HKU's World-First 'Liver-in-Cube' Revolutionises Liver Cancer Treatment with Precision

Liver cancer is the sixth most common cancer worldwide and the third leading cause of cancer-related deaths. A recent report published in 'The Lancet' predicts that the number of new liver cancer cases will increase from 870,000 in 2022 to 1.52 million by 2050, nearly doubling the figure. If the current trend continues, this increase could result in 1.37 million deaths.

Traditional cancer therapies often overlook patient-specific and dynamic tumor immune environments, causing ineffective treatments, toxic side effects, and critical delays. The University of Hong Kong (HKU) has developed 'Liver-in-Cube', the world's first 3D-bioprinted platform that precisely reconstructs the liver cancer microenvironment in the lab using a patient's own cells and extracellular matrix. This platform offers a fast and reliable service to help patients identify the most effective personalised treatments and pave the way for a standardised, high-throughput solution for drug assessment and development.

The invention can accurately simulate tumour characteristics of individual patients, such as the cell numbers, tissue stiffness and immune microenvironments, enabling doctors to swiftly assess the efficacy and side effects of various drugs and emerging therapies, leading to more precise treatment decision. This technology has received the ‘Gold Medal’ at the International Exhibition of Inventions of Geneva, ‘Special Grand Prize’ at Prize of the China Invention Association, and ‘Best-Performing Start-Up Award’at Asia Summit on Global Health (ASGC) Conference.

The technology has received the ‘Gold Medal’ at the International Exhibition of Inventions of Geneva, ‘Special Grand Prize’ at Prize of the China Invention Association, and ‘Best-Performing Start-Up Award’at Asia Summit on Global Health (ASGC)Conference. Photo source: HKUMed

From ‘Trials to Tailored Treatment’: Seizing the Golden Treatment Window

Currently, there is a lack of personalised drug-screening platforms for liver cancer treatment in the market, which often makes patients undergo multiple treatment failures in the search for the most suitable drug. This not only imposes a heavy financial burden but may also delay the timing in killing the tumour cells effectively. The 'Liver-in-Cube' directly addresses this pain point by accelerating the evaluation of the efficacy and side effects of various drugs for patients, allowing doctors to identify the optimal treatment method for patients and reducing the risk of cancer recurrence due to treatment delays. The ‘Liver-in-Cube' has now started patient recruitment at local hospitals to expedite clinical trials and advance its transition into clinical application.

The 'Liver-in-Cube' developed by HKU, Photo source: HKUMed

Dual Value in Clinical and Research Excellence

Professor Man Kwan, Chair Professor in the Department of Surgery, School of Clinical Medicine, HKUMed, who led the research project, stated that ‘Liver-in-Cube' can speed up the identification of the most effective drugs for patients, significantly enhancing treatment efficiency and reducing side effects, with the potential to greatly improve patient survival rates. In pharmaceutical development, the technology serves as a substitute for animal models, accelerating preclinical efficacy and safety testing for new drugs with more accurate data to increase the success rate of further clinical trials. This invention can shorten the new drug development cycle with reducing costs. In the field of basic research, the model assists researchers in exploring immune regulation mechanisms and discovering new therapeutic targets and strategies. The application prospects of the ‘Liver-in-Cube' are extensive, and its technological framework can be expanded to other liver diseases and cancers, promoting the widespread adoption of precision medicine. Currently, the technology is undergoing clinical trials in local public and private hospitals. The team aims to leverage the scientific data to facilitate the commercialisation of the technology and make it available in both local and overseas markets, thus benefitting a wide range of patients.

The University of Hong Kong (HKU) has developed‘Liver-in-Cube’,the world’s frst 3D-bioprinted platform that precisely reconstructs the liver cancer microenvironment in the lab using a patient’s own cells and extracellular matrix. Photo source: HKUMed

Five core technologies of ‘Liver-in-Cube':

• 1. Novel Technology for Cell and Matrix Protein Separation: Simultaneously extracts hepatocytes, tumor cells, immune cells, and matrix proteins from the tissue of the liver cancer patient, accurately simulating individual tumor characteristics.

• 2. Advanced 3D Bioprinting: Creates a biomimetic model incorporating normal tissue, tumor tissue, and vascular structures, surpassing traditional 3D cell culture and organoid products in reproducing a patient's tumor architecture.

