Outcome Of Applying A Preoperative Three-Dimensional Anatomical Study on Complicated Abdominal Surgeries

Abstract

Background: Three-dimensional technology is currently implemented within many health specialties it used in surgery to facilitate identification of complex abdominal problems. This has led to the wide usage of robotic procedures in complex operations.

Objective: To evaluate the role of 3D assisted surgical procedures compared with conventional surgeries that rely on conventional computed tomography (CT) and magnetic resonance imaging (MRI).

Materials and Methods: A prospective comparative cohort study conducted over 12 months, from May 2025 through April 2026, included participants from local tertiary hospitals. The study included 86 adult patients. They were randomly divided into two groups; each contained 43 patients. Group one (G1) included those who underwent a 3D anatomical identification based on CT, MRI as well as other standard imaging investigations. While group two (G2) included those patients who only underwent CT, MRI and other standard imaging investigations to act as control. Outcomes included modification of the preoperative surgical strategy, unexpected intraoperative deviation from the final plan, operative time, estimated blood loss, complications, resection-margin status where applicable, and postoperative length of stay. Postoperative morbidity was graded using the Clavien-Dindo classification.

Results: The study cohort comprised 86 patients, with 43 patients in each group. Review of the 3D reconstruction (G1) modified the planned surgical strategy in 16 of 43 patients (37.2%). Unexpected intraoperative deviation from the final preoperative plan occurred in 4 patients (9.3%) in this group versus 12 patients (27.9%) in G2, (OR 0.26, 95% CI 0.08-0.90; p=0.050). Mean operative time was 178.4 ± 44.2 versus 207.1 ± 50.6 minutes (p=0.006), and median estimated blood loss was 260 mL (IQR 180-410) versus 390 mL (IQR 250-600) (p=0.012). Surgeon-rated anatomical confidence was higher with 3D planning (4.6 ± 0.5 vs 3.8 ± 0.6; p<0.001). Overall postoperative complications occurred in 10/43 (23.3%) versus 15/43 (34.9%), and median postoperative length of stay was 5 days (IQR 4-7) versus 6 days (IQR 5-8) (p=0.041).

Conclusion: Patient-specific 3D reconstruction-assisted planning (G1) was associated with modification of preoperative surgical strategy, fewer unexpected intraoperative deviations from the final plan, greater surgeon-rated anatomical confidence, shorter operative time, lower estimated blood loss, and shorter postoperative length of stay. However, non-significant differences in postoperative morbidity, major complications, and oncological margin status were not recorded.