Preoperative Modeling of the Rectovesicle Space and Pelvis in the Surgical Treatment of Patients with Uterine and Vaginal Aplasia

Abstract

<h3>Study Objective</h3> To develop a differentiated approach to the choice of the method of peritoneal colpopoiesis based on anatomical features using three-dimensional computer-assisted technologies. <h3>Design</h3> Prospective Level II study. <h3>Setting</h3> Department of Operative Gynecology, National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia. <h3>Patients or Participants</h3> 32 patients with utero-vaginal aplasia (MRKH), who were hospitalized in the Department of Operative Gynecology for surgical treatment in 2021. <h3>Interventions</h3> We performed an MRI of the pelvis following a newly developed protocol and obtained three-dimensional (3D) images of the pelvis for each patient with uterine and vaginal aplasia. Layer-by-layer thin-slice modeling and segmentation of the anatomical structures of the pelvis were then conducted using the appropriate software. All patients underwent laparoscopic or laparo-vaginal peritoneal colpopoesis, and the intraoperative data were compared with a previously created, personalized three-dimensional model. <h3>Measurements and Main Results</h3> The detail obtained with thin-slice 3D computer modeling correlated precisely with intraoperative findings and allowed for additional detail. The average layered thickness of the rectourethral and rectovesical spaces was 5.5 mm ± 3.2 mm; in two patients (6.3%) the thickness was less than 2 mm. Data on topographic positioning of the single ureters (4 patients) resulted in precise preoperative planning. The exact position of 2-layered Denonvilliers' fascia in relation to the rectum and other structures was clearly seen in all patients. Precise preoperative modeling of vascular, muscular, and neurologic elements in the lateral aspects of the recto-vesicular allowed for effective data-based intraoperative navigation. <h3>Conclusion</h3> The findings of 3-D thin-slice computer modeling of the pelvis in patients with the uterine and vaginal aplasia correlated precisely with the intraoperative findings. Its use enhances the precision of preoperative evaluation, optimizes surgical planning, and allows for data-based intraoperative navigation during colpopoesis. This modeling is especially useful in surgical planning in patients with complex pelvic anatomy.