Planning the treatment: preoperative 3D reconstruction

Computed tomography and/or magnetic resonance imaging are commonly used for definite diagnosis of liver tumors, but they furnish only two-dimensional data to the surgeon, which in many cases is difficult to use during surgical treatments because the surgeon must evaluate the three-dimensional (3D) aspect of the lesion to be removed or ablated and understand patients’ hepatic features and vascular structures. The limitations of this imaging techniques mainly are due to the absence to furnish a realistic 3D perception of the anatomical intra-hepatic structures as the relationship of the lesion and the vasculo-biliary anatomy. Furthermore, in recent years, laparoscopic surgery underwent rapid development, but it requires preoperative planning more accurately than open surgery: laparoscopic ultrasound should help the surgeon to identify the position of the lesion, its relationship with Glissonian pedicles and the best resection lines. 3D reconstruction view and 3D printing technologies can clearly demonstrate the precise spatial anatomy of a nodule and can help the surgeons improve their surgical preparations, which can be used for either liver resection or thermoablation. The use of 3D-printed models or holograms in the operative room during the operation increases the surgical accuracy. This article describes all the phases of the hepatic 3D modeling and printing procedure, convenient for improving our preoperative surgical preparation for personalized surgery.