On October 28, 2002, a small team of scientists from MeVis Research - today the Fraunhofer Institute for Medical Image Computing (Fraunhofer MEVIS) - visited the Kyoto University Hospital to introduce liver surgeon Professor Koichi Tanaka to operation planning software developed by the team in Bremen. At the time, Professor Tanaka was the leading expert in living donor liver transplantation, a medically and logistically challenging procedure to transplant a part of the liver from a healthy donor into the body of a critically ill recipient. Professor Tanaka has carried out approximately one third of around 3000 living donor liver transplantations performed around the world until that time. For religious and ethical reasons, living donor liver transplantations are especially common in Asia.

After the researchers from Bremen demonstrated their developments for patient-specific operation planning, Professor Tanaka was greatly impressed. He requested that the team use their computer analysis for the next day’s living donor liver transplantation and present the results during the following morning case conference. The analysis, generated overnight, showed that a significantly smaller graft than what the Japanese surgeons had planned would suffice for the recipient. The decision was made to use the MeVis plan, which involved less risk to the donor, and the operation was successfully completed. From this day forward, Professor Tanaka did not perform a single living donor liver transplantation without the assistance of the researchers from Bremen.

The partnership between Bremen and Kyoto that grew out of this visit was an important milestone on the path towards clinically relevant and practical computer support for living donor liver transplantations. Since then, analysis has considered the effects of planned resections on not only the liver regions supplied by blood from the portal vein, but also the regions drained by the hepatic vein. Combining and weighting the patient-specific spatial supply and drainage patterns of the liver permits reliable assessment of operational risk for both donor and recipient, generation of an optimized proposal to divide the donor liver, and the anastomosis of the transplant’s vessels to the bloodstream of the recipient.

In addition to Kyoto University Hospital, many other transplantation centers worldwide have become partners in using Bremen’s operation planning services for living donor liver transplantation, including the Lahey Clinic in Boston and the Asian Center for Liver Diseases and Transplantation in Singapore. The clinical and practical benefits of the procedure have been proven by leading international surgeons and published in multiple academic journals.

In the context of an R&D project funded by the German Federal Ministry of Education and Research (BMBF) from 2003 to 2004, MeVis developed an internet-supported, FDA-certified service for computer-assisted image data analysis and operation planning (Distant Services). In March 2004, a small company was spun off, and since 2007, these and other services have been offered commercially by MeVis Medical Solutions AG in Bremen. In addition to the planning of living donor liver transplantations, the research team in Bremen also supports complicated operations to remove liver tumors. To date, over 150 clinics worldwide have used Bremen’s service, totaling over 6000 processed clinical liver cases.

Researchers at Fraunhofer MEVIS are currently involved in projects to extend the procedure, including connecting mobile devices as well as systems to supporting surgeons when transferring planned resection paths in the operating room. A further focus is the transfer of image-based operation planning to other organs such as the lungs.