ArticleAnnals of surgical oncology2026
A Widely Applicable CAD-Based Intraoperative 3D Navigation Method for Hepatopancreatobiliary Surgery.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn 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.
methodsThe 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.
resultsSurgical 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).
conclusionsIntraoperative CAD-based navigation is simple, cost-effective, and time-efficient, with strong potential for widespread adoption and educational value in HPB surgery.
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