Hepatic hemangiomas (HHs) are benign liver lesions often discovered incidentally on imaging for various unrelated pathologies. We herein review the etiology, classification, diagnostic imaging, and management of HHs.A comprehensive systematic review was performed utilizing MEDLINE/PubMed and Web of Science databases, with the end of search date being March 1, 2022, regarding HH diagnosis, imaging, and management.HHs can be broadly classified as capillary hemangiomas or cavernous hemangiomas. While the exact pathophysiology related to the development of HHs remains largely unknown, hormone exposure has been postulated to cause HH growth. HHs appear homogenously hyperechoic on US with distinct margins and posterior acoustic enhancement. While cavernous hemangiomas appear as well-defined hypodense lesions on pre-contrast CT images with the same density as the vasculature, one of the most reliable imaging features for diagnosing cavernous hemangiomas is high signal intensity on T2 weighted images. While most HHs are asymptomatic, some patients can present with pain or compressive symptoms with bleeding/rupture being very rare. Kasabach-Merritt syndrome is a rare but life-threatening condition associated with thrombocytopenia and microangiopathic hemolytic anemia. When HHs are symptomatic or in the setting of Kasabach Merritt syndrome, surgery is indicated. Enucleation is an attractive surgical option for HH as it spares normal liver tissue. Most patients experience symptom relief following surgical resection.HHs are very common benign liver lesions. High-quality imaging is imperative to distinguish HHs from other liver lesions. Surgery is generally reserved for patients who present with symptoms such as pain, obstruction, or rarely Kasabach-Merritt syndrome. Surgery can involve either formal resection or, in most instances, simple enucleation. Patients generally have good outcomes following surgery with resolution of their symptoms.© 2022. The Society for Surgery of the Alimentary Tract.

The risk of spontaneous bleeding or rupture of liver hemangiomas still remains unknown. The aim of this review was to analyze the problem of spontaneous bleeding or rupture in liver hemangiomas and to identify factors leading to bleeding in these cases.A MEDLINE search was undertaken to identify articles in English, French, German, Italian, and Spanish from 1898 to 2010. Basic data such as age and sex of patients were collected. Additional data such as risk factors or causes of rupture were also analyzed. Cases were divided into spontaneous and non-spontaneous ruptures.A total of 97 cases are described. In 51 of the 97 patients (52.6%) a non-spontaneous rupture was identified. Only in 46 out of the 97 cases (47.4%) was a spontaneous rupture found. Non-spontaneous rupture was significantly more frequent in patients aged <40 years than in older ones (p = 0.0099). Mean size of the ruptured lesions was 11.2 cm (range 1-37 cm). Massive bleeding occurred in 88 patients (90.7%). Reported mortality over the past 20 years has been significantly lower than before (p < 0.001). The overall mortality for the period under study was ~35%.The spontaneous rupture of a hepatic hemangioma is to be considered an exceptional event. Preventive surgery should be considered only for lesions of at least 11-cm size in special cohorts of patients.© 2011 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Three-dimensional reconstruction visualization technology (3D-RVT) is an important tool in the preoperative assessment of patients undergoing liver resection. However, it is not clear whether this technique can improve short-term and long-term outcomes in patients with hepatocellular carcinoma (HCC) compared with two-dimensional (2D) imaging.

This study aimed to develop an automated segmentation system for biliary structures using a deep learning model, based on data from magnetic resonance cholangiopancreatography (MRCP).Living liver donors who underwent MRCP using the gradient and spin echo technique followed by three-dimensional modeling were eligible for this study. A three-dimensional residual U-Net model was implemented for the deep learning process. Data were divided into training and test sets at a 9:1 ratio. Performance was assessed using the dice similarity coefficient to compare the model's segmentation with the manually labeled ground truth.The study incorporated 250 cases. There was no difference in the baseline characteristics between the train set (n=225) and test set (n=25). The overall mean Dice Similarity Coefficient was 0.80±0.20 between the ground truth and inference result. The qualitative assessment of the model showed relatively high accuracy especially for the common bile duct (88%), common hepatic duct (92%), hilum (96%), right hepatic duct (100%), and left hepatic duct (96%), while the third-order branch of the right hepatic duct (18.2%) showed low accuracy.The developed automated segmentation model for biliary structures, utilizing MRCP data and deep learning techniques, demonstrated robust performance and holds potential for further advancements in automation.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

