The impact of three‐dimensional reconstruction and standardised CT interpretation (AMIGO) on the anatomical understanding of mesenteric vascular anatomy for planning complete mesocolic excision surgery: A randomised crossover study

Abstract

Background: Preoperative planning is a crucial aspect of safe complete mesocolic excision (CME) surgery. 3D models derived from imaging may help improve anatomical understanding of the complex vascular anatomy. Here, we assessed the effect of 3D models on surgeons' anatomical understanding in comparison to a systematic approach for CT scan interpretation (AMIGO).Method: Fifteen cases were included in the study. Two GI radiology consultants reviewed each scan to ascertain the vascular anatomy. Virtual 3D models were produced and displayed on a web-based platform (https://skfb.ly/6OZUZ). A total of 13 surgical trainees were recruited. Candidates were assessed after baseline anatomical training and subsequently using the AMIGO method and 3D models. Five cases were randomly allocated in each round of testing for each participant. The primary outcome measure was an objective vascular anatomy knowledge score. The secondary outcome measure was subjective feedback from participants.Results: Both 3D and AMIGO significantly improved anatomical understanding in comparison to baseline testing. However, 3D was superior to AMIGO (3D [n = 65; median score 8/14] vs. AMIGO [n = 65; median score 6/14; p < 0.0001]. For 13/15 patient cases examined, 3D was superior to the AMIGO method. Eleven participants demonstrated better anatomical understanding using 3D models versus AMIGO. Ten participants preferred 3D models in comparison to standard CT imaging.Conclusions: 3D models improve anatomical understanding of mesenteric vascular anatomy in a group of colorectal surgical trainees in comparison to a formal CT interpretation method. 3D models may be a useful planning adjunct to 2D imaging for CME surgery.

Principled Personalised Operative Strategy using 3D Virtual Modelling Ahead of Complete Mesocolic Excision with Central Vascular Ligation for Proximal Colon Cancer.

“…3DVM have been introduced and promoted in other surgical specialties mostly for the primary purpose of tumor localization and organ sparing techniques [12][13][14][15]. In colonic cancer surgery, the predominant determinant of colonic length excision is not marginal clearance but vascular su ciency following appropriate lymphadenectomy and the associated major vascular excision.…”

Developing a phantom for simulating robotic-assisted complete mesocolic excision using 3D printing and medical imaging

“…CME is considered complex mainly because the vascular structures of the right colon have a high degree of variability [ 29 , 30 ]. Efforts have been made to standardize the procedure of central dissection [ 31 – 33 ], and standardized patient-specific preoperative planning using 3D models to improve anatomical understanding [ 34 , 35 ].…”

Human factors in pelvic exenteration: themes in high‐performing teams

“…There may be a role for three-dimensional modelling and reconstruction in surgical planning. This has been done to map mesenteric vascular anatomy for planning complete mesocolic excision in colon cancer [15] but…”

“…There may be a role for three‐dimensional modelling and reconstruction in surgical planning. This has been done to map mesenteric vascular anatomy for planning complete mesocolic excision in colon cancer [15] but has not yet been described in pelvic exenteration. Robotic‐assisted surgery was not performed in any of the centres included; it has been described for pelvic exenteration, with associated training and cost implications [16].…”