**8. Clinical application of Hisense CAS for diagnosis and surgical plans in children with large liver tumors**

An 11-month-old male infant was referred with abdominal distension and loss of appetite for the past 2 months [27]. Upon examination, a firm, non-tender mass with a smooth surface was evident arising from the right lobe of the liver, which filled the abdominal cavity. Serum ALT, AST, GGT, ALP, and Alb were normal. Both serum α-fetoprotein (AFP) and carcinoembryonic antigen (CEA) levels were within normal ranges. Ultrasound (US) revealed a welldefined, multicystic mass involving the liver. Enhanced CT images similarly showed a giant cystic mass with minimally enhanced septation and peripheral solid components (**Figure 10**).

The DICOM data obtained from the CT images were uploaded to 3D simulation software, the Hisense Computer Assisted Surgery System (Hisense, China) to simulate the liver. The relationship between HMH and the intrahepatic vasculature was revealed in a 3D context (**Figure 11**). The right hepatic vein (RHV), the middle hepatic vein (MHV), and the left hepatic vein (LHV) were confluent with a common trunk. The hepatic veins (HVs), the portal veins (PVs), and the inferior vena cava (IVC) were displaced, with no obvious infiltration or encasement. The volume of both the functional liver and the HMH was automatically calculated. The positional relationship between the vessels and HMH could be confirmed from any angle instantaneously in the computer. Various virtual hepatectomies were performed to predict the risk and the difficulty of the actual hepatectomy. Finally, an optimal surgical

**Figure 10.** Preoperative enhanced CT scan.

plan was developed using 3D simulation software to safeguard RHV. The enucleation of HMH for the case was performed after adequate preoperative preparation.

**7.2. Liver tumor database and simulated liver surgery**

68 Liver Research and Clinical Management

large liver tumors and those with vascular variation.

**plans in children with large liver tumors**

**Figure 10.** Preoperative enhanced CT scan.

The liver tumor database shows the reconstructed digital liver image and simulated liver resection according to the surgeon's preoperative plan, and the intraoperative video of clinical cases, aiming to share the experience gained by staff at our center freely around the world. With the help of Hisense CAS, the successful surgical resection of liver tumors in pediatric patients has improved in our center. With the 3D simulation, we have found that we can clearly understand the anatomical variation in intrahepatic vasculature, the correlation of vasculature with liver tumors, and calculate the remnant liver volume of the simulated liver easily. In the database, we would like to show some difficult cases, such as those with very

**8. Clinical application of Hisense CAS for diagnosis and surgical** 

An 11-month-old male infant was referred with abdominal distension and loss of appetite for the past 2 months [27]. Upon examination, a firm, non-tender mass with a smooth surface was evident arising from the right lobe of the liver, which filled the abdominal cavity. Serum ALT, AST, GGT, ALP, and Alb were normal. Both serum α-fetoprotein (AFP) and carcinoembryonic antigen (CEA) levels were within normal ranges. Ultrasound (US) revealed a welldefined, multicystic mass involving the liver. Enhanced CT images similarly showed a giant cystic mass with minimally enhanced septation and peripheral solid components (**Figure 10**). The DICOM data obtained from the CT images were uploaded to 3D simulation software, the Hisense Computer Assisted Surgery System (Hisense, China) to simulate the liver. The relationship between HMH and the intrahepatic vasculature was revealed in a 3D context (**Figure 11**). The right hepatic vein (RHV), the middle hepatic vein (MHV), and the left hepatic vein (LHV) were confluent with a common trunk. The hepatic veins (HVs), the portal veins (PVs), and the inferior vena cava (IVC) were displaced, with no obvious infiltration or encasement. The volume of both the functional liver and the HMH was automatically calculated. The positional relationship between the vessels and HMH could be confirmed from any angle instantaneously in the computer. Various virtual hepatectomies were performed to predict the risk and the difficulty of the actual hepatectomy. Finally, an optimal surgical After laparotomy, the fluid was aspirated using a 20 G needle from the cystic components of HMH to reduce its volume, thereby facilitating surgical resection. The resection line at the rim of HMH, which was indicated by virtual hepatectomy was made using the electrotome. The hepatic portal occlusion was used to reduce the risk of bleeding. The hepatic parenchyma was dissected using the CUSA system. The intrahepatic vessels were dissected to be safeguarded or else ligated and divided, a matter that had been assessed by the virtual hepatectomy. After 20 min, the HMH was removed with surrounding rim of normal liver tissue. The right hepatic vein was successfully safeguarded. The remnant liver volume was about 210 ml, which approximately equaled the automatically calculated remnant liver volume (230.1 ml). There was no anatomical discrepancy between the operation and the 3D simulation. The convalescence was uneventful. Histopathology confirmed the diagnosis of mesenchymal hamartoma (**Figure 12**).

In summary, three-dimensional (3D) imaging could significantly improve the resection rate of pediatric tumors and increase the safety of the surgery. Dong's digital liver classification system and human digital liver classification system will be useful for surgeons all around the world.

**Figure 11.** Comparison of 3D simulation and intraoperative liver anatomy.

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**Figure 12.** Resected HMH tumor and pathology.
