To explore the application value of three-dimensional visualization and virtual reality (VR)-assisted indocyanine green (ICG) molecular fluorescence imaging in hepatectomy for central liver cancer.

One patient diagnosed with central liver cancer who underwent mesohepatectomy in Zhujiang Hospital of Southern Medical University in July 2018 was recruited in this study. The 27-year-old male patient was admitted to our hospital due to "liver space-occupying lesion for 2 d in physical examination". The informed consent of the patient was obtained and the local ethical committee approval was received. Three-dimensional visualization and VR technology were performed for preoperative evaluation and surgical planning. ICG molecular fluorescence imaging combined with non-vascular occlusion was applied during mesohepatectomy.

With three-dimensional visualization, organs were well displayed. The liver morphology, the adjacent relationship between tumor and hepatic vessels, and the distribution of important vessels could be clearly observed from multiple angles. The variation of common hepatic artery originated from the superior mesenteric artery. VR model demonstrated that the tumor was located in the Ⅳa, Ⅴ and Ⅷ segments. The tumor was approximately 11.5 cm×11.1 cm×8.5 cm in size, and it closely adhered to the main of right hepatic vein, which was invaded for 1 cm at the root with continuous interruption. Preoperative evaluation by the three-dimensional visualization and VR model matched with the intraoperative findings. Preoperative surgical planning was in accordance with the actual operation. The patient recovered well after operation. CT scan and three-dimensional visual reconstruction at postoperative 3 months showed that the middle lobe of liver was removed, the middle hepatic vein was absent, the left and right hepatic venous blood supply was in good condition, and no tumor residue or recurrence was found.

Three-dimensional visualization, VR combined with ICG molecular fluorescence imaging can be used in the resection of central liver cancer. Combined with non-vascular occlusion liver resection, the surgical safety can be improved and the risk of postoperative complications can be reduced.