Getting Started with 3DSurG: A Step-by-Step Guide for SurgeonsIntroduction
3DSurG is a surgical planning platform that integrates patient imaging, 3D modeling, and workflow tools to help surgeons plan, simulate, and communicate operative strategies. For surgeons new to 3D surgical planning, adopting 3DSurG can shorten planning time, improve surgical precision, and enhance team communication. This guide walks you through setup, image import and segmentation, model review, planning and simulation, guide/implant design basics, intraoperative use, and tips for integrating 3DSurG into your practice.
1. Preparing to Use 3DSurG
Before you begin, ensure the following:
- Clinical indication: Confirm that 3D planning will influence surgical decisions (complex reconstructions, deformity corrections, tumor resections, custom implants, or patient-specific guides).
- Hardware & network: A modern workstation with a dedicated GPU, reliable internet, and DICOM access to your PACS. Check 3DSurG’s system requirements.
- Team & workflow: Identify a clinical champion (surgeon) and support from radiology/IT and OR staff. Map where planning tasks will occur (clinic, pre-op planning session, vendor support).
- Regulatory & data governance: Verify institutional policies for sending DICOM data to third-party platforms and obtain necessary consents.
2. Account Setup and Initial Configuration
- Create a surgeon account and complete any required training or credentialing with 3DSurG.
- Configure user roles and permissions (surgeon, planner/technician, admin).
- Connect 3DSurG to your imaging source: set up secure DICOM transfer from PACS or upload encrypted DICOM files directly. Confirm anonymization settings if required.
- Customize templates and default implant/guide libraries to match your preferred manufacturers and common case types.
3. Importing and Preparing Imaging
- Choose appropriate imaging: high-resolution CT (≤1 mm slice thickness) is standard for bony work; CT angiography or MRI may be needed for soft tissue or vascular planning.
- Upload or pull studies into 3DSurG. Verify correct series selection (bone vs. soft tissue windows).
- Check image quality and orientation; correct any gantry tilt or incomplete coverage before segmentation.
4. Segmentation and 3D Model Generation
- Start automatic segmentation tools to generate bone, cartilage, and relevant soft-tissue masks. Automated algorithms often provide a fast initial result—review carefully.
- Manually refine segmentations where necessary: remove artifacts, separate fused structures (e.g., teeth from bone), and define margins around pathologic tissue. Use slice-by-slice or brush tools for precision.
- Generate surface meshes (STL) from finalized segmentations. Inspect for holes, non-manifold edges, or spikes; run smoothing and decimation conservatively to preserve anatomy critical for fit or alignment.
5. Anatomy Review and Measurement
- Use multiplanar views and 3D render to inspect anatomy and pathology. Rotate, clip, and add transparency to visualize relations between structures (nerves, vessels, tumor).
- Take precise measurements: distances, angles, volumes. Save measurement presets for reproducibility (e.g., defect size, osteotomy angles, component offsets).
- Annotate landmarks and save them as part of the case for future reference or to guide manufacturing of guides/implants.
6. Surgical Planning and Simulation
- Define goals: desired alignment, resection margins, implant position, correction vectors. Enter target parameters into the planning workspace.
- Plan osteotomies and resections using virtual cutting tools. Snap guides to anatomical landmarks and preview resections in multiple views.
- Simulate implant placement: import standard implant models or custom designs, adjust position and orientation, and assess bone coverage and screw trajectories.
- Run collision checks and virtual range-of-motion tests to identify impingement or inadequate clearance.
- Save plan versions and use comparison tools to document iterative changes and rationale.
7. Designing Patient-Specific Guides and Implants
- If ordering guides or custom implants, export required files (final plan, guide geometry, STL of planned implant) following vendor specifications.
- Ensure surgical guide fitting surfaces include adequate contact area and unambiguous registration features (teeth, cortical ridges). Mark orientation and drill sleeve positions clearly.
- For custom implants, collaborate with engineers: provide load/constraint expectations, soft-tissue considerations, and fixation preferences. Review manufacturer-generated CAD within 3DSurG or via secure review tools for fit and screw access.
- Verify material choices, sterilization constraints, and labeling requirements before manufacturing.
8. Preoperative Review and Team Communication
- Generate surgical reports and annotated screenshots from 3DSurG to include in the patient chart and OR packet.
- Host a multidisciplinary pre-op meeting using the 3D model: involve anesthesiology, nursing, and device reps to walk through the plan and instrumentation needs.
- Provide the OR team with printed guides, template trays, implant lists, and estimated surgical times derived from the plan.
9. Intraoperative Use
- Bring visual references into the OR: printed 3D models, laser-printed guides, or digital displays. Confirm sterile handling procedures for guides and instruments.
- Use patient-specific guides for osteotomies, resections, or drilling when applicable—verify fit on exposed anatomy before committing to definitive cuts.
- If using navigation or intraoperative imaging, register the patient to the preoperative 3D plan and confirm alignment with intraoperative landmarks or fluoroscopy.
- Document deviations from the plan and, if necessary, update the 3D model post-op for outcomes analysis.
10. Postoperative Follow-Up and Quality Improvement
- Compare postoperative imaging to the planned model to assess accuracy (alignment, implant position, resection margins). Use measurable metrics and store them in a quality database.
- Review cases at regular intervals to identify systematic errors (planning steps that cause recurring fit issues) and refine templates or training accordingly.
- Collect patient outcomes (function scores, complications) and correlate with planning choices to demonstrate clinical value and support reimbursement where applicable.
11. Practical Tips and Common Pitfalls
- Use high-quality imaging—poor CT is the most common cause of planning errors.
- Maintain clear communication with engineers and device reps; ambiguous instructions lead to delays and remakes.
- Avoid over-smoothing meshes when surface detail is needed for guide fit.
- Keep a version history of plans; small changes can have big intraoperative effects.
- Pilot simpler cases first (e.g., elective knee osteotomies) before tackling highly complex reconstructions.
12. Case Example (Brief)
- Case: Complex mandibular reconstruction after tumor resection.
- Imaging: high-res facial CT with 0.6 mm slices.
- Steps: import CT → auto-segment bone → manual refine tumor margins → plan resection and fibula free-flap harvest virtual osteotomies → design cutting guides for mandible and fibula → order guides and patient-specific plate → pre-op team review → intraop guide verification and fixation → postoperative CT to confirm alignment.
- Outcome measures: resection margin accuracy, plate fit, occlusion restoration, operative time saved.
13. Learning Resources and Training
- Complete vendor-provided training modules and hands-on workshops.
- Participate in multidisciplinary planning sessions to learn practical nuances from radiologists and engineers.
- Start with simulation-only cases and review outcome correlations to build confidence.
Conclusion Adopting 3DSurG involves technical setup, imaging quality control, careful segmentation, deliberate planning, and close collaboration with engineering and OR teams. With practice and good workflows, 3D surgical planning can improve precision, shorten OR time, and enhance patient-specific care.
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