Local, semi-automatic, three-dimensional liver reconstruction or external provider? An analysis of performance and time expense

Abstract

Purpose In hepatobiliary surgery, preoperative three-dimensional reconstruction based on CT or MRI can be provided externally or by local, semi-automatic software. We analyzed the time expense and quality of external versus local three-dimensional reconstructions. Methods Three first-year residents reconstructed data from 20 patients with liver pathologies using a local, semi-automatic, server-based program. Initially, five randomly selected patient datasets were segmented, with the visualization of an established external company available for comparison at all times (learning phase). The other fifteen cases were compared with the external datasets after completing local reconstruction (control phase). Total time expense/case and for specific manual and semiautomated reconstruction steps were recorded. Segmentation quality was analyzed by testing the equivalence for liver and tumor volumes, portal vein sectors, and hepatic vein territories. Results The median total reconstruction time was reduced from 2.5 h (learning phase) to 1.5 h (control phase) (− 42%; p < 0.001). Comparing the total and detailed liver volumes (sectors and territories) as well as the tumor volumes in the control phase equivalence was proven. In addition, a highly significant correlation between the external and local analysis was obtained over all analyzed segments with a very high ICC (median [IQR]: 0.98 [0.97; 0.99]; p < 0.01). Conclusion Local, semi-automatic reconstruction performed by inexperienced residents was feasible with an expert level time expense and the quality of the three-dimensional images was comparable with those from an external provider.

Using virtual 3D-models in surgical planning: workflow of an immersive virtual reality application in liver surgery

“…The reconstruction can either be performed by an external provider or locally with (semi-)automatic segmentation software. In our department, semi-automatic, server-based software (Synapse 3D, FUJIFILM Europe GmbH, Düsseldorf) is utilized by trained members of our surgical team [ 11 ]. DICOM (Digital Imaging and Communications in Medicine) data can easily be transferred from the radiologic PACS System (Sectra AB, Linköping, Sweden) to synapse 3D.…”

“…DICOM (Digital Imaging and Communications in Medicine) data can easily be transferred from the radiologic PACS System (Sectra AB, Linköping, Sweden) to synapse 3D. Transfer and reconstruction take about 2 h as previously described [ 11 ]. After completion of the reconstruction, the visualization is exported as stereolithography (STL) files, which are the standardized file format for 3D printing.…”

Virtual reality and 3D printing improve preoperative visualization of 3D liver reconstructions—results from a preclinical comparison of presentation modalities and user’s preference

“…The segmentation of the 2D scan stands at the beginning of all 3D presentation formats. Regardless of the provider (external or local) the reconstruction is always initially presented as 3D PDF, therefore the 3D PDF is the fastest and most cost-efficient modality (15). The printing process of 3D models can take days and is associated with high costs (25,41).…”

“…The three-dimensional visualizations were based on the preoperative computed tomography (CT) scans. A surgical resident of the department (FH), who has five years of clinical experience in a surgical high volume liver center and three years of experience using the reconstruction software, performed all reconstructions (15). These reconstructions can be directly exported from the software to a 3D PDF as well as to stereolithography (STL) files, which are required for the 3D PR models as well as the VR application.…”

Liver Resection for Intrahepatic Cholangiocarcinoma—Single-Center Experience with 286 Patients Undergoing Surgical Exploration over a Thirteen Year Period

“…In selected cases, three-dimensional CT-scan of the liver including volumetry, virtual tumor resection, and computer-assisted risk analysis was performed prior to the resection. These were performed either by an external provider (MeVis Distant Services, MeVis AG, Bremen, Germany) or with a local reconstruction software (Synapse 3D, Fujifilm AG, Tokyo, Japan) by a trained surgical resident [8]. Since 2017, 3D-prints of the liver were performed on special request of the surgeon with nonflexible polyurethane rubber [9].…”