Pelvic Surgery

High-definition Atlas-based surgical planning for Pelvic Surgery


Colorectal cancer is the third most frequent cancer diagnosed in men and the second most in women. Surgical resection of the rectum with a Total Mesorectal Excision procedure (TME) is the predominant surgical treatment option for rectal cancer. Introduction of the TME technique has reduced local recurrence rates dramatically. However, the shape of the pelvis and the position of the organs within the pelvis hamper a good view on the very closely related and difficult to detect nerves, lymphatics and vessels during surgery.

Although world-wide TME training programmes pay special attention to nerve sparing techniques, clinical studies still report a high incidence of pelvic organ dysfunction like urine and faecal incontinence and sexual dysfunction.

We plan to address these problems by developing a unique new surgical planning system that has at its core the highest resolution digitised histological sections of the pelvis. Based on the histology, 3-D segmentations thereof and the physical measurements that we plan to perform of the various involved tissue types, we will derive a detailed and physically correct biomechanical simulation model: The Virtual Surgical Pelvis (VSP).

During the second phase of this research, we will develop the necessary atlas-based registration and transformation techniques with which the VSP can be made patient-specific, based on pre-operative high-field MRI data.


The VSP will be integrated with a surgical planning system. This combination will enable the operating surgeon to simulate and plan the TME surgery in 3-D, with real-time and realistic visual feedback on the predicted bio-mechanical behaviour of the anatomical structures of the pelvis. In addition, the VSP will eventually be applicable for use in the planning of other pelvic surgical procedures and will be an invaluable tool in surgical training.

This research requires the close collaboration of expert surgeons, anatomists and medical imaging and visualisation specialists. The departments of Surgery and Anatomy of the Leiden University Medical Centre (LUMC) have a longstanding collaboration and have jointly publish for almost 15 years on colorectal surgery.

In combination with the Medical Visualisation group and the Department of Biomechanical Engineering of the Delft University of Technology (TU Delft), we have just the right combination of expertise and infrastructure.


  • The Unified Anatomical Human (Beta): Model-based Representation of Heterogeneous Anatomical Data. N.N. Smit, A.C. Kraima, M.C. Deruiter, D. Jansma and C.P. Botha. CASA 2012 – Workshop on 3D Physiological Human, Singapore, May 2012 (click for details)
  • A Unified Representation for the Model-based Visualization of Heterogeneous Anatomy Data. N.N. Smit, A.C. Kraima, M.C. Deruiter, D. Jansma and C.P. Botha. Eurovis 2012, Vienna, Austria, June 2012 (click for details)