ObjectiveTo evaluate the feasibility and accuracy of a novel three dimensional (3D) preoperative simulation software in a clinical setting for patients undergoing precise hepatectomy. MethodsThe clinical data of 85 patients with hepatocellular carcinoma underwent precise hepatectomy were retrospectively studied. All the patients received CT screening and subsequent evaluation on the liver resection volume and margin and the percentage of resected tumor by 3D preoperative simulation software, which compared with the actual resection liver values. The operation plan was optimized by virtual hepatectomy. ResultsThe liver, tumor as well as blood vessel could be clearly showed and reconstructed by 3D preoperative simulation software. All the patients underwent precise hepatectomy. After operation ascites occurred in 3 patients on 2 d, moderate pleural effusion occurred in 2 patients on 2 d, and bile leakage appeared in 4 patients on 5 d, which were improved by conservative treatment. The length of stay in all patients ranged from 6 to 88 d (mean 23 d), and no recurrence and death occurred within 30 d of operation. The predicted resection liver volume was significantly correlated with the actual resection volume (r=0.960, Plt;0.001), and the difference between the mean volume of predicted and actual resection liver was not significant (896.7 ml vs. 819.1 ml， t=1.851, P=0.068). In addition, the predicted resection margin was also correlated with the actual resection margin (r=0.972, Plt;0.001), with the difference in the mean resection margin was not significant too (12.2 mm vs. 11.9 mm， t=1.143, P=0.256). No patients suffered from severe postoperative complications. ConclusionsThe 3D preoperative simulation software is able to evaluate and simulate liver resection accurately, which may contribute to a safe precise hepatectomy plan.