Virtual liver models in pre-surgical planning, intra-surgical navigation and prognosis analysis

Major liver resection (hepatectomy) is required for patients with liver metastasis (e.g., from colorectal cancer) and hepatocellular carcinoma (e.g., from chronic hepatitis B infection). Hepatectomy is based principally on the segmental anatomy of the liver, which has few reliable external landmarks to orientate the surgeon. Anatomical variations are common and significant flow alterations after surgery are thought to be a cause for liver dysfunction. Live donor liver transplants (LDLT) are becoming more frequent due to the shortage of cadaver liver donors. Success of this operation is critically dependent on detailed intra-hepatic 'replumbing' to achieve adequate vascular and bile flows post-operatively. Models of hepatic anatomy are currently being used to aid pre-surgical planning and intra-operative guidance. Moreover, multi-scale, biophysical and physiological models have been developed for the prediction of flow variations and parenchymal regrowth after liver transplantations or major resections. The aim of this paper is to provide a brief review of the state-of-the-art models and new trends.