Personalized 3D surgical planning in liver transplantation: A new era in preoperative assessment and management of vascular and biliary complications

Abstract

PURPOSE: This study aimed to analyze next-generation 3D modeling software utility for personalized surgery in the field of liver transplantation. METHODS: A retrospective cross-sectional pilot study was conducted at two referral centers including cases of liver transplantation-related complications - either preoperative portal vein thrombosis (PVT) or postoperative portal, arterial or biliary strictures - for which high-quality radiologic imaging was available. 3D model diagnostic accuracy was evaluated on arterial complications comparing the thrombosis/stenosis extension described by the virtual model and the actual site of the new arterial anastomosis at retransplantation (gold standard). In addition, the perceived benefit of 3D reconstructions was assessed through a questionnaire submitted to the experienced surgeons of the team (Likert scale, 1 to 5). RESULTS: Thirty-nine patients were included in the study population: 17 with arterial thrombosis/stenosis, 11 with portal vein thrombosis and 11 with biliary strictures diagnoses. The concordance rate between 3D models' virtual reproduction and intraoperative findings evaluated for arterial complications was 88.2%. According to the most experienced surgeons of the team, 3D models provide a high benefit in surgical planning (4.6/5 on a Likert scale). CONCLUSIONS: Virtual reconstructions are particularly useful in transplantation-related complication management, giving reliable representation of structures' caliber, trajectory, and spatial relationships; identifying anatomical variants and locating the level, length, and severity of vascular and biliary strictures. In such a complex scenario, the 3D models' visual clarity helps harmonize perspectives within the multidisciplinary team, fostering more informed and shared clinical decisions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00423-026-03984-w.