Three-Dimensional Reconstruction of Hepatic Imaging to Tailor Complex Liver Resection: A Preliminary Australian...

Safe hepatic resection relies on precise understanding of patient-specific anatomy. This is challenging with conventional two-dimensional imaging and can lead to unnecessarily large resections. While three-dimensional (3D) reconstruction offers superior visualisation, its adoption has been limited by complex workflows. This study reports an initial experience of an Australian centre using the streamlined Fujifilm Synapse 3D system for planning complex liver resections.

We prospectively evaluated five patients undergoing complex hepatic resection. Patient-specific 3D models were generated from preoperative computed tomography/magnetic resonance imaging scans. Two hepatobiliary surgeons used these interactive models to assess tumour anatomy, simulate resections, and devise a consensus operative strategy. The primary aim was to assess the technology's feasibility and its influence on bespoke surgical plans, particularly the adoption of parenchyma-sparing surgery (PSS).

The 3D models directly influenced the surgical plan in four of five cases. In two patients with multifocal metastases and borderline liver function, 3D planning enabled complex PSS that increased the future liver remnant by an estimated 30%, avoiding high-risk hepatectomies. In two others with large hepatocellular carcinomas, the models facilitated super-selective anatomical resections that maximised parenchymal preservation.

Our initial experience demonstrates the Synapse Fujifilm 3D reconstruction system is a practical and clinically valuable tool. By providing intuitive, patient-specific anatomical detail, it facilitates a shift towards complex PSS, refining surgical approaches, enhancing operative safety for patients with challenging hepatic malignancies.