• 3. AI-assisted patient parameterisation and printing: Utilising AI models trained on clinical biobanks, we correlate pathological features, tissue stiffness, and tumor immune microenvironment subtypes to determine the optimal geometric structure and bio-ink composition for each patient.

• 4. Customised patient-specific tumor characterisation system: By precisely measuring patient-specific parameters such as tumor stiffness and immune profiles, we reconstruct a highly biomimetic, individualized tumor microenvironment for each patient.

• 5. Innovative Tumor Model with Microvascular System: Enables continuous drug testing and evaluation of various therapies, enhancing the assessment of treatment effects in a laboratory setting.

Led by Professor Man Kwan from the Department of Surgery, HKUMed, the research
team focuses in the study of postoperative recurrence and immune microenvironment
of liver cancer. Over the decades, the team has become internationally recognised as
the leading force in the fields of liver oncology, transplant oncology, and transplant
immunology.

A research team from the Department of Orthopaedics and Traumatology, School of Clinical Medicine, LKS Faculty of Medicine of the University of Hong Kong (HKUMed), has demonstrated that robotic total hip replacement has a lower reoperation rate than the conventional technique. The study found a 90-day reoperation rate of only 0.6% with robotic procedures as compared to 2.5% with conventional procedures. Robotic procedures thus promise long-term benefits for patients, enabling them to regain mobility and return to normal life.

End-stage hip arthritis causes severe groin pain, joint stiffness and functional deficit, including impairment in walking, sitting and standing. While total hip replacement is a common operation, complications can occur and may lead to reoperation and prolonged recovery times.

Precision in robotic arm assisted total hip replacement

Compared to conventional technique, robotic hip replacement utilises three-dimensional computed tomography scans for precise preoperative planning of both acetabular and femoral components. During surgery, acetabular bone preparation and implant positioning are carried out under robotic arm guidance, allowing for precise control over bone removal and cup placement.

Dr Henry Fu Chun-him, Clinical Associate Professor and Chief of the Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, School of Clinical Medicine, HKUMed, said, ‘The robotic arm allows the direction and depth of the acetabular cup placement to be executed in accordance with preoperative planning, achieving angular precision down to 2 degrees and depth accuracy within 2mm.’

Six-year local data confirms safety advantages of robotic hip replacement

The research team reviewed the results of 553 primary total hip replacement surgeries performed in Queen Mary Hospital and the Duchess of Kent Children's Hospital at Sandy Bay Joint Replacement Centre between 1 January 2019 and 31 December 2024. These included 311 robotic total hip replacements and 242 conventional total hip replacements. The rate of reoperation within 30 and 90 days after surgery was lower for the robotic total hip replacement.

Dr Fu added, ‘Early reoperations after total hip replacement are devastating. With robotics, the rate of reoperation at 90 days is only 0.6%.’ In cases requiring reoperation in the robotic group, all procedures were done in a closed manner without the need for surgical reopening. In contrast, the conventional group had a 2.5% reoperation rate due to periprosthetic fractures and wound infections, requiring surgical reopening and resulting in prolonged recovery times.

While robotic procedures were associated with an overall increase in operative time of 14 minutes, the team observed a clear learning-curve effect, with surgical times progressively approaching those of conventional manual procedures.

Growing utilisation of robotic surgery

HKUMed Department of Orthopaedics and Traumatology was the first in Hong Kong to utilise robotic arm technology for joint replacement surgery in public hospitals, beginning in January 2019.

Dr Amy Cheung Yim-ling, Honorary Clinical Assistant Professor and Deputy Division Chief of the Division of Joint Replacement Surgery of the same department, said, ‘The utilisation of robotics for total hip replacement in Queen Mary Hospital and the Duchess of Kent Children' s Hospital at Sandy Bay has risen steadily from 32% in 2019 to 85% in 2025. In the local public sector, robotic procedures now account for 49% of total hip replacement surgeries.’

HKUMed study demonstrates that robotic total hip replacement has a lower reoperation rate than the conventional technique. The research team members include Dr Henry Fu Chun-him (right) and Dr Amy Cheung Yim-ling.

HKUMed study demonstrates that robotic total hip replacement has a lower reoperation rate than the conventional technique. The research team members include Dr Henry Fu Chun-him (right) and Dr Amy Cheung Yim-ling.

Dr Henry Fu Chun-him (right) highlights that increased experience has progressively shortened the surgery time of robotic total hip replacement. Ms Lai (middle), a patient who has recovered after the robotic surgery, shares that the robotic surgery helps her regain mobility and return to normal life.