The liver is, in one sense, the most deceptive organ in surgery. On a CT scan, it appears as a homogeneous grey mass. The tumours within it are visible. But the precise three-dimensional relationship between a tumour and the hepatic veins, portal vein branches, and bile ducts that thread through the parenchyma — the structures that determine what can be safely removed — is something that flat imaging communicates poorly. Surgeons with decades of experience routinely encounter surprises once they are inside. The question is whether those surprises were avoidable.
The patient presented with a large tumour in the right lobe of the liver. Imaging confirmed the diagnosis and showed the extent of the mass. A hepatobiliary surgeon assessed the case for resection. The critical concern was the proximity of the tumour to the right hepatic vein and the posterior sectoral portal pedicle. Resecting the tumour with adequate oncological margins while preserving enough functional liver volume, and without compromising the vascular supply to the remnant, required a degree of spatial precision that the available 2D imaging made difficult to plan with confidence.
The surgical team requested a 3D printed model from Osteo3d. CT data was segmented to isolate the liver parenchyma, the tumour, the hepatic vein system, the portal vein branches, and the bile duct tree. These structures were rendered in distinct colours within a single printed model — the overall liver contour transparent enough to reveal the internal anatomy within it, with the tumour, vessels, and ducts visible in their true spatial relationships.
The model provided immediate clarity. The tumour was closer to the right hepatic vein than the 2D axial images had conveyed. A segment of the posterior right liver that had been provisionally included in the planned resection was identifiable on the model as safely preservable — with direct vascular supply running clear of the intended resection plane. The resection line was adjusted accordingly, increasing the planned functional remnant volume. The team also identified a short-course right hepatic duct variant whose preservation would be critical.
Surgery proceeded with the model available on the sterile field for reference. The resection was completed with clear margins. The bile duct variant was preserved. The patient's recovery was uncomplicated.
This case reflects a consistent finding across hepatobiliary surgery: the surgeon who has held the anatomy in their hands before the incision operates differently from the surgeon who has only viewed it on a screen. Liver models do not replace the CT. They translate it — from a set of images that must be mentally reconstructed into a physical object that can be examined from any angle, passed between members of the surgical team, and referred to in the moment of decision.
Osteo3d Team
Clinical Affairs