the digital human biliary system tomographic anatomy, biliary system casting anatomy, individualized
liver ducts, 3D printing of complex biliary diseases, virtual simulation surgery, 3D laparoscopy, molecular imaging, and endoscopic technology, as well as the three-dimensional visualization and precise diagnosis and treatment theory, platform construction, and application to
gallbladder diseases, biliary calculi, biliary tumors, and other diseases. The editor also used
paper, video, and other media, fusing writing modes to specically show the various types of
hepatobiliary ducts, vascular classication, disease classication, how to build a threedimensional visualization platform for biliary diseases, how to implement virtual surgery, how
to make surgical decisions based on platform evaluation, and specic instructions during surgery, etc., to make high-tech digital three-dimensional virtual reality possible. The visual diagnosis and treatment platform has become close to the clinic, practical, easy for clinicians to
master and use, and truly a sharp sword to guide clinicians to accurately perform complex biliary surgery and improve surgical treatment effects.
I sincerely appreciate the innovative achievements made by Prof. Fang and his young team
for the cause of digital surgery in our country, and I look forward to his continuous efforts to
overcome difculties and rise to the top. Therefore, I wrote this preface.
JieshouLi
Academician of the Chinese Academy of Engineering
Professor of Surgery
General Hospital of Eastern Theater Command
Nanjing, China
October 19, 2020
Foreword III
Foreword IV
The twenty-rst century is a new century in which surgery penetrates and integrates with biology, informatics biology, informatics, and imaging. It is a new century in which various new
concepts, technologies, and equipment are constantly introduced, with the aim of “minimizing
patient injury and accelerating patient rehabilitation.” The intersection of digital medicine and
clinical surgery is a profound revolution in the twenty-rst century in which information engineering and medical technology break through their stereotypes and innovate. The creation of
a series of new instrumentation and technologies including surgical navigation, 3D reconstruction, 3D printing, virtual simulation surgery platform construction, 3D laparoscopic surgery,
and robotic surgery is born from the prime intention of the surgeon: to use the most minimally
invasive technical means to allow patients to receive the best treatment at the least cost, with
the least injury, and obtain the best treatment effect. In such an era of technological innovation,
we ushered in the publication Biliary Tract Surgery: Application of Digital Technology, Prof.
Fang Chihua’s third monograph on digital surgery after Digital Liver Surgery and Digital
Pancreatic Surgery.
The biliary tract has its special tissue structure and blood supply and metabolism characteristics. The slender and complicated bile tree inherits the liver and pancreas, the two most
important metabolic organs of the human body, and is connected to the intestine. Biliary surgical diseases are common and frequently occur in China. Diseases such as cholelithiasis and
hepatolithiasis, or diseases with poor prognosis and difcult treatment, such as gallbladder
cancer and hilar cholangiocarcinoma, seriously endanger people’s health. In the past, due to
the low-pressure hydrodynamic characteristics of the biliary tract, its three-dimensional reconstruction was difcult to present simultaneously with the blood vessels. By only relying on
inspection methods such as B-ultrasound, CT, and MRCP, it was difcult to accurately evaluate the diagnosis before surgery, resulting in unsatisfactory treatment effects. For example, in
the past, the residual stone rate of hepatolithiasis was as high as 20–50%. Many patients suffered from multiple operations, but the disease has not yet been cured, and eventually they are
on the road to end-stage bile disease. Therefore, Academician Huang Zhiqiang has repeatedly
called for surgeons to use the “third eye,” “third hand,” and “sixth sense” to explore the secrets
of complicated biliary trees and strive for the success of difcult biliary surgery. “Let the
patient live happily, and this is the most important thing.”
Prof. Fang has been committed to clinical research on the application of digital medical
technology in hepatobiliary and pancreatic surgery for nearly ten years under the guidance of
his tutor Academician Shizhen Zhong. Supported by the National Eleventh and Twelfth FiveYear “863” plans and major special projects of Guangdong Province, he organized a multidisciplinary team to develop a 3D visualization system for abdominal medical images with
independent intellectual property rights, and built the theory of hepatobiliary and pancreatic
diseases, which has greatly improved the accuracy of disease diagnosis and effectively reduced
surgical complications. This book is accompanied by pictures and texts, which introduces the
latest knowledge in all aspects of digital human biliary system tomographic anatomy, biliary
system casting anatomy, and individualized liver ducts, as well as 3D printing of biliary diseases, virtual simulation surgery, 3D laparoscopy, molecular imaging, and endoscopic technology. This book demonstrates the application of 3D visualization technology to guide the
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