The comparison of 2-dimensional with 3-dimensional hepatic visualization in the clinical hepatic anatomy education

Jonas Jurgaitis^{1, 2}, Marius Paškonis^{1, 2}, Jonas Pivoriūnas³, Ieva Martinaitytė³, Agnius Juška³, Rūta Jurgaitienė⁴, Artūras Samuilis⁵, Ivo Volf⁶, Maks Schöbinger⁶, Peter Schemmer⁷, Thomas W. Kraus⁸, Kęstutis Strupas^{1, 2}

¹Clinic of Gastroenterology, Nephrourology, and Surgery, Faculty of Medicine, Vilnius University, ²Center of Abdominal Surgery, Clinics of Santariškės, Vilnius University Hospital, ³Faculty of Medicine, Vilnius University, ⁴Institute of Anatomy, Kaunas University of Medicine ⁵Center of Radiology, Clinics of Santariškės, Vilnius University Hospital, Lithuania, ⁶Division of Medical and Biological Informatics, German Cancer Research Center (DKFZ), ⁷Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls-University of Heidelberg, ⁸General, Visceral, and Minimal Invasive Surgery Hospital, Nordwest GmbH, Germany

Key words: clinical hepatic anatomy; hepatic resection planning; computed tomography; 3-dimensional visualization; surgical education.

Summary. Objective. To determine whether 2-dimensional or 3-dimensional hepatic visualization is better for the medical students to be used while studying the clinical hepatic anatomy.

Material and methods. Twenty-nine patients who underwent surgical intervention due to focal hepatic pathology at the Department of General Surgery, University of Heidelberg, and at Clinics of Santariškės, Vilnius University Hospital were included in the retrospective cohort study. Before the surgical intervention, the computed tomography (CT) liver scan and 3-dimensional (3D) hepatic visualization were performed. A total of 58 2-dimensional and 3-dimensional digital liver images, mixed up in random sequence not to follow each other with a specially designed questionnaire, were presented to the students of Faculty of Medicine, Vilnius University. Their aim was to determine tumor-affected liver segments, to plan which liver segments should be resected, and to predict anatomical difficulties for liver resection. Results were compared with the data of real operation.

Results. The students achieved better results for tumor localization analyzing 3D liver images vs. CT scans. This was especially evident determining the localization of tumor in segments 5, 6, 7, and 8 (P<0.05). Furthermore, the results of proposed extent of liver resection have been found to be better with 3D visualization (mean±SD – 0.794±0.175) in comparison with CT scans (mean±SD – 0.670±0.200), (P<0.001).

Conclusions. Computer-generated 3D visualizations of the liver images helped the medical students to determine the tumor localization and to plan the prospective liver resection operations more precisely comparing with 2D visualizations. Computer-generated 3D visualization should be used as a means of studying liver anatomy.

Correspondence to J. Jurgaitis, Clinic of Gastroenterology, Nephrourology, and Surgery, Faculty of Medicine, Vilnius University, Santariškių 2, 08661 Vilnius, Lithuania. E-mail: jonas.jurgaitis@santa.lt

Received 27 December 2007, accepted 12 June 2008