Digital sculpting in surgery: a novel approach to depicting mesosigmoid mobilization

• Published in: Techniques in coloproctology 2014-07, Vol.18 (7), p.653-660
• Main Authors: Peirce, C., Burton, M., Lavery, I., Kiran, R. P., Walsh, D. J., Dockery, P., Coffey, J. C.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Cadaver; Colorectal Surgery; Computer Simulation; Gastroenterology; Humans; Imaging, Three-Dimensional; Medicine; Medicine & Public Health; Mesocolon - surgery; Models, Anatomic; Original Article; Proctology; Sensitivity and Specificity; Software; Surgery; Surgery, Computer-Assisted - methods
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-013-1116-6

Background The aim of the present study was to develop a unique anatomic replica of the mesocolon using digital graphical software in order to provide an educational template for mesosigmoidectomy. Methods The colon and mesocolon were fully mobilized from ileocecal to mesorectal levels in a cadaver. Both colon and mesocolon provided a template from which to generate a three dimensional replica in ZBrush. The model was deformed in ZBrush, to compare and contrast current and classic interpretations of mesosigmoidal topography. An animation was developed in which the replica was deformed to mimic operative mobilization. Contiguous shape changes were captured in two-and-a-half-dimensional (2.5D) screen snapshots. This was repeated for medial to lateral and lateral to medial mobilization of the mesosigmoid. Results Topographic differences between classic and current appraisals of mesocolic anatomy were evident in 2.5D format. Using the model generated, contiguous shape changes during mesosigmoidal mobilization (i.e., between the left mesocolon, mobile/apposed mesosigmoid, and mesorectum) were replicated in animation format. By extracting and compiling 2.5D screen grabs a pictorial chronology of mobilization was developed. Conclusions Recent advances in mesocolic topography can be captured and rendered using advanced digital sculpting software with high-end graphics capabilities. This approach permits a depiction of contiguous changes in mesosigmoidal topography during mesosigmoidal mobilization. A compilation of images in either animation or screen grab format obviates the interpolation of shape changes required using standard educational approaches.