To investigate the application value of three-dimensional visualization in hepatectomy and to analyze its error in the design of semi-hepatic transection plane.

Clinical data of 59 patients included in the monograph entitled Liver Resection by Top Chinese Masters were retrospectively analyzed. Among them, 37 patients were male and 22 female, aged (54±14) years on average. 46 patients were diagnosed with malignant liver tumors, 1 case with hilar cholangiocarcinoma, 2 cases with hepatic cystadenomas, 3 cases with hepatic hemangiomas, 1 case with focal nodular hyperplasia, 3 cases with hepatolithiasis, 1 case with hepatic hydatid disease and 2 cases of living donor liver resection. Surgical videos related to semi-hepatic transection and corresponding semi-hepatic transection plane designed by three-dimensional visualization before operation were screened. The intraoperative transection plane was compared with the preoperatively designed plane and the error and causes were analyzed.

Three-dimensional reconstruction was adopted in 18 cases before operation, and 14 of them were included in the analysis. Preoperative and intraoperative transection planes were not matched in 10 cases, while matched basically in4 cases. Liver was not resected along the Cantlie line in 9 cases, including 7 cases of cutting along the longitudinal axis of middle hepatic vein, 1 case along the right side wall of inferior vena cava, and 1 case of cutting line deviating from the midpoint of gallbladder resection. Liver was resected along the Cantlie line in1 case, but the designed plane failed to avoid the tumor.

Three-dimensional reconstruction is not applied frequently in hepatic resection. Preoperative design of liver transection plane should be implemented by qualified professional technicians, and jointly reviewed and examined by senior surgeons of hepatic surgery and experienced physicians of imaging or related technicians. Semi-hepatic transection plane should be designed along the Cantlie line in combination with the principle of liver cancer resection.