Static Digital Twins for Surgical Planning in Complex Gynecologic Cancer Recurrence: A Proof-of-Concept Feasibility Study

STUDY OBJECTIVE: To evaluate the feasibility and surgical impact of static digital twin reconstructions in patients undergoing resection for complex pelvic or abdominal recurrences of gynecologic cancers. DESIGN: Prospective and observational feasibility study. SETTING: Academic tertiary care center with integrated biomedical engineering support. PATIENTS: Four patients with suspected oligometastatic recurrence of gynecologic malignancy involving vascular, urinary, nervous, or skeletal structures, deemed eligible for curative-intent surgery and 8 historical controls with recurrent leiomyosarcoma selected for exploratory comparison. INTERVENTIONS: Included patients underwent high-resolution cross-sectional imaging followed by semiautomated 3D segmentation and static digital twin reconstruction using Mimics Medical software (Materialise, Leuven, Belgium). Virtual models were co-reviewed by surgeons and engineers for surgical planning. During surgery, the digital twin was available for intraoperative navigation. Postoperative concordance between the model and intraoperative findings was evaluated by a multidisciplinary team (surgeon, radiologist, and clinical engineer) using an internally developed 1-5 rating scale. MEASUREMENTS AND MAIN RESULTS: All procedures were completed without intraoperative complications. The mean operative time was 191.5 minutes (range 120-270). In each case, the static digital twin allowed enhanced preoperative planning, identification of anatomical variants (e.g., duplicated ureter), and optimized team coordination. Surgical findings were highly concordant with the preoperative 3D models. No unplanned injuries or postoperative complications were observed. Intraoperative decision-making was positively influenced by the use of the model in all cases. CONCLUSION: Static digital twins are feasible and effective tools for surgical planning in complex gynecologic cancer recurrences. Their use supports anatomical understanding, interdisciplinary coordination, and intraoperative safety. Further research is needed to validate their impact on surgical outcomes and workflow efficiency.