Three-Dimensional Virtual Endoscopy for Laparoscopic and Thoracoscopic Liver Resection Takeshi Aoki, MD, PhD, Masahiko Murakami, MD, PhD, Tomotake Koizumi,

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Three-Dimensional Virtual Endoscopy for Laparoscopic and Thoracoscopic Liver Resection Takeshi Aoki, MD, PhD, Masahiko Murakami, MD, PhD, Tomotake Koizumi, MD, PhD, Akira Fujimori, MD, PhD, Haytham Gareer, MD, Yuta Enami, MD, PhD, Reiko Koike, MD, Makoto Watanabe, MD, PhD, Koji Otsuka, MD, PhD Journal of the American College of Surgeons Volume 221, Issue 2, Pages e21-e26 (August 2015) DOI: 10.1016/j.jamcollsurg.2015.04.012 Copyright © 2015 American College of Surgeons Terms and Conditions

Figure 1 Preoperative simulation of port position using 3-dimentional virtual endoscopy (3DVE). Optimal placement of ports position were simulated prior to surgery using 3DVE. Journal of the American College of Surgeons 2015 221, e21-e26DOI: (10.1016/j.jamcollsurg.2015.04.012) Copyright © 2015 American College of Surgeons Terms and Conditions

Figure 2 Each row shows the 3-dimensional virtual endoscopy (3DVE) image (left column) and the original laparoscopic camera image (right column). (A) The tumor location was confirmed on the 3DVE, and then the portion of the diaphragm located just above the tumor was opened. (B) Intraoperative thoracoscopic ultrasonography was performed on the liver surface to identify the tumor margin. (C) Clips were applied on segmental branch 8 of the portal vein before dissection (arrow). See Supplementary Video 1. Journal of the American College of Surgeons 2015 221, e21-e26DOI: (10.1016/j.jamcollsurg.2015.04.012) Copyright © 2015 American College of Surgeons Terms and Conditions

Figure 3 Each row shows the 3-dimensional virtual endoscopy (3DVE) image (left column) and the original laparoscopic camera image (right column). (A) The tumor (arrow) was located in Couinaud's segment III. (B) Clips were applied on the lateral sectional branch of the hepatic artery (arrowhead) before dissection. (C) Identification of the left portal branch. (D) Clips were applied on portal segmental branch 2 (P2) (arrowhead). (E) Clips were applied on portal segmental branch 3 (P3) (arrowhead) before dissection. (F) The sectional branch of the left hepatic vein was transected using a laparoscopic linear stapler. See Supplementary Video 2. Journal of the American College of Surgeons 2015 221, e21-e26DOI: (10.1016/j.jamcollsurg.2015.04.012) Copyright © 2015 American College of Surgeons Terms and Conditions