Extended right posterior sectionectomy (ERPS) preserves more liver parenchyma than right hepatectomy when hepatocellular carcinoma (HCC) is in the right posterior section (RPS) and part of the right anterior section (RAS), but the difficulty lies in the precise determination of the cutting plane, especially under laparoscopy.[Torzilli et al. in Annals of surgery. 247:603-611, 2008] If the right hepatic vein (RHV) is not invaded by the tumor, it can help to divide the ventral and dorsal plane (VP, DP) as surgical landmark.[Makuuchi in International Journal of Surgery. 11:S47-S49, 2013] (Fig. 1) This study presented a laparoscopic modular ERPS (LMERPS) guided by projection plane extension from the RHV. Fig. 1 Projection plane extending from the right hepatic vein. a & b: The VP was bounded by the RHV and its projection; c & d: The DP was bounded by the RHV, IVC, and DL of the RPS and RAS. RHV, right hepatic vein; VP, ventral plane; DP, dorsal plane; IVC, inferior vena cava; DL, demarcation line; RPS, right posterior section; RAS, right anterior section METHODS: A 56-year-old man was seen with HCC in the (RPS) and segment 8 following two laparotomies. After releasing intraperitoneal adhesions, the short hepatic veins were severed to expose the inferior vena cava (IVC). The right posterior Glission pedicle (RPGP) was clamped to control RPS inflow and allow determination of the demarcation line (DL) between the RPS and RAS using ICG fluorescence staining.[Chen et al. in Annals of surgical oncology. 29:2034-2040, 2022] Intraoperative ultrasound identified the RHV projection to satisfy the requirements of oncologic treatment. The VP and DP were incised along the DL and RHV projection. The RHV was exposed fully on the cutting plane and the tumor was completely removed finally.The operation was completed in 265 min, with a blood loss of 50 ml. The diagnosis was HCC with a negative resection margin. The patient was discharged on postoperative day 8 without any complications.LMERPS guided by a projection plane extending from the RHV is feasible and effective.© 2023. The Society for Surgery of the Alimentary Tract.

Laparoscopic extended segmentectomy VII is a technically challenging procedure owing to a lack of clear anatomical landmarks and difficulty in determining the cutting plane (Wang in J Am Coll Surg 238:321-330, 2024; Liu in Surg Oncol 38:101575, 2021). On the basis of precise surgical planning, we present a laparoscopic extended segmentectomy VII guided by the right hepatic vein.A 65 year-old male patient presented with a right hepatic mass. The three-dimensional liver model showed that the tumor was mainly located in segment 7, invading part of segment 8 (Fig. 1A). The right hepatic vein (RHV) trunk was not invaded by the tumor, and the segment 6/7 intersegmental vein was present; these served as the surgical landmarks for determining the cutting plane (Fig. 1B) (Wang in Updates Surg 75:1941-1948, 2023). Firstly, the Glissonean pedicle of segment 7 (G7) was dissected from the dorsal side of the liver. The ischemic area was identified and marked by clamping G7. Then, the intraoperative ultrasound confirmed the RHV trunk projection to satisfy the requirements of oncologic treatment (Lin in J Gastrointest Surg 27:1494-1495, 2023). Liver parenchymal transection was performed peripherally, followed by the exposure of the segment 6/7 intersegmental vein and RHV trunk on the cutting plane. Further transection was then continued along the RHV trunk, up to its root. Fig. 1 Precise surgical planning; A the tumor location, B the cutting plane extending from the RHV trunk and S6/7 intersegmental vein. RHV right hepatic vein, IVC inferior vena cava, S6/7 intersegmental vein intersegmental vein between segment 6 and 7, S7 segment 7, S8 segment 8 RESULTS: The operative time was 260 min, with an intraoperative blood loss of 50 ml. The pathology confirmed moderately differentiated hepatocellular carcinoma with a negative surgical margin. The patient was discharged on postoperative day 9 without any complications.On the basis of precise surgical planning with a three-dimensional liver model, the laparoscopic extended segmentectomy VII guided by the RHV is feasible and effective.© 2025. Society of Surgical Oncology.

