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Page 8 of 16 Kościuszko et al. Hepatoma Res 2021;7:51 https://dx.doi.org/10.20517/2394-5079.2021.17

The authors found that virtual reconstructions provided information that was not obtained through
conventional imaging techniques. They qualitatively explored the possibilities for the use of 3D imaging.
The only measurable result provided is the number of procedures performed: seven patients received
interventions (out of twelve). The authors also found that combining reconstructions from different CT
phases on one 3D image provided further useful information. The authors had difficulty distinguishing
between portal branches and collaterals, and reduced contrast in the post-thrombotic vessels did not allow
proper identification.

[50]
In 2013, Souzaki et al. presented an augmented reality navigation system for endoscopic and open
surgery. In their case series, one patient had been diagnosed with hepatoblastoma. Initial CT and MRI
studies were performed with multimodality markers (Chiyoda Technol, Tokyo, Japan) fixed to the patient’s
body surface. 3D images were reconstructed using 3D viewer software (Virtual Place 300, AZE Co Ltd.,
Tokyo, Japan). Each multimodality marker’s coordinates were obtained with an optical tracking device
(Polaris, Nrthern Digital Inc., Ontario, Canada). A video camera registering the surgical image had a rotary
encoder to measure the rotation parameters. Liver borders were detected by the system, and preoperative
3D images were superimposed onto video camera live images on the screen. The authors’ most significant
difficulty was concerning motion and deformation of the intraoperative images of the liver. Respiratory
movement and deformation caused by pressure are essential factors that create differences between the
images and reality. Due to intraoperative organ movement, it was impossible to follow the intraoperative
organ deformations. The authors also found that the 3D image projected onto 2D monitors produced
dissatisfying results.

Souzaki et al. published in 2015 a case report of using a 3D-printed liver model based on preoperative CT
[51]
for a PRETEXT IV hepatoblastoma case, located at the porta hepatis after the neoadjuvant chemotherapy.
The model was created in a 3D workstation with ZedView, 3D Doctor, FreeForm (analytical software) and
CATIA, a three-dimensional interactive application. The model was printed on an Objet 500 connex 3
printer (Stratasys, USA) with the tumour, hepatic veins and portal veins seen through a translucent body.
The tumour was resected completely. The surgical margins were negative, and the patient was discharged
home. No recurrence was detected for a year. The authors found that the object can be sterilised and held in
the surgeon’s hand during surgery. Compared with 3D images, the authors found that the 3D model after
fabrication cannot be changed and manipulated during surgery.

Su et al. published, also in 2015, a case series of 21 paediatric patients with complex liver tumours. The
[52]
authors used Hisense Gemini 3-dimensional Medical Imaging Reconstruction (HIGEMI) and a computer-
assisted surgery (CAS) system. The images were segmented using the seeding technique. They segmented
the liver, tumour, hepatic arteries, portal vein, hepatic veins and inferior vena cava. The authors recorded
histopathological reports, duration of surgery, intraoperative blood loss, transfusions and complications.
One patient died. This is the only paper that mentions the HIGEMI system.

[53]
Soejima et al. described the case of an 11-month-old girl with biliary atresia after Kasai surgery who had
to undergo a liver transplant. The transplant turned out to be large-of-size and impossible to perform from
the CT image’s initial calculations. For a more detailed analysis of this area’s anatomy, the researchers
decided to make 3D models of the donor and recipient liver. ZedView (Data Design, Nagoya, Japan)
software was used to prepare the models. Thanks to those models, the resection line was changed to a more
optimal one, and the operation was planned. The surgery proceeded without intraoperative complications;
only slight blood loss was noted, and transfusion was not needed. Unfortunately, the postoperative course
was complicated by infection. The patient died due to an intracranial haemorrhage 135 days after the