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Surgical Endoscopy

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01-11-2020

Semi-automated vs. manual 3D reconstruction of central mesenteric vascular models: the surgeon’s verdict

Authors: Javier A. Luzon, Rahul P. Kumar, Bojan V. Stimec, Ole Jakob Elle, Arne O. Bakka, Bjørn Edwin, Dejan Ignjatovic

Published in: Surgical Endoscopy | Issue 11/2020

Abstract

Background

3D vascular anatomy roadmaps are currently being implemented for surgical planning and navigation. Quality of the reconstruction is critical. The aim of this article is to compare anatomical completeness of models produced by manual and semi-automatic segmentation.

Methods

CT-datasets from patients included in an ongoing trial, underwent 3D vascular reconstruction applying two different segmentation methods. This produced manually-segmented models (MSMs) and semi-automatically segmented models (SAMs) which underwent a paired comparison. Datasets were delivered for reconstruction in 4 batches of 6, of which only batch 4 contained patients with abnormal anatomy. Model completeness was assessed quantitatively using alignment and distance error indexes and qualitatively with systematic inspection. MSMs were the gold standard. Assessed vessels were those of interest to the surgeon performing D3-right colectomy.

Results

24 CT-datasets (13 females, age 44–77) were used in a paired comparative analysis of 48 3D-models. Quantitatively, SAMs showed structural improvement from Batch 1 to 3. Batch 4, with abnormal vessels, showed the highest error-index values. Qualitatively, 91.7% of SAMs did not contain all mesenteric branches relevant to the surgeon. In SAMs, 1 (12.5%) right colic artery-RCA scored as a complete vessel. 3 (37.5%) RCAs scored as incomplete and 4 (50%) RCAs were absent. 6 (25%) of 24 middle colic arteries-MCA scored as complete vessels. 11 (45.8%) scored as incomplete while 7 (29.2%) MCAs were absent. 13 (54.2%) of 24 ileocolic arteries-ICA were complete vessels. 11 (45.8%) scored as incomplete. None (0%) were absent. Additionally, it was observed that 10 (41.7%) of SAMs contained all their jejunal arteries, when compared to MSMs. Calibers of “complete” vessels were significantly higher than in “missing” vessels (MCA p < 0.001, RCA p = 0.016, ICA p < 0.001, JAs p < 0.001).

Conclusion

Despite acceptable results from quantitative analysis, qualitative comparison indicates that semi-automatically generated 3D-models of the central mesenteric vasculature could cause considerable confusion at surgery.

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Title: Semi-automated vs. manual 3D reconstruction of central mesenteric vascular models: the surgeon’s verdict
Authors: Javier A. Luzon
Rahul P. Kumar
Bojan V. Stimec
Ole Jakob Elle
Arne O. Bakka
Bjørn Edwin
Dejan Ignjatovic
Publication date: 01-11-2020
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 11/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-07275-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Semi-automated vs. manual 3D reconstruction of central mesenteric vascular models: the surgeon’s verdict

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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