Extended left hepatectomy -: modified operation planning based on three-dimensional visualization of liver anatomy

Background. Based on the patient history of a 62-year-old man with a centrally located hepatocellular carcinoma we describe the potential influence of three-dimensional computed tomography (3D CT) on operation planning in extended left hepatectomy. Method and results. By 3D reconstruction of the liver, not only variations of the intrahepatic vascular structure but also the number and extent of portal venous segments, as well as their relation to hepatic veins, can be visualized. Thus, areas at risk for either devascularization or venous congestion may be identified prior to liver resection. This is particularly important in extended hepatectomies with a small liver remnant, where already minor complications may have fatal consequences. Conclusion. In these resections, operation planning may be improved substantially by pre-operative 3D reconstruction.