Three-Dimensional Imaging Applications in Hepatic Surgery

Three-dimensional (3D) imaging has transformed hepatic surgery by enabling precise visualisation of liver anatomy, pathology and vascular structures prior to and during operative procedures. Preoperative 3D reconstruction based on computed tomography or magnetic resonance imaging data allows for volumetric assessment of future liver remnant, detailed mapping of portal and hepatic veins, and tailored resection planning. Virtual simulation platforms facilitate rehearsal of complex segmentectomies, minimising unexpected vascular encounters and reducing operative time. In parallel, 3D printing of patient-specific liver models provides tactile feedback for surgical teams and enhances multidisciplinary discussion of resection strategies, particularly in the context of multifocal tumours or rare anatomical variants. Intraoperative integration of 3D navigation, augmented reality overlays and real-time imaging modalities such as magnetic resonance or fluorescence enhances orientation within the hepatic parenchyma and supports margin-negative resection without unnecessary sacrifice of healthy tissue.

These innovations have yielded measurable improvements in safety and efficiency. Surgeons report shorter operating times, reduced blood loss and fewer postoperative complications when employing 3D-guided workflows. Moreover, the ability to fuse preoperative models with live intraoperative data has broadened the scope of minimally invasive and robotic approaches by compensating for the limited tactile feedback inherent in those techniques. As computational power and imaging resolution continue to advance, 3D applications are poised to become standard practice in hepatobiliary units worldwide, promoting more precise, less invasive and better-informed hepatic surgery.

Research from Nature Portfolio

Foundational work has delineated the developmental origins and vascular physiology underlying liver segmentation through three-dimensional embryonic reconstructions. By applying advanced 3D-remodelling software to early human livers, researchers have clarified how asymmetric branching of portal and umbilical veins, as well as the emergence of hepatic vein outlets, determine cryptic lobar boundaries and consistent segmental topography. This anatomical framework underpins modern segment-based navigation, ensuring that patient-specific 3D models accurately reflect true vascular territories and support precise surgical planning.

Research from all publishers

Intraoperative magnetic resonance imaging has been integrated into hepatectomy workflows to detect small hepatocellular carcinoma lesions invisible on ultrasound, achieving complete resection with high tumour-free margins and confirming the safety and efficacy of real-time 3D guidance for small and deep-seated nodules.

Prospective preoperative cohorts have demonstrated that 3D-printed dry-laboratory liver models significantly reduce intraoperative blood loss and overall perioperative complications in complex laparoscopic resections, validating the protective role of patient-specific tangible guides in surgical planning for intricate hepatobiliary disease.

Three-dimensional visualization combined with image fusion technology has been applied in liver cancer with portal vein tumour thrombus to deliver accurate future liver remnant assessment, precise classification of tumour thrombi and seamless intraoperative navigation, thereby improving surgical safety and aligning operative plans with real-time anatomical findings.

Three-Dimensional Imaging Applications in Hepatic Surgery publication trend

The graph below shows the total number of articles in three-dimensional imaging applications in hepatic surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Three-dimensional reconstruction: Computational rendering of organ structures in three dimensions from two-dimensional imaging data to visualise anatomy and plan interventions.

Segmentation: Digital process of delineating discrete anatomical regions or lesions within imaging datasets to enable volumetric analysis and model generation.

Volumetry: Measurement of organ or tissue volumes, particularly future liver remnant, to predict postoperative functional capacity and reduce the risk of liver failure.

Fluorescence navigation imaging: Intraoperative technique using fluorescent dyes to highlight biliary or vascular structures under specialised lighting, aiding real-time orientation.

3D-printed model: Physical replica of a patient’s liver anatomy produced by additive manufacturing, used for preoperative simulation and surgical rehearsal.

References

1. The Effect of Three‐Dimensional Preoperative Simulation on Liver Surgery. World Journal of Surgery (2017).
2. Human liver segments: role of cryptic liver lobes and vascular physiology in the development of liver veins and left-right asymmetry. Scientific Reports (2017).
3. Feasibility, safety, and efficacy of intraoperative magnetic resonance imaging-guided hepatectomy for small hepatocellular carcinoma: A retrospective study. PLOS ONE (2024).
4. Precise planning based on 3D-printed dry-laboratory models can reduce perioperative complications of laparoscopic surgery for complex hepatobiliary diseases: a preoperative cohort study. BMC Surgery (2024).
5. Application of 3-dimensional visualization and image fusion technology in liver cancer with portal vein tumor thrombus surgery. Medicine (2024).