Virtual Liver Set to Improve Surgery Outcomes

European researchers have developed a virtual liver that promises to improve the prospects of recovery for patients with diseases such as liver cancer and cirrhosis of the liver. The initial work was carried out in the framework of the EUREKA project Odysseus. EUREKA promotes international, market-oriented research.

The virtual liver is now being developed further in the EU-funded PASSPORT (Patient specific simulation and preoperative realistic training for liver surgery) project. PASSPORT is funded to the tune of EUR 3.6 million under the Information and Communication Technologies (ICT) Theme of the Seventh Framework Programme (FP7).

Between them, cirrhosis of the liver and liver cancer kill around 90,000 people in Europe every year. Surgery represents a major tool in the treatment of these diseases. The aim is to completely remove the diseased tissue while ensuring that the patient still has enough healthy liver tissue to survive. Currently, doctors use medical images of the liver to decide which patients have enough healthy liver tissue to undergo surgery. However, interpreting these two-dimensional (2D) images is rather difficult, as is their examination and analysis with other experts who are not present in person.

Enter the Odysseus project, which has developed software that can generate a three-dimensional (3D) image of a patient's liver and allow it to be shared by experts in different locations. The software provides doctors with detailed information on the shape of the patient's liver and the location of blood vessels in the organ. These details should lead to an increase in the number of patients who are considered eligible for surgery and help doctors to plan operations.

"Thanks to the 3D modelling, the future of liver surgery has gained more precision through accurate definition of the liver's blood vessels," commented Professor Luc Soler of the Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD) in France.

As well as providing doctors with an important new diagnostic tool, the software has also shed new light on the way the liver is segmented. Until now, liver surgery has been based on a model of the liver dating from 1957. The 3D modelling software reveals that in fact up to 50% of patients have a liver structure that differs markedly from that of the old model.

In fact, the system comprises a whole suite of technologies. In addition to the Virtual Patient Modelling tools which enable a pre-operative assessment to be carried out, Diagnosis and Virtual Planning software allows tools to be positioned within 3D images that can be reconstructed on any multimedia-equipped computer.

Two simulators even allow surgeons to practice the planned surgery on the virtual liver before operating on the patient. The simulators mimic the texture and resistance of liver tissue, and users comment that it is hard to tell the difference between the simulator images and photographs of surgery. The simulators can also be used to train surgeons.

Crucially, a communication system called Argonaute permits users in different locations to interact and offer advice based on the images at the same time.

The project partners, who hail from France, Germany and Norway, are already working to bring their new technologies to the market and implement their new system in hospitals.

Meanwhile, the work which began in Odysseus is continuing through the PASSPORT project, which began in June 2008.

PASSPORT will add biological, mechanical, dynamic and appearance information to the geometric model developed by Odysseus. The project partners have already made improvements to the software and made it freely available on the Internet.

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