Application of computer assisted surgical system for hilar tumor resection at second hepatic portal area in children

Objective To explore the relationship between liver tumors and hepatic veins in children and assess the clinical value of computer-assisted surgery (CAS) system for pediatric liver surgery. Methods The clinical data of 27 cases with liver tumors at second hepatic portal area was analyzed from January 2013 to June 2017.There were 19 boys and 8 girls aged from 2 months to 10 years with a mean age of (2.3±2.9) years.Maximal and median diameters of tumor were 21.0 cm and 10.2 cm respectively.Prior to surgery, liver three-dimensional reconstruction by Hisense CAS was performed to observe the relationship between intrahepatic vessels and liver tumor and calculate the intended resection range and the remaining liver volume.Intrahepatic vascular shape and variation, surgical approach, operative duration, blood loss, intraoperative blood transfusion and postoperative complications were observed. Results According to preoperative three-dimensional reconstruction, tumors invaded single (n=5), two (n=1) and three main hepatic veins (n=1). Among 20 cases of oppressed main hepatic vein, inferior vena cava was oppressed in one case and another case had diffuse total hepatic lesion.Right hepatectomy (n=11), left hepatectomy (n=3), left trisectionectomy (n=3), mesohepatectomy (n=7) and right anterior lobe resection (n=3) were performed.The median tumor volume was (10.67×8.57×6.48) cm3, median operative duration 162 (60-260) min, median blood loss 20 (2-400) ml, median red blood cell transfusion 1.85 (0.1-8) units and median postoperative hospitalization 10.2 (7-14) days.One case of postoperative pleural effusion was treated by closed drainage of pleural cavity. Conclusions The above CAS is capable of distinctly and accurately delineating the relationship between liver tumor and hepatic vein in children.It may evaluate the feasibility of surgery and optimize operative plans for children with second hilar tumors. Key words: Surgery, computer-assisted; Three-dimensional imaging; Second hepatic portal area; Liver neoplasm; Hepatic vein