Enhancing preoperative planning for colorectal liver metastases: the role of open source 3D reconstruction across different levels of surgical expertise

Background: This prospective study evaluated open-source 3D reconstruction's impact on the preoperative assessment of colorectal liver metastases (CRLM) compared to standard 2D computed tomography (CT), focusing on its role as an “educational equalizer.” Methods: Thirty physicians, stratified by expertise, evaluated 10 cases of varying complexity. Performance was measured via a standardized scoring system (0–8), execution time, and satisfaction surveys. Results: 3D modeling significantly improved diagnostic accuracy, with median scores increasing from 3.0 to 6.0 (p < 0.001). Mean evaluation time was reduced from 268.5 to 147.5 s (p < 0.001). Notably, Juniors using 3D reached accuracy levels comparable to Specialists using 2D-CT. User satisfaction was significantly higher for 3D reconstruction (p < 0.001). Conclusions: 3D reconstruction reinforces 2D-CT for CRLM planning, enhancing anatomical understanding and reducing cognitive workload. By supporting varying expertise levels, it acts as a useful educational tool for surgical training.