Computed-tomography image segmentation and 3D-reconstruction of the female pelvis for the preoperative planning of sacrocolpopexy: preliminary data

Background: Minimally-invasive sacrocolpopexy is the gold standard procedure for advanced apical prolapse. Nonetheless, sacrocolpopexy has potential serious complications leading many surgeons to avoid this excellent surgical procedure. To overcome these limitations, preoperative planning with 3D models of the female pelvis is proposed. The aim of the study is to evaluate the feasibility of pelvic anatomy reconstruction with the ITK-SNAP software and highlight its potential benefits in this intervention. Methods: Thirty patient-specific 3D models of the female pelvis were created using ITK-SNAP and the EndoCAS Segmentation Pipeline extension for image segmentation: contrast-enhanced computed tomography (CE-CT) data sets of women who underwent examinations for reasons other than prolapse were used. The distances of pelvic structures from the sacral promontory were standardised and measured, and correlations among these distances were evaluated with Spearman’s correlation coefficient. Results: Pelvic anatomy reconstruction was feasible for all CE-CT data sets. A statistically significant correlation was found between the distances of the cava bifurcation and common iliac vessels from the sacral promontory. An area for proximal mesh attachment was defined: it is free from the passage of iliac vessels in 97.5% of cases. A significant statistical correlation was found between the distances of the midpoint of the bispinous diameter and the uterine cervix from the sacral promontory; a process of linear regression showed that the latter measure can be estimated by multiplying the first one by 0.86. Conclusions: Pre-surgical 3D reconstructions of the female pelvis using ITK-SNAP could help achieve widespread use of sacrocolpopexy: further comparative studies are needed to evaluate the outcomes with and without their use.