Seeing the invisible: Three-dimensional liver modeling from simulation to the scalpel

Area of Science:

• Hepatobiliary Surgery
• Medical Imaging
• Surgical Technology

Background:

• Liver resections demand precise planning due to complex patient-specific anatomy.
• Traditional 2D planning increases risks in complex cases like extended hepatectomies.
• 3D technologies offer potential solutions for enhanced surgical decision-making.

Purpose of the Study:

• To review the role of 3D liver technologies in surgical planning and decision-making for liver resections.
• To synthesize evidence on digital visualization, 3D printing, and intraoperative navigation in liver surgery.
• To identify benefits, limitations, and future directions for 3D applications in liver resection.

Main Methods:

• Narrative, question-driven review of clinical studies.
• Focus on liver resection workflows utilizing 3D visualization/planning, 3D printing, or intraoperative navigation.
• Analysis of reported benefits and challenges associated with 3D technologies.

Main Results:

• 3D planning significantly benefits anatomically complex or borderline liver resection cases.
• Benefits include enhanced decision transparency and process-level endpoints (mapping, orientation).
• Consistent effects on morbidity and liver-specific outcomes are limited; AR/MR navigation faces registration and deformation challenges.

Conclusions:

• 3D liver technologies, including visualization, printing, and navigation, are valuable for complex liver resections.
• Further research needs to standardize outcomes, define error budgets, and report task-relevant accuracy.
• 3D printing is beneficial for high-stakes anatomy, communication, and education, with feasibility considerations.