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Background <p>In hepato-pancreato-biliary (HPB) surgery, precise anatomic understanding is essential.1.Ann Hepatobiliary Pancreat Surg. 23:145–154;2.J Hepatobiliary Pancreat Sci. 30:851–862; In Japan, advanced HPB board certification requires preoperative schema drawing.3.J Hepatobiliary Pancreat Sci. 24:252–261 Although three-dimensional (3D) imaging improves preoperative recognition,4.Ann Gastroenterol Surg. 6:190–196;5.Ann Surg Oncol. 32:3539–3543;6.Ann Surg Oncol. 31:6567–6568; no widely adopted system exists for real-time intraoperative navigation.7.Ann Surg. 271:e4–e7;8.Int J Comput Assist Radiol Surg. 20:117–129;9.Gastroenterol Res Pract. 2021:9621323; At the authors’ institution, schematic diagrams have been used, but they are time-consuming and limited in detail. To overcome these limitations, the authors developed a simple, low-cost intraoperative 3D navigation method using free computer-aided design (CAD) applications.</p> Methods <p>The authors analyzed 32 HPB cases managed between January and August 2025. Computed tomography (CT) data were reconstructed into 3D images using REVORAS (Ziosoft Inc., Tokyo, Japan). Based on these images, schematic diagrams were created with Procreate (Savage Interactive Pty Ltd., Australia), and CAD models were generated with Fusion 360 (Autodesk Inc., San Francisco, CA, USA) and Shapr3D (Shapr3D Zrt., Budapest, Hungary). The creation times were measured and compared.</p> Results <p>Surgical approaches included open (<i>n</i> = 14), robotic (<i>n</i> = 16), and laparoscopic (<i>n</i> = 2) procedures comprising pancreatic (<i>n</i> = 18), hepatic (<i>n</i> = 13), and sarcoma (<i>n</i> = 1) resection. Both schematic diagrams and CAD models were created in all cases. The median creation time was significantly shorter for CAD models (7 min 25 s) than for diagrams (19 min 48 s) (<i>p</i> &lt; 0.01). The CAD models enabled real-time anatomic sharing via tablets with TilePro integration in the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA).</p> Conclusions <p>Intraoperative CAD-based navigation is simple, cost-effective, and time-efficient, with strong potential for widespread adoption and educational value in HPB surgery.</p>

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A Widely Applicable CAD-Based Intraoperative 3D Navigation Method for Hepatopancreatobiliary Surgery

  • 期刊论文

  • 发表日期：

    2025年12月17日

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  • Ryota Ito,
  • Atsushi Oba,
  • Hayato Baba,
  • Gaku Shimane,
  • Kota Sugiura,
  • Yui Sawa,
  • Yoshiyuki Shibata,
  • Sho Kiritani,
  • Kosuke Kobayashi,
  • Yoshihiro Ono,
  • Yosuke Inoue,
  • Hiromichi Ito,
  • Ryuji Yoshioka,
  • Yoshihiro Mise,
  • Akio Saiura,
  • Yu Takahashi

摘要

Background

In hepato-pancreato-biliary (HPB) surgery, precise anatomic understanding is essential.1.Ann Hepatobiliary Pancreat Surg. 23:145–154;2.J Hepatobiliary Pancreat Sci. 30:851–862; In Japan, advanced HPB board certification requires preoperative schema drawing.3.J Hepatobiliary Pancreat Sci. 24:252–261 Although three-dimensional (3D) imaging improves preoperative recognition,4.Ann Gastroenterol Surg. 6:190–196;5.Ann Surg Oncol. 32:3539–3543;6.Ann Surg Oncol. 31:6567–6568; no widely adopted system exists for real-time intraoperative navigation.7.Ann Surg. 271:e4–e7;8.Int J Comput Assist Radiol Surg. 20:117–129;9.Gastroenterol Res Pract. 2021:9621323; At the authors’ institution, schematic diagrams have been used, but they are time-consuming and limited in detail. To overcome these limitations, the authors developed a simple, low-cost intraoperative 3D navigation method using free computer-aided design (CAD) applications.

Methods

The authors analyzed 32 HPB cases managed between January and August 2025. Computed tomography (CT) data were reconstructed into 3D images using REVORAS (Ziosoft Inc., Tokyo, Japan). Based on these images, schematic diagrams were created with Procreate (Savage Interactive Pty Ltd., Australia), and CAD models were generated with Fusion 360 (Autodesk Inc., San Francisco, CA, USA) and Shapr3D (Shapr3D Zrt., Budapest, Hungary). The creation times were measured and compared.

Results

Surgical approaches included open (n = 14), robotic (n = 16), and laparoscopic (n = 2) procedures comprising pancreatic (n = 18), hepatic (n = 13), and sarcoma (n = 1) resection. Both schematic diagrams and CAD models were created in all cases. The median creation time was significantly shorter for CAD models (7 min 25 s) than for diagrams (19 min 48 s) (p < 0.01). The CAD models enabled real-time anatomic sharing via tablets with TilePro integration in the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA).

Conclusions

Intraoperative CAD-based navigation is simple, cost-effective, and time-efficient, with strong potential for widespread adoption and educational value in HPB surgery.