The impact of 3-dimensional models and surgical navigation for open liver surgery.

Purpose: Understanding patient-specific liver anatomy is crucial for patient safety and achieving complete treatment of all tumors during surgery. This study evaluates the impact of the use of patient-specific 3D liver models and surgical navigation on procedural complexity in open liver surgery.

Methods: Patients with colorectal liver metastases scheduled for open liver surgery were included between June 2022 and October 2023 at the Netherlands Cancer Institute. Patient-specific 3D liver models could be used upon request during the surgical procedure. Subsequently, surgeons could request additional surgical navigation by landmark registration using an electromagnetically tracked ultrasound transducer. Postoperatively, surgeons assessed the impact of the use of the model and navigation on procedural complexity on a scale from 1 to 10.

Results: 35 patients were included in this study, with a median number of 8 (ranging from 3 to 25) tumors. 3D models were utilized in all procedures. Additional navigation was requested in 21/35 of patients to improve intraoperative planning and tumor localization. The mean procedural complexity score with navigation was 4.3 (95% CI [3.7, 5.0]), compared to 7.8 (95% CI [6.6, 9.0]) with the 3D model alone. Both visualization methods improved lesion localization and provided better anatomical insight.

Conclusion: 3D models and surgical navigation significantly reduce the complexity of open liver surgery, especially in patients with bilobar disease. These tools enhance intraoperative decision-making and may lead to better surgical outcomes. The stepwise implementation of the visualization techniques in this study underscores the added benefit of surgical navigation beyond 3D modeling alone, supporting its potential for broader clinical implementation.