The role of preoperative 3D reconstruction in optimizing surgical planning and intraoperative guidance during laparoscopic distal pancreatectomy: a pilot study.

Introduction: Laparoscopic distal pancreatectomy (LDP) is a technically demanding minimally invasive procedure due to the complex relationship between pancreatic lesions, splenic vessels, and the pancreatic duct. Accurate preoperative assessment is essential, particularly when considering spleen preservation. Conventional computed tomography (CT) and magnetic resonance imaging (MRI) provide important diagnostic information but are limited by their two-dimensional representation. Three-dimensional (3D) reconstruction may improve anatomical understanding and surgical planning. This pilot study reports our preliminary experience using preoperative 3D reconstruction for surgical planning and intraoperative guidance during LDP. Materials and methods: This single-center prospective pilot case series included two adult patients undergoing elective LDP. Preoperative CT and MRI were processed using dedicated segmentation software to generate patient-specific 3D models. Results: In both cases, 3D reconstruction influenced the preoperative surgical strategy regarding spleen management. In the first patient, close tumour involvement with the splenic vessels and pancreatic duct led to planned splenectomy, whereas in the second patient, preserved separation from the vessels supported a spleen-preserving approach. Intraoperative findings confirmed the preoperative 3D assessment in both cases. Real-time consultation of the 3D model and intraoperative ultrasound facilitated safe dissection and pancreatic transection. Histology revealed well-differentiated neuroendocrine tumours in both patients. Conclusion: These proof-of-concept observations suggest that preoperative 3D reconstruction may facilitate anatomical understanding and support personalized surgical planning and decision-making during LDP, particularly with regard to spleen preservation.