In malignant hepatic neoplasm, anatomic resection could improve survival and limit complications from hepatectomy. Our purpose was to develop an intraoperative method for identifying segment and subsegment of the liver with high-sensitivity near-infrared fluorescence imaging.The subjects were 35 patients with hepatic malignant liver disease who received hepatectomy in 2006. The segments of liver method of identification that used infrared observation camera system termed Photo Dynamic Eye-2 (PDE-2) with indocianine green (ICG) for the patient with malignant liver tumor (hepatocellular carcinoma: 13 cases; metastatic liver cancer: 18 cases; intrahepatic cholangio carcinoma: 4 cases) were performed before liver resection.Although greenish stain of the liver surface after the injection of ICG via portal vein is not visible clearly without infrared observation camera system PDE-2, 1 minute after injection of ICG with fluorescent using infrared observation camera system PDE-2, demarcation of liver segment and subsegment was clearly detected. Ten minutes after injection of ICG with fluorescent using infrared observation camera system PDE-2, fluorescence of liver subsegment remained. Stained subsegment and segment of liver were identifiable in 33 (94.3%) of the 35 patients. There were no complications or side-effects related to the injection of patent blue dye.We demonstrated here that near-infrared fluorescence imaging system is a novel and reliable intraoperative technique to identify hepatic segment and subsegment for anatomical hepatic resection.

Near-infrared fluorescence cholangiography improves the clinical effects of laparoscopic cholecystectomy. However, the administration of indocyanine green remains controversial. Both the intraoperative strategy (IS, 0.05 mg) and preoperative strategy (PS, 0.25 mg/kg body weight, 1 day before operation) have been shown to be superior to the standard strategy (2.5 mg, intraoperative). This trial was designed to determine whether IS offers noninferior visualization of biliary ducts compared with PS.

Laparoscopic parenchyma-sparing hepatectomy (PSH) is an effective treatment for colorectal liver metastases (CRLMs), but ensuring the safety and radicality of the procedure, particularly for deep-seated tumors, remains challenging. Surgical navigation technologies such as augmented reality navigation (ARN) and indocyanine green fluorescence imaging (ICG-FI) are increasingly utilized to guide surgery, yet their efficacy for CRLMs is unclear. This study aims to evaluate the short-term and long-term outcomes of ARN combined with ICG-FI-guided (ARN-FI) laparoscopic PSH for CRLMs.Between January 2020 and December 2022, 89 consecutive patients who underwent laparoscopic PSH for CRLMs were included in the study. Patients were divided into an ARN-FI group (n = 38) and a non-ARN-FI group (n = 51) based on the use of ARN-FI. Inverse probability treatment weighting (IPTW) was used to balance baseline characteristics and minimize potential selection bias. Short-term and long-term outcomes were compared between the two groups. Cox regression analysis was conducted to identify risk factors associated with recurrence-free survival (RFS) and hepatic RFS.After IPTW, there were 87 patients in the ARN-FI group and 89 patients in the non-ARN-FI group. Shorter parenchymal transection time, postoperative hospital stays, and wider margins were observed in the ARN-FI group. There was no significant difference in RFS or hepatic RFS between the groups. Mutant KRAS status was an independent risk factor for both RFS and hepatic RFS, while tumor diameter ≥ 5 cm and deep-seated location were risk factors for hepatic RFS. In the subgroup analysis of deep-seated tumors, the ARN-FI group also showed less intraoperative blood loss, a lower rate of strategy change, shorter postoperative recovery times, a higher R0 resection rate, and improved RFS and hepatic RFS.In laparoscopic PSH for CRLMs, ARN-FI may improve surgical efficiency and accuracy. Especially for deep-seated tumors, it has the potential to reduce blood loss and attain higher R0 resection rates.Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

