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Kościuszko et al. Hepatoma Res 2021;7:51 https://dx.doi.org/10.20517/2394-5079.2021.17 Page 13 of 16

hepatobiliary surgery because it seems much more comfortable to grasp the anatomy while using 3D models
and visualisations.

Another promising advancement is cinematic rendering (Siemens Healthineers), a new type of 3D imaging
with a realistic photo quality visualisation. This novel rendering algorithm simulates the propagation and
interaction of light passing through the volumetric images. Elshafei et al. compared cinematic rendering
[87]
with conventional computed tomography imaging in a randomised, two-sequence crossover study.
Cinematic rendering allowed for faster and more correct comprehension of the surgical anatomy. A similar
[88]
conclusion was drawn by Binder et al. who studied cinematic rendering in preclinical anatomy education.
The use of cinematic rendering of focal liver masses was described in 2019 .
[89]
CONCLUSIONS
Paediatric liver tumours are rare, and, in some complex cases, the treatment approach has to be made
individually. This is one of the instances where 3D imaging starts to play a role. It is possible that computer-
aided surgical planning will become routine in all major surgeries. Due to technical advances, the process
will become more automatic and will take less time. It will also become more available and affordable.

One of the main aims of virtual imaging is organ preservation in cases of locally advanced liver tumours. As
for now, the impact of virtual imaging has rarely been analysed in the paediatric population. 3D
reconstructions can allow for more aggressive surgical treatment when spatial relationships and crucial
anatomical structures are depicted.

The conclusions of the reviewed articles are very enthusiastic, and the progress that has already been made
in the field of computer-aided paediatric liver surgery is impressive. It is time to design studies appropriate
for measuring the new technologies’ effects on liver surgery outcomes.

The learning curves of those new technologies certainly have to be included in the study designs.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study and performed data analysis and
interpretation: Kościuszko D, Anzelewicz S, Czauderna P
Participated in the discussion, prepared tables and shaped the overall structure: Niemirycz-Makurat A,
Gołębiewski A, Kościuszko D
Prepared the final manuscript: Kościuszko D, Niemirycz-Makurat A, Anzelewicz S

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.