To evaluate the application value of three-dimensional visualization in laparoscopic anatomical hepatectomy for type Ⅰ hepatolithiasis.

Clinical data of 33 patients with type Ⅰ hepatolithiasis admitted to Xiangxi Autonomous Prefecture People's Hospital from June 2017 to March 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 14 patients were male and 19 female, aged from 26 to 71 years, with a median age of 49 years. According to the preoperative CT three-dimensional reconstruction model of hepatic artery, portal vein, hepatic vein and bile duct, preoperative simulated surgery was performed, and the optimal surgical plan was determined. Combined with the intraoperative ultrasound navigation, laparoscopic anatomical hepatectomy was performed. Perioperative conditions were observed.

Three-dimensional reconstruction images could clearly display the morphology of the first, second, third hepatic bile ducts, and the size, quantity distribution of stones, the range of narrowed or dilated bile ducts, portal vein, hepatic vein, hepatic artery and its branches of patients. The consistency rate between intraoperative findings and preoperative three-dimensional reconstruction images was 100%(33/33), and the consistency rate between intraoperative procedures and surgical plan was 100%(33/33). All the patients successfully completed laparoscopic hepatectomy, and no patient was converted to open surgery. Among them, left hemihepatectomy was performed in 10 cases, left lateral lobectomy in 8, right hemihepatectomy in 3, right anterior lobectomy in 1, right posterior lobectomy in 5 and segmental or combined segmental resection in 6, respectively. The average operation time was (208±61) min, intraoperative blood loss was (284±68) ml, and no blood transfusion was delivered. The length of postoperative hospital stay was (11±4) d.No patient died after operation. Postoperative complications occurred in 3 patients, including 1 case of hepatic effusion, 1 case of gastric emptying disorder and 1 case of reactive right pleural effusion, which were cured after conservative treatments. T-tube angiography at postoperative 2 months detected no residual stone or bile duct stenosis, and no recurrence of cholangitis.

Three-dimensional visualization can help to perform precise laparoscopic hepatectomy in patients with type Ⅰ hepatolithiasis, which can completely remove the stones and lesions, mitigate the stenosis, drain unobstructed, and reduce the incidence of complications.