OBJECTIVETo study the value of three-dimensional (3D) visualization, 3D printing and 3D laparoscopy (3-3D techniques) in the diagnosis and surgical treatment of hepatic tumors.

METHODSFrom November 2013 to January 2015, 22 patients with hepatic tumors admitted in our department underwent abdominal thin-slice CT scanning. The CT images were imported into Medical Image three Dimensional Visualization System (MI-3DVS) for 3D reconstruction. Standard Template Library (STL) files were exported for 3D printing. The hepatic vascular classification and predicted liver resection were performed with the aid of MI-3DVS system. The 3D models were then printed and virtual liver resections were executed accordingly. Based on these preoperative surgical planning data, we performed anatomical hepatectomy using 3D laparoscopy, and the intraoperative blood loss, volume of virtual and actual liver resection and postoperative hospital stay were recorded.

RESULTSAccording to Michels's classifications, 19 patients had type I, 2 had type II, and 1 had type VIII hepatic arteries; based on Cheng classifications, the portal vein was classified into type I in 17 cases, type II in 2 cases, and type III in 2 cases, and type IV in 1 case; according to Nakamura classifications, the right hemiliver hepatic vein was classified into type I in 10 cases, type II in 7 cases, and type III in 5 cases. In the virtual operations, the mean volume of liver resected was 490 ± 228 ml and the mean remnant liver volume was 885 ± 139 ml, with a remnant to functional liver volume ratio of (71 ± 11)%. The 3D printed models stereoscopically displayed the location of the liver tumors and adjacent liver vascular structure clearly. Laparoscopic hepatectomy was performed successfully in 20 patients guided by the 3-3D techniques, and the other 2 patients required convertion to open hepatectomy. The mean operation time was 186 ± 92 min, the intraoperative blood loss was 284 ± 286 ml, the mean actual liver resection volume was 491 ± 192 ml, and the mean postoperative hospital stay of the patients was 8.6 ± 3.7 days.

CONCLUSIONSThe 3-3D technique can facilitate the evaluation of preoperative risk and critical anatomical structures and navigate the surgical procedure in real time in anatomical hepatectomy for hepatic tumors.