Effective preoperative abdominal incision planning on a patient with a history of repeated abdominal operations using a three-dimensional reconstruction technique: a case report

Abstract

This case report describes the use of a three-dimensional reconstruction technique to plan the abdominal incision in order to avoid incision-related complications in a 53-year-old female patient who had had a cystic mass in the liver for 16 years and had undergone four previous surgeries. The patient presented with a recurrent cyst. The surgical team used three-dimensional reconstruction to model the liver mass, the area of abdominal wall weakness due to previous surgeries, bowel adhesions, skeletal structure and whole abdominal contour. The models were superimposed upon each other to reveal the relationship between the various features so that the optimum incision point could be selected so as to avoid the area of abdominal wall weakness, bowel adhesions and vital organs. The actual surgical incision was made based on the three-dimensional reconstruction models and the surgeon was able to avoid the area of abdominal wall weakness and bowel adhesions as planned. No incisional hernia and wound infection were observed postoperatively and the incision healed well. The three-dimensional reconstruction technique for preoperative surgical incision planning on patients with a history of multiple abdominal surgeries can minimize incision-related complications and achieve good therapeutic results.

Keywords: Three-dimensional reconstruction; incision complications; incision planning; repeated abdominal operations.

Figure 1.

A 53-year-old female patient had been suffering from a cystic mass in the liver for 16 years and had undergone four previous surgical treatments. The patient presented with abdominal distension and a recurrent cystic mass was diagnosed. Enhanced computed tomography scan images showing the cystic mass (white arrows) in the liver at different transverse levels.

Figure 2.

A computer-assisted three-dimensional reconstruction technique was used to plan the most appropriate surgical incision in advance of the actual surgery in a 53-year-old female patient who had been diagnosed with a recurrent cystic mass. (a) Cystic mass in the liver; (b) weak area of the abdominal wall; (c) bowel adhesion to the abdominal wall; (d) skeletal reconstruction used for positioning; (e) reconstruction of the abdominal contour; (f) images of the cystic mass, weak area of the abdominal wall, bowel adhesive area, bones and contour of the abdomen were all superimposed upon each other to help with the selection of the optimal surgical incision point; (g) overlay of image F onto the patient's actual abdominal contour picture; (h) the surgical incision point that was selected for surgery. The colour version of this figure is available at: http://imr.sagepub.com.

Figure 3.

Representative photographs of the actual surgical incision (a) and the healed incision (b) in a 53-year-old female patient who had been diagnosed with a recurrent cystic mass in whom a computer-assisted three-dimensional reconstruction technique was used to plan the most appropriate surgical incision in advance of the actual surgery. The colour version of this figure is available at: http://imr.sagepub.com.