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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_585_Библиотеки_им_академика_М_И_Перельмана.pdf
10 Digital Surgical Diagnosis andManagement ofCholecystolithiasis
207
rial terminal branches while adjusting the threshold value,
because of the need to complete operations such as bone
removal. In this case, local vascular surface rendering can
be used to supplement the modelling, and then the effect
of 3D reconstruction of the arterial system can be fully
displayed in a combined form.
• 3D Reconstruction of the Portal Venous System CT
data of the portal venous system was segmented and
Fig. 10.2 Automatic image
segmentation. (a) Read
pictures in a DICOM viewer;
(b) data are converted and
saved; (c) import data in
MI-3DVS to prepare for
segmentation; (d) 3D
reconstruction is performed in
the MI-3DVS; (e) liver
segmentation; (f) Gallbladder
segmentation; (g) calculus
segmentation; (h) arterial
system segmentation; (i)
portal venous system
segmentation; (j) hepatic
venous system segmentation
reconstructed by surface rendering (region growing
method) (Fig.10.4fb).
3D Reconstruction oftheGallbladder, Gallbladder
Stones, andBiliary Tract
• Data for gallbladder and biliary reconstruction in the arterial or venous phase, requires reasonable selection based
on the gallbladder, biliary tract, and surrounding tissues.
a
b
208
Fig. 10.2 (continued)
N. Xiang et al.
c
d
10 Digital Surgical Diagnosis andManagement ofCholecystolithiasis
209
Fig. 10.2 (continued)
e
f
210
Fig. 10.2 (continued)
N. Xiang et al.
g
h
10 Digital Surgical Diagnosis andManagement ofCholecystolithiasis
Fig. 10.2 (continued)
211
i
j
212
N. Xiang et al.
a
b
c
Fig. 10.3 Image segmentation. (a) Gallbladder segmentation; (b) calculus segmentation; (c) liver and gallstone segmentation
Enhanced scan data with substantial differences in CT
thresholds between gallbladder, biliary tract, and surrounding tissues were selected as sources of 3D reconstruction data (Fig.10.4c).
• Stones were segmented and reconstructed by surface
rendering.
• The specic reconstruction method is the same as that of
the liver (Fig.10.4d).
• Segmentation and reconstruction of gallbladder image
bined and displayed stereoscopically to be observed from
all directions, and they could also be enlarged, reduced, and
rotated. Different tissue structures were rendered in different colors: the liver was reddish-brown, the bile duct was
green, the bile duct stone was black, the artery was red, the
portal vein was purple, and the hepatic vein was blue; which
increased the stereoscopic sensation of the 3D hepatobiliary model. The simulated cholecystolithiasis was performed
using PHANTOM, force feedback equipment.
with an unclear boundary require several steps to reconstruct organs. Finally, the reconstruction of the gallbladder is completed by the combined function (Fig.10.4e–h).
Surgical Procedure
Step 1 When the transparency of liver and gallbladder is set
at 0.5 (50%), the distributions of blood vessels and gallstones
10.2.1.4 Surgical Simulation
The 3D models of liver and gallbladder were imported into
the FreeForm Modeling System for smoothing and removing some excessive details and noises. They could be com-
in the liver are visible (Fig.10.5).
Step 2 Activate the arterial system, introduce a needle to
suture the cystic artery (Fig.10.6), and cut the gallbladder
artery (Figs.10.7 and 10.8).
10 Digital Surgical Diagnosis andManagement ofCholecystolithiasis
213
a
b
d
c
Fig. 10.4 3D reconstructed image. (a) Abdominal aorta and hepatic
artery; (b) Portal vein and hepatic vein; (c) Gallbladder and common
bile duct; (d) The liver; (e) Overall view of 3D model; (f) The transpar-
e
ency of the liver is 0, showing its internal structure; (g) Biliary tract
transparency is set to 0 to show calculi; (h) The transparency of liver
and biliary tract is 0, showing the location of calculi
214
N. Xiang et al.
fg
h
Fig. 10.4 (continued)
Step 3 Activate the gallbladder, introduce a scalpel,
and show the process of incision of the gallbladder bed
(Figs.10.9 and 10.10).
Step 4 Show the resection line of the gallbladder
(Fig.10.11), and remove the gallbladder (Fig.10.12).
Step 5 Introduce the needle, suture the end of the cystic duct (Fig.10.13), and show the suture of the cystic duct
(Fig.10.14).
10.2.2 Application Value of3D Visualization
inGallbladder Stone
Difculties that cannot be foreseen by traditional imaging
before an operation may frequently be encountered during
cholecystectomy. For example:
• Variation in the origin, course, and number of gallbladder
arteries, which may increase the risk of intraoperative
gallbladder artery hemorrhage.
• A variant right hepatic artery issuing from the superior mesenteric artery courses through the posterior or right posterior of
extrahepatic bile duct, and then enters into the liver through the
posterior triangle of the gallbladder, which may increase the
risk of injury of the right hepatic artery during the operation.
• Variation of the gallbladder duct and extrahepatic bile
duct may increase the risk of bile duct injury.
• The exposure of the branches of middle hepatic vein or
portal vein to the gallbladder bed may increase the risk of
accidental hemorrhage during operation.
• Recurrent acute attack of cholecystitis may result in fusing
with surrounding organs and tissues and unclear anatomical
detail.
10 Digital Surgical Diagnosis andManagement ofCholecystolithiasis
Fig. 10.5 The structure of
gallbladder stones and blood
vessels is visible when the
transparency of liver and
gallbladder is set at 0.5
215
Fig. 10.6 Simulation of
gallbladder resection, and
suture of the gallbladder
artery
216
Fig. 10.7 Cystic artery
excision
N. Xiang et al.
Fig. 10.8 Cut off the cystic
artery