Towards personalized trocar placement: assessment of patient-specific abdominal wall distension due to pneumoperitoneum

To quantify how pneumoperitoneum affects abdominal shape and how this is influenced by patient characteristics. Data from 73 patients undergoing minimally invasive (robot-assisted or laparoscopic) surgery were collected, including RGB-Depth (RGB-D) videos and patient characteristics (weight, height, sex, and age). Abdominal landmarks were ink-marked, and video analysis quantified global and regional wall distension. Global wall distension is defined as the mean displacement of all landmarks, and regional deformations are the mean displacements in specific regions, divided into medio-lateral and cranio-caudal regions. Associations between deformations and patient variables were evaluated using univariate and multivariate analyses. Pneumoperitoneum induced a mean global shape change of 3.6 cm (± 0.9 cm), varying from 1.3 to 5.8 cm. Global wall distension correlated with height, sex, age, and medio-lateral region (P < 0.05). Multivariate analysis identified height, age, and medio-lateral region as independent predictors. This study shows that abdominal wall distension due to pneumoperitoneum varies between patients, and depends on height, age, and abdominal region. This provides important insights into patient-specific abdominal wall distension due to pneumoperitoneum. These insights support personalized surgical planning and may inform patient-specific simulations for optimized trocar placement.