Three-Dimensional Models of Liver Vessels for Navigation during Laparotomic Attenuation of Intrahepatic Portosystemic Shunt in Dogs

SIMPLE SUMMARY: Portosystemic shunt (PSS) is a common abnormality in dogs where through an aberrant vessel, blood from the intestines bypasses the liver. Lack of hepatic detoxication can lead to a fatal outcome. The treatment of choice is a surgical closure of the shunt. In the case of the intrahepatic location of the shunt, its identification is often difficult and requires traumatic preparation of the liver, which influences the postoperative prognosis. Therefore, in order to reduce liver trauma, we printed 3-dimensional (3D) individual patient liver models, scaled 1:1, and used them for planning the surgery and as a guide during intraoperative identification of the shunt. Here, we present the application of this method in four dogs with intrahepatic PSS. The advantages of the 3D technology are simple and precise planning of the surgery, fast intraoperative identification of the shunt, and low invasive dissection of the liver parenchyma. We conclude that 3D technology can potentially raise the recovery rate. ABSTRACT: Laparotomic attenuation of an intrahepatic portosystemic shunt (IHPSS) is more difficult than an extrahepatic one, and results in a higher risk of complications because the identification of the aberrant vessel in the liver remains often a challenge. Excessive preparation and traction of the parenchyma results in trauma, bleeding, and prolonged surgery, which is what worsens the prognosis. Therefore, based on computed tomographic angiography, we printed 3-dimensional (3D) individual patient liver models, scaled 1:1, and used them for surgery planning and as a guide during intraoperative identification of the shunt in four dogs with IHPSS. The advantages of the 3D technology are simple and precise planning of the surgery, fast intraoperative identification of the shunt, and low invasive dissection of the liver parenchyma. We conclude that 3D technology can potentially raise the recovery rate. To the best of our knowledge, this was the first application of 3D models in the surgery of canine IHPSS.