To evaluate the application value of three-dimensional visualization in the evaluation of giant liver tumors before laparoscopic resection.

Clinical data of 24 patients who underwent laparoscopic resection of giant liver tumors in the 900^th hospital of PLA Joint Logistics Support Force from January 2017 to December 2020 were retrospectively analyzed. Among them, 10 patients were male and 14 female, aged (48±5) years on average. 10 patients were diagnosed with primary liver cancer, 12 cases with hepatic hemangioma and 2 cases with focal nodular hyperplasia of the liver. The informed consents of all patients were obtained and the local ethical committee approval was received. Preoperatively, two-dimensional CT images were collected and imported into three-dimensional visualization software. The images of liver, hepatic artery system, portal vein system, hepatic vein system and tumors were subjected to image segmentation and three-dimensional reconstruction. Surgical plan was determined according to three-dimensional reconstruction results. The resection plane of the liver was pre-designed. Appropriate surgical routes and patterns were selected.

All 24 patients successfully completed three-dimensional visualization model reconstruction. Three-dimensional reconstruction could clearly display the anatomy of various vascular systems in the liver, the exact location and size of the tumor and its adjacent relationship with blood vessels. Three-dimensional visualization detected that the total liver volume was 2 732(2 325-2 964) ml, the liver tumor volume was 1 366(1 145-1 758) ml, and the pre-resected liver volume was 1 595(1 108-1 806) ml. The estimated ratio of the remaining liver volume to standard liver volume was 46.7%(41.4%-62.2%). All 24 patients successfully completed laparoscopic resection of giant liver tumors. The consistence rate between the actual surgical routes and procedures, and preoperative plans was 100%. The actual resected liver volume of patients with malignant liver tumors and focal nodular hyperplasia was 1 602(1 203-1 806) ml, which was 100% consistent with the pre-resected liver volume before operation. The intraoperative blood loss was 700(100- 2 000) ml. The incidence of postoperative complications was 25%(6/24). No severe hepatic insufficiency or death occurred after operation.

Three-dimensional visualization can deliver accurate evaluation of giant liver tumors before laparoscopic resection, facilitate precise intraoperative procedures, and enhance the accuracy and safety of laparoscopic resection of giant liver tumors.