• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

A new technology of “One-stop shop” liver surgery simulation equipped with assessment of total and regional liver functional reserve

Mitsuo Shimada, MD, Shuichi Iwahashi, MD, Yuji Morine, MD, Satoru Imura, MD, Tetsuya Ikemoto, MD, Yu Saito, MD, Masato Yoshikawa, MD, Jun Higashijima, MD. Tokushima University

Objective of the technology

We have reported a possible “One-stop shop” liver surgery simulation using one-time dynamic CT (Hepatogastroenterology 2013), furthermore, correlation between signal intensity (SI) of MRI using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) and hepatobiliary scintigraphy Tc-99m galactosyl human serum albumin (GSA) to assess regional hepatic functional reserve (J Gastroenterol 2012). Herein, we introduce a new technology of “One-stop shop” liver surgery simulation equipped with assessment of liver functional reserve.

Description of the technology and method of its application

Characteristics of this “One-stop shop” technology are as follows: (1) one-time examination, (2) no-radiation exposure, (3) demonstration of liver vasculatures including, artery, portal vein, hepatic vein and biliary tract, (4) diagnosis of tumors in the liver, (5) calculation of volume of total and each segment, and especially (6) estimation of liver functional reserve in both total liver and each segment, leading to decision making of limit of resected volume of the liver.

Dynamic MRI images using fat-suppressed T1-weighted gradient-echo images with a 3D acquisition sequence were obtained before and after intravenous administration of Gd-EOB-DTPA (0.1 mg/kg body weight). The hepatocyte-phase images obtained 20 min after the injections were used for evaluation. 3D-reconstruction of MRI imaging was done by SYNAPSE VINCENT software (Fuji Medical Systems, Japan), and 3D-reconstruction was performed with manual tracing method.

Assessment of liver functional reserve:

The SI of the eight Couinaud segments of the liver were measured using a circular ROI. The SI of the right erector spine muscle was also measured at the level of the porta hepatis. ROI acquisition was performed using a commercially available picture archiving and communication system (SYNAPSE, Fujifilm Medical, Tokyo, Japan). The standardized signal intensity for each Couinaud segment was calculated as follows: standardized SI = SI of each Couinaud segments /SI of muscle. The standardized TLFR was defined as follows:

Standardized TLFR = ∑ [k=1 to 8] (standardized SI of segment (k) × volume of segment (k)) / Body surface area (FV/m2)

Preliminary results

Our technology using one-time EOB-MRI succeeded in clearly demonstrating hepatic vasculatures including biliary tract, diagnosis of hepatic tumors, and volumetry without any radiation exposure.

With this standardized TLFR value, the following formula of resection limit was established using 28 normal liver cases (on the assumption that 70% of the liver can be resected) and 5 unresectable cirrhotic cases (recipient of transplantation) (on the assumption that 0% of the liver can be resected).

The estimated resection limit (%) = 70% × (the standardized TLFV of patient – 962)/1,076.

Other 30 patients who underwent hepatectomy were retrospectively investigated for validation of this formula. One patient having resection volume with over the resection limit died of liver failure, however, the other 29 cases within their resection limits did not suffer from liver failure.

Conclusion

Our new technology of “One-stop shop” liver surgery simulation could contribute safety of liver surgery, especially laparoscopic hepatectomy, because of no radiation exposure, and accurate assessment of anatomical variations and estimation of total and regional liver functional reserve (resection limit).


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 84298

Program Number: ETP744

Presentation Session: Emerging Technology Poster

Presentation Type: Poster

32

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons