Three-dimensional virtual reconstruction as a tool for preoperative planning in the management of complex anorectal fistulas

Abstract

The making of three-dimensional virtual models is a promising technology in preoperative planning, but that is not used in the treatment of anorectal fistulas. The objective of this work is to describe the development and initial experience of the construction of a virtual three-dimensional model of the pelvic anatomy of a patient, allowing the exact identification of the relationships between the fistulous tracts of complex anorectal fistulas and the other pelvic structures. An MRI was performed on this patient, and the images were exported to the Vitrea fX Workstation® software. A radiologist did the analysis and segmentation of the images that were then sent to a three-dimensional image processor (Meshlab v. 1.3.3 – ISTI – CNR Research Center, Pisa University, Italy). The final 3D color image was analyzed by the surgeon and used to guide the catheterization of the fistulous pathways, the internal orifice and to assist in the identification of adjacent structures. The final three-dimensional model presented a high correlation with the intraoperative findings and facilitated the surgical planning.

Three‐dimensional modelling as a novel interactive tool for preoperative planning for complex perianal fistulas in Crohn's disease

“…Three-dimensional reconstruction of complex fistulas aids surgeons with an easier identification of secondary fistula, internal anal orifices or occult/deep abscess, which may otherwise be challenging to identify from MRI alone [5].…”

“…This creates the need for better diagnostic models such as 3D image processing and reconstruction (3D-IPR) with artificial intelligence (AI) algorithms. 3D-IPR models have demonstrated that they can be used as an important tool for the management of these complex cases as well as creating a more spatial and intuitive model for surgical strategy planning [5]. Therefore, they can provide useful information and adequate knowledge of the anatomical relationships of those anorectal fistulas with adjacent pelvic structures so suitable surgical management can be planned and performed [5,6].…”

“…3D-IPR models have demonstrated that they can be used as an important tool for the management of these complex cases as well as creating a more spatial and intuitive model for surgical strategy planning [5]. Therefore, they can provide useful information and adequate knowledge of the anatomical relationships of those anorectal fistulas with adjacent pelvic structures so suitable surgical management can be planned and performed [5,6]. Moreover, physical representation of fistula tracts improves the surgeon's understanding as well as patients' thoughts about surgical strategy [7].…”