Three-Dimensional Reconstruction in the Planning of a Complex Liver Surgery

Objective: through 03 clinical cases, we present our experience in using 3D reconstruction in the planning of complex liver surgery. 

Context: in hepatic surgery, the three-dimensional reconstruction of the liver anatomy has proved its utility in the planning of the surgical procedure. The creation of a digital twin specific to each patient allows us to study the different possibilities of resection through preoperative simulations. 

Methods and patients: within the oncological surgery department of the BLIDA cancer center, between October 2017 and August 2021, 46 patients with primary or secondary liver lesions had benefited from a 3D reconstruction based on preoperative tomographic imaging. For each patient, a 3D model of the liver had been realized highlighting within semi-transparent hepatic parenchyma all the intrahepatic (portal veins, hepatic arteries, biliary tree, and tumor lesions.) and extrahepatic (vena cava, portal vein, hepatic arteries, and bile ducts.) elements.

This 3D model is used in the analysis and preoperative discussion of the different therapeutic possibilities (resectability, extent of resection, precise volumetry) and the planning of the surgical protocol to be followed.

In multifocal tumors or voluminous tumors requiring major hepatic resections, the spatial representation of the specific anatomy of the patient had allowed detecting the possibility of realizing less extensive resections thus allowing a parenchymal sparing and to secure the operative act more by foreseeing the possible intraoperative accidents.

Conclusion: exhaustive preoperative imaging (CT and MRI) is necessary before any hepatobiliary surgery. It allows providing precise vascular mapping, realizing a resectability assessment, and participating in the surgical planning thanks to radio-surgical coordination. The creation of a 3D model from conventional tomographic imaging could become essential before any hepatobiliary surgery because of the spatial dimension it provides to the surgeon.