Functional 3DVR imaging of abdominal wall hernias

Abstract

The purpose of this illustrative pictorial series is to demonstrate the value of an image technique known as 3D Volume Rendering (3DVR) for the pre-operative visualization and assessment of complex abdominal hernias. A small subset of complex abdominal hernia cases were selected from our early clinical experience with 3DVR to illustrate the value of visualizing standard 2D computed tomography (CT) data from a 3D perspective. For the surgeon, preoperative 3DVR can assist the holistic understanding of abdominal hernias and any associated fascial defects, unsuspected additional hernias, dysfunctional abdominal wall bulges/eventrations, muscle denervations or atrophic changes, mesh placements, other post-surgical changes such as scarring, and relevant skeletal changes. For the patient, 3DVR provides an easily grasped understanding of the relevant anatomy, the nature of the problem at hand, and the scale of the surgical challenge. Images of this kind can help the surgeon to more effectively manage unrealistic patient expectations or explain dysfunctional bulges that do not require surgery. A functional 3DVR approach to pre-operative imaging can provide the surgeon with a more complete understanding of any hernia defect and the relevant background status of the abdominal wall in general. This can be useful in planning a more effective operative approach and help to improve surgical outcomes.

Accuracy and applicability of the novel pneumoperitoneum three-dimensional volume rendering technique in adhesive small bowel obstruction

“…Future application of cinematic rendering technology can generate photorealistic images with the potential to depict the anatomic details more accurately, which can further improve the diagnostic accuracy of interintestinal adhesions (22,23). Pneumoperitoneum 3DVR enables the surgeon to accurately assess the patient's intra-abdominal adhesions before the operation and can be used for the analysis and judgment of the obstruction mechanism to make a reasonable surgical plan (24,25). The surgeon can correctly select the position of the first trocar for the placement of the laparoscope, which is one of the key steps in laparoscopic surgery (Figure 3C).…”

“…Pneumoperitoneum 3DVR enables the surgeon to accurately assess the patient’s intra-abdominal adhesions before the operation and can be used for the analysis and judgment of the obstruction mechanism to make a reasonable surgical plan ( 24 , 25 ). The surgeon can correctly select the position of the first trocar for the placement of the laparoscope, which is one of the key steps in laparoscopic surgery ( Figure 3C ).…”

“…If pneumoperitoneum 3DVR indicates extensive and dense parietal adhesions or clumps of interintestinal adhesions that can easily cause iatrogenic intestinal rupture, laparoscopic surgery is not suitable ( Figure 5 ). For the patient, 3DVR allows the surgeon to easily obtain an understanding of any complex anatomy, the expected outlook of the surgical effect, and the specific and objective risk measurement ( 25 ). For medical students, 3DVR provides a visualized educational tool for ASBO.…”

Imaging Insights Into Abdominal Wall Function

“…hernias (Figure 8), occasionally revealing additional unsuspected hernias that may be inconspicuous and easily overlooked on standard 2D images alone. They can also aid the perception of dysfunctional bulges/eventrations, muscle denervations and/or atrophic changes, mesh placements, other post-surgical changes such as scarring, and any relevant skeletal changes (13).…”