Patient-specific 3-Dimensional reconstruction of female pelvis from Contrast Enhancement Computed Tomography (CE-CT) for planning and simulation of sacral cervico/colpopexy: feasibility and preliminary data.
Andrea Giannini (IT), Gianluca Albanesi (IT), Eleonora Russo (IT), Paolo Mannella (IT), Tommaso Simoncini (IT)
[Giannini] University of Pisa, [Albanesi] University of Pisa, [Russo] University of Pisa, [Mannella] University of Pisa, [Simoncini] University of Pisa
Context: Abdominal sacral hystero-cervicopexy is the gold standard procedure for surgical repair of advanced prolapse but it is associated to potentially serious complications because the area of attachment of the mesh is surrounded by critical anatomical structures, thus identification of pre-sacral ligament can be difficult. Objective: to establish the feasibility of 3D reconstruction of female pelvis anatomy, in particular of presacral area in order to characterize patients’ specific anatomy in the planning and simulation of prolapse surgery. Methods: Using an open-source ITK-SNAP software implemented by a toolkit for segmentation process, the EndoCAS Segmentation Pipeline; we obtained thirty 3-Dimensional reconstruction of female pelvis from Contrast Enhancement Computed Tomography (CE-CT). Patients, Intervention: We measured distances from the potential standardized point of attachment of the mesh on S1 vertebral body (point C) to principal pelvic vascular, urological and bone structures of interest. No correlation between presacral fat and mentioned structures was found. Main outcome measures: Reconstruction was completed in all patient models. We detected a statistically significant correlation between the distance from Point C and right iliac vessel, the bifurcation of caval vein and between the distance from ischiatic spines plane to uterine cervix (p<0.001). Results: A presacral quadrilateral area clear of relevant anatomical structures was found in 97,5% of cases. Conclusions: This “presacral box” may represent the ideal and safe area of cranial attachment of the mesh. The knowledge of the distance from Point C to ischiatic spines plane may turn into a safer and better tailored patient-specific surgical approach. The use of precise numerical models of the female pelvic system might provide the tools to simulate, planning and tailoring POP surgery.