Feasibility and clinical value of virtual reality based on 3D model in colorectal endometriosis for surgical planning

Colorectal endometriosis (CRE) is one of the most severe forms of deep pelvic endometriosis with a high risk of major postoperative complications. While pelvic MRI is the gold standard for preoperative assessment, its interpretation remains challenging. This study aimed to evaluate the feasibility and potential clinical value of three-dimensional (3D) MRI-based modeling as a tool to support preoperative planning in patients with CRE.

All patients who underwent laparoscopic segmental rectosigmoid resection for deep endometriosis (DE) between January 1, 2008 and December 31, 2019 in the gynecologic surgery department of Hautepierre Hospital with preoperative pelvic MRI performed at the Strasbourg New Civil Hospital were retrospectively included. Segmentation was carried out by a gynecologic surgeon using VP Planning® software on T2-weighted 3D axial images. The resulting 3D models were then evaluated by four expert gynecologic surgeons using a structured questionnaire assessing anatomical accuracy and potential usefulness for surgical planning.

Fourteen 3D models of the pelvic anatomy were produced. The comparison of the modeling data with operative reports was satisfactory with a good correlation of the modeling with the operative findings. The interest of modeling in surgical planning were evaluated at 7.6 / 10. Surgeons believed that 3D modeling could help them understand the complexity of the surgery in 79 % of the cases presented.

This study demonstrates the technical feasibility of 3D surface-based modeling of CRE using pelvic MRI. The 3D models obtained seems to have interesting potential in the context of pre operative planning.