Laparoscopic ultrasound-guided liver microwave ablation requires precise navigation and spatial accuracy. We developed an image fusion navigation system that integrates laparoscopic, ultrasound, and 3D liver model images into a unified real-time visualization. The Apple Vision Pro mixed reality device projects all essential image information into the surgeon's field of view in real-time. This system reduces cognitive load and enhances surgical precision and efficiency. Comparative experiments showed a significant improvement in puncture accuracy under AVP guidance (success rate of 90%) compared to traditional methods (42.5%), benefiting both novice and experienced surgeons. According to the NASA Task Load Index evaluation, the system also reduced the workload of surgeons. In eight patients, ablation was successful with minimal blood loss, no major complications, and rapid recovery. Despite challenges such as cost and fatigue, these results highlight the potential of mixed reality technology to improve spatial navigation, reduce cognitive demands, and optimize complex surgical procedures.© 2025. The Author(s).

Intraoperative hemorrhage during laparoscopic hepatectomy (LH) is a risk factor for negative postoperative outcomes. Ensuring appropriate hemostasis enhances the safety of surgical procedures. An automatic bleeding recognition system based on deep learning can lead to safer surgeries; however, deep learning models that are useful for detecting and stopping bleeding in LH have not yet been reported. In this study, we aimed to develop a deep learning model to automatically recognize bleeding regions during liver transection in LH.In this retrospective feasibility study, bleeding scenes were randomly selected from LH videos, and the videos were divided into frames at 30 frames per second. Bleeding regions within the images were annotated by pixels, and subsequently, all images were assigned to the training, validation, and test datasets to develop the deep learning model. A convolutional neural network algorithm was used to perform semantic segmentation. After training and validation, the model was evaluated using images from the test dataset. Precision, recall, and Dice coefficients served as the evaluation metrics for the model.In total, 2203 annotated images from 44 LH videos were utilized and divided into 1500, 400, and 303 frames for the training, validation, and test datasets, respectively. The precision, recall, and Dice coefficient values of the model were 0.76, 0.79, and 0.77, respectively.We developed an automatic bleeding recognition model based on semantic segmentation and verified its performance. The proposed model is potentially useful for intraoperative alerting or evaluating surgical skills in the future.© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

There are few studies on the risk factors of postoperative complications after surgical treatment of hepatic hemangioma (HH). This study aims to provide a more scientific reference for clinical treatment.The clinical characteristics and operation data of HH patients undergoing surgical treatment in the First Affiliated Hospital of Air Force Medical University from January 2011 to December 2020 were retrospectively collected. All enrolled patients were divided into two groups based on the modified Clavien-Dindo classification: Major group (Grade II/III/IV/V) and Minor group (Grade I and no complications). Univariate and multivariate regression analysis was used to explore the risk factors for massive intraoperative blood loss (IBL) and postoperative Grade II and above complications.A total of 596 patients were enrolled, with a median age of 46.0 years (range, 22-75 years). Patients with Grade II/III/IV/V complications were included in the Major group (n = 119, 20%), and patients with Grade I and no complications were included in the Minor group (n = 477, 80%). The results of multivariate analysis of Grade II/III/IV/V complications showed that operative duration, IBL, and tumor size increased the risk of Grade II/III/IV/V complications. Conversely, serum creatinine (sCRE) decreased the risk. The results of multivariate analysis of IBL showed that tumor size, surgical method, and operative duration increased the risk of IBL.Operative duration, IBL, tumor size, and surgical method are independent risk factors that should be paid attention to in HH surgery. In addition, as an independent protective factor for HH surgery, sCRE should attract more attention from scholars.© 2023. The Author(s).