PelVis: Atlas-based Surgical Planning for Oncological Pelvic Surgery
IEEE Transactions on Visualization and Computer Graphics
Due to the intricate relationship between the pelvic organs and vital structures, such as vessels and nerves, pelvic anatomy is often considered to be complex to comprehend. In oncological pelvic surgery, a trade-off has to be made between complete tumor resection and preserving function by preventing damage to the nerves. Damage to the autonomic nerves causes undesirable post-operative side-effects such as fecal and urinal incontinence, as well as sexual dysfunction in up to 80 percent of the
... 80 percent of the cases. Since these autonomic nerves are not visible in pre-operative MRI scans or during surgery, avoiding nerve damage during such a surgical procedure becomes challenging. In this work, we present visualization methods to represent context, target, and risk structures for surgical planning. We employ distance-based and occlusion management techniques in an atlas-based surgical planning tool for oncological pelvic surgery. Patient-specific pre-operative MRI scans are registered to an atlas model that includes nerve information. Through several interactive linked views, the spatial relationships and distances between the organs, tumor and risk zones are visualized to improve understanding, while avoiding occlusion. In this way, the surgeon can examine surgically relevant structures and plan the procedure before going into the operating theater, thus raising awareness of the autonomic nerve zone regions and potentially reducing post-operative complications. Furthermore, we present the results of a domain expert evaluation with surgical oncologists that demonstrates the advantages of our approach. Index Terms-Atlas, surgical planning, medical visualization RELATED WORK In this section, we describe work related to our method, such as visualization methods for surgical planning and general visualization techniques applicable in our context. Much work has been done on applying visualization techniques to improve surgical planning, mainly in orthopedic, hepatic, facial and neurosurgery. A full overview of these surgical planning methods is out of the scope of this paper, but additional information can be found in the book by Preim and Botha  . Estimating distances between organs and relevant structures is an important task during surgical planning. Some previous works in surgical planning have used color mapping and isolines to encode distances.