Preoperative Virtual 3D Modeling and Planning for Splenectomy

Abstract

Objectives: To explore the possibilities of preoperative 3D modelling and analysis system based on multislice computed tomography data, to evaluate its effectiveness in performing laparoscopic splenectomy for the primary immune thrombocytopenia. Methods: A patient, (61 yrs) with the diagnosis of idiopathic thrombocytopenic purpura, recurrent course. For 10 years she had been observed and underwent the numerous courses of conservative treatment; she also took daily 60 mg of prednisolone. The blood platelet levels reduced below 30×109/l. The splenectomy was indicated due to the failure of conservative treatment. Multislice computed tomography with contrast bolus was performed. For preoperative planning a color 3D model of the surgical site was created on the basis of the obtained data in the “Autoplan” system. Systems giving the ability to plan surgical intervention combines the medical equipment, PACS system (picture archiving and communication system) available onsite advanced image-viewing workstations that can guide physicians; the ability to view images from various workstations via the network including the navigation enabling physicians to create the accurate and realistic models from stereo cameras, and to use computers as well as mobile computing devices directly in the operating room. The patient was underwent laparoscopic hybrid splenectomy. Results: According to the 3D model a main type of vascularization of the spleen was revealed. The distal part of the pancreatic tail did not reach (1.5 cm) the gate of the spleen. Accessory spleens and periprotsess were absent. The data of 3D model were confirmed intraoperatively and allowed performing a laparoscopic hybrid splenectomy without technical difficulties precisely with a minimal blood loss. The postoperative period was uneventful. The patient was discharged on the 5th day in a satisfactory condition. The parameters of platelet level have reached the reference values (356×109 /l). Conclusion: Preoperative 3D modelling permits the surgeon to make pre-operative planning and provides him with important information on individual topographic and anatomic features in forthcoming operation sites. The information about the individual characteristics of the splenic vascularization and pancreatic topography in its gate lets to allocate and ligate vessels precisely, that improves the quality of hemostasis and also reduces the probability of the pancreatic injury. Preoperative visualization of accessory spleens increases the radicalism of the surgery. Keywords: Splenectomy, thrombocytopenia, computer tomography, 3D modelling, hemostasis, vascularization. Read more →