3D-guided planning significantly enhances laparoscopic hepatectomy for complex liver tumors.

• Reduced intraoperative blood loss: 80 ml vs. 160 ml (p < 0.001).
• Lower bile leakage rate: 3.1% vs. 15.4% (p = 0.015) in matched pairs.

Consider adopting 3D-assisted techniques for better outcomes in challenging cases.

• In special-segment cases, operative times were shorter: 180 min vs. 250 min (p < 0.001) with 3D guidance.
• Bile leakage in special segments also decreased: 9.5% vs. 42.9% (p = 0.014).