Abstract:

Currently, orthotopic liver transplantation (LT) represents the treatment of choice for most end-stage liver diseases. Advances in surgical techniques and immunosuppressive therapy have markedly increased its success. However, the main obstacle in LT remains the lack of donor organs with a current mortality rate for patients on the waiting list of up to 20%. This chapter focuses on developments in SLT techniques and living-donor LT to alleviate this problem. SLT yields a net gain of organs, in that it uses one organ to save either an adult and a child, or two adults. The initially used technique of ex-situ splitting is being replaced progressively by the in-situ splitting technique, which yields better preserved grafts. The latest step has been the introduction of living-donor segmental LT. The systematic combination of both techniques may lead to a further reduction of mortality for patients on the waiting list for LT.

Authors:

Nils R. Frühauf, M.D., Massimo Malagó, M.D., Andrea Frilling, M.D., F.A.C.S., Susanne Beckebaum, M.D., Christoph E. Broelsch, M.D., Ph.D., F.A.C.S.

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Abstract:

For living donor liver transplantation (LDLT), accurate diagnostic evaluation is essential. Problems arise in assessment of the vascular, bile duct anatomy, liver graft volume, and vascular territories involved. Requirements for the realization of decision-support and enhanced precision in the planning of surgery in LDLT engineering fields are a three-dimensional (3D) visualization system that improves anatomic assessment, allows for interactive surgery planning, and acts as an intraoperative guide. Thirteen LDLT candidates and three LDLT recipients were assessed by "multislice" computer-tomographic examinations. Image processing for 3D visualization included segmentation and calculation of centre lines. A hierarchical mathematical model representing the vascular and biliary tree was created, which allowed calculation of individual vascular territories. Precision of 3D computed tomography (CT)-based visualizations was superior to diagnostic modalities used currently. In addition to detection of decisive anatomic variants, computerized interactive insertion of splitting lines allowed for better planning of the surgical approach and image-guided surgery. 3D CT-based visualization in LDLT facilitates diagnostic evaluation with high accuracy. Multiple examinations, especially with regard to invasive diagnostics, may be avoided. Surgical strategy was directly influenced by the detection of vascular and biliary variants.

Authors:

Jens Harms M.D., Holger Bourquain M.D., Michael Bartels M.D., Heinz-Otto Peitgen Ph.D., Thomas Schulz M.D., Thomas Kahn M.D., Jan Hauss M.D., Josef Fangmann M.D.

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