Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_585_Библиотеки_им_академика_М_И_Перельмана.pdf
The hepatic
ducts
12 Digital Surgical Diagnosis andManagement ofHepatolithiasis
267
Fig. 12.45 3D model of liver
with different transparency.
(a) 3D model when the liver
transparency is 0; (b) when
the liver transparency is 0.5,
the 3D model of internal
structure is displayed
a
The dilated biliary
vein
and calculus
The hepatic artery
The portal vein
b
original two-dimensional image (Fig.12.45a, b). Different
tissue structures were rendered in different colors: the liver
was reddish brown; the bile duct, green; the arterial system,
red; the portal vein, purple; the hepatic vein and inferior vena
cava, blue; the left hepatolithiasis, black (Figs. 12.45 and
12.46). The virtual scalpel can be used to cut the liver at will,
with real-time manifestation and strong haptic feedback. The
whole surgical procedure has good interactivity, immersion
and operability.
Surgical Procedures
• Introduce the virtual scalpel and activate the virtual liver
(Fig.12.47).
• When the transparency of the liver is 0.5, the left hepatic
dilated bile duct and stones are shown, and the route of
hepatectomy is determined (Fig.12.48).
• The process of left hepatectomy (Figs. 12.49 and
12.50a–c).
• Left hepatic artery was activated and transected
(Fig.12.51a).
• The left branch of the portal vein was activated and transected (Fig.12.52a, b).
• The left hepatic duct was activated and transected
(Fig.12.53a–c).
• Activate the left liver, bile duct, arteries and veins, and
stones (Fig.12.54).
• The left liver was observed by rotation while removing it.
The stones can be displayed when the transparency of the
left liver is set to 0 (Fig.12.55a–c).
• The left hepatic artery, left portal vein, and left hepatic
duct were sutured respectively with a suture needle, suture
line, and line knot (Fig.12.56a–c).
• The left hepatic duct, left hepatic artery, and left portal
vein were sutured (Fig. 12.57), and the enlarged left
hepatic section (Fig.12.58) was observed.
12.8.2.2 Virtual Liver Resection forLeft
andRight Hepatolithiasis
The 3D model of liver and gallbladder with left and right
hepatolithiasis was reconstructed and imported into the
268
Fig. 12.46 3D model when
the liver transparency is 1
Q. Lu et al.
Fig. 12.47 Import the virtual
scalpel and activate the virtual
liver
12 Digital Surgical Diagnosis andManagement ofHepatolithiasis
Fig. 12.48 Left
hepatolithiasis is shown and
the route of cutting the left
liver is determined when the
transparency of the liver is 0.5
269
Fig. 12.49 Follow the
established cutting route and
cut the liver
270
Q. Lu et al.
a
b
Fig. 12.50 (a) The process of cutting when the liver transparency is 0.5; (b) the process of cutting when the liver transparency is 0.5; (c) The left
liver parenchyma is cut off when the liver transparency is 1
12 Digital Surgical Diagnosis andManagement ofHepatolithiasis
271
c
Fig. 12.50 (continued)
FreeForm Modeling System. By varying the level of transparency of the liver and bile duct, the structure of the liver
and all its internal ducts can be observed and displayed. Its
expression of content and the color coding of different vessels were the same as those of the left hepatectomy virtual
surgery. The virtual scalpel can be used to cut the liver at
will, with real-time effect and realistic haptic feedback,
while the whole surgical procedure has good interactivity,
immersion, and operability.
Surgical Procedures
• Introduce the virtual scalpel, activate bile duct, and open
common bile duct (Fig.12.59).
• Choledocholithotomy for stone extraction (Fig.12.60).
• When the transparency of the liver was 0.5, the left
hepatic dilated bile duct and stones were shown, and the
route of hepatectomy was determined (Figs.12.48 and
12.61).
• The process of left hepatectomy (Figs. 12.62a, b and
12.63a–c).
• The left hepatic artery, left portal vein branch, and left
hepatic duct were sutured respectively by suture needle,
suture line, and line knot (Figs.12.64 and 12.65).
• The process of partial right hepatectomy (Figs. 12.66,
12.67, 12.68, 12.69, and 12.70).
• Choledochojejunostomy (Figs.12.71, 12.72, and 12.73).
Because various 3D visualization software cannot simulate the physiological function of the liver at present, it is
impossible to completely virtualize the real surgical scene,
such as tissue bleeding, elastic deformation of soft tissue,
real-time blood circulation of various liver tubes, and ow of
bile. Therefore, the combination of morphological and functional aspects is an important research direction for the future
optimization of visual simulation surgery systems.
12.9 3D Printing ofLiver intheDiagnosis
andManagement ofComplicated
Hepatolithiasis
3D printing technology is mainly a rapid prototyping technology. It is based on digital model les and uses adhesive
materials such as powder metal or plastics. The synthesis of
objects can be constructed by layer printing.
After 3D reconstruction, 3D printing of the liver can truly
restore the characteristics of organs invivo. Thus, based on
3D visualization, the liver model can be closer to reality
(Fig.12.74). Its advantages include: the location, size, shape
of stones can be displayed through the physical model, and
the relationship between stones and vessels can be observed
in all directions; Intuitive real-time intraoperative indirect
navigation is provided.
272
Fig. 12.51 (a) Hepatic artery
is activated when the liver
transparency is 0.5; (b) Left
hepatic artery is cut off when
the liver transparency is 0.5
Q. Lu et al.
a
b
12 Digital Surgical Diagnosis andManagement ofHepatolithiasis
Fig. 12.52 (a) Activation of
the left branch of the portal
vein; (b) Cut off the left
branch of the portal vein
273
a
b
274
Q. Lu et al.
a
Fig. 12.53 (a) Activation of the bile duct in the left liver; (b) cut off the left hepatic duct; (c) cut off the left hepatic duct
b
12 Digital Surgical Diagnosis andManagement ofHepatolithiasis
275
c
Fig. 12.53 (continued)
Fig. 12.54 Activation of the
left liver, bile duct, arteries
and veins, and stone
276
Q. Lu et al.
a
b
Fig. 12.55 (a) Remove the left liver; (b) remove the left liver and rotate; (c) set the transparency of removed left liver to 0, to reveal calculi