EP460 - 3D Model of Perianal Fistula Improves Understanding of Anatomy and Operative Decision-Making

Purpose/Background: Perianal fistula is a complex surgical condition that leads to a substantial impact on a patient's quality of life. Pelvic MRI is the gold standard for evaluation and surgical planning. However, trainees, patients, and physicians report identifying perianal fistulas on MRI for surgical planning and understanding can be very difficult.

This prospective pilot study aimed to assess the utility of a 3D model of perianal fistulas when compared to standard MRI for surgical planning, understanding of disease and patient education.

Methods/Interventions: Two practicing colorectal surgeons were each asked to evaluate the anonymized case notes from 10 historical patients that they had never seen before for a total of 20 measurements. They were then provided with each patient's preoperative standard MRI images and report and asked to complete a survey about their surgical planning, patient communication, and understanding of the patient's anatomy. Subsequently, they were given a 3D model of the patient's fistula anatomy as seen in figure 1 and the survey was repeated. The surgeons were finally given the operative report and were asked about the agreement between the patient's operation and the surgeon's initial planned operation.

Results/Outcomes: The surgeons answered questions on a Likert scale that was coded numerically from 1-5. After being shown a 3D model of the patient's fistula, there was a significant increase in the surgeons' confidence of their knowledge of the patient's fistula anatomy by 13.0%, their ability to explain the surgery to a patient by 11.5%, and their ability to explain the patient's anatomy to a peer or trainee by 10.7%. The surgeons also reported a significant increase in confidence that the patient would understand their own anatomy and the surgery that would be performed by 28.6% and 21.5% respectively. This data is reflected in table 1 which includes Likert response averages as well as percent increase in response.

Surgeons also noted that after viewing the 3D model, they would change their surgical plan in 30% of cases. In these cases, the surgeons consistently noted that they would opt for a less invasive approach such as a seton placement versus a fistulotomy.

Conclusion/Discussion: These findings indicate the potential positive impact that a 3D model of perianal fistula anatomy can have on patient care and education. Participating surgeons reported increased confidence not only for surgical planning but also in the potential to improve patient understanding of their disease and surgery and even changing their surgical decision making. With great emphasis placed on patient centered care, the utility of 3D models as an adjunct to standard MRI is likely to be highly beneficial. Future directions should focus on confirming these findings in a larger cohort of providers and evaluating the real-world implementation of 3D models in a clinical setting.

Figure 1
Example of 3D vEUA model from Entrolytics shown to physicians
Table 1
Survey results of physicians after viewing standard 2D MRI and report and after viewing 3D model of the patient's pelvic anatomy.