D-COMPASS

Integrated abdominal wall reconstruction planning · 0.8.0 readable D-COMPASS output and combined manoeuvre effects / rules 0.8.0 readable-output-and-combined-manoeuvre-effects

DefectClosureOverlapMeshPlaneAccessSeparationStability
Development prototype. The clinical rule set and operative instructions require expert validation before clinical deployment.
1A

Patient data

Clinical factors, current abdominal-wall status and previous operations.

Basic data

Clinical factors

Current stoma

Previous abdominal and pelvic operations

Add each relevant operation separately. Previous hernia repairs and meshes will be calculated from this list.

1B

CT data

Manual entry now; later this object can be populated by the CT analyser.

Defect and hernia field

Reduction and closure geometry

Abdominal wall geometry

LevelOffset YRight rectusLinea albaLeft rectus
3rd above
2nd above
1st above
Umbilicus
1st below
2nd below
Reset
2

D-COMPASS algorithm

Transparent domain-by-domain result generated from patient and CT data.

Standardscore 0 · confidence 45%
EHSM2–M4 W2
BMI27.7
Mesh required18.0 × 20.0 cm
OperationeTEP Rives–Stoppa
D

Defect

M2–M4 W2 — 8.0 × 10.0 cm

  • EHS classification: M2–M4 W2.
  • Defect 8.0 × 10.0 cm; centre X 0.0 cm and Y 0.0 cm relative to the umbilicus.
  • Space from defect edge to semilunar line: left 5.0 cm, right 5.0 cm.
  • An abdominal wall defect has been identified.
C

Closure

Longitudinal fascial closure at risk of failure without tension-reduction manoeuvres

Fascial defect axis
longitudinal
Original scar axis
none
Bulging/deformation axis
not assessed
Planned suture axis
longitudinal
Perpendicular dimension
8.0 cm
Oblique-axis angle
not applicable / not entered
Closure feasibility
difficult
Tanaka index / LoD
0.0%
Content reduction
likely safe
Tissue quality
not directly measured no major risk flag
Missing mobility
0.0–2.0 cm
BTA estimated gain
BTA: medialisation 2.0–4.0 cm per side, total 4.0–8.0 cm; estimated volume-preparation benefit 5.0–10.0%.
TAR estimated gain
Unilateral TAR: medialisation 4.0–6.0 cm; bilateral TAR: total medialisation 8.0–12.0 cm; estimated volume-preparation benefit 10.0–20.0%.
Weight-loss estimate
Weight loss: no direct fascial-mobility gain; estimated volume-preparation benefit 0.0–5.0% for the current BMI category.
Omentectomy estimate
Omentectomy: no direct fascial-mobility gain; estimated content-volume reduction 0.5–2.0 L and effective volume-preparation benefit 5.0–15.0%.
Best manoeuvre candidates
BTA — required preoperative preparation.
Closure assurance
covered by conservative minimum-gain estimates
LoD volume-preparation target
0.0%
Volume-preparation assurance
covered by conservative minimum-gain estimates
Required right-edge movement
4.0 cm
Required left-edge movement
4.0 cm
  • A perpendicular closure dimension of 8–12 cm raises concern that closure may not be achieved without BTA, TAR or another tension-reduction manoeuvre.
  • BTA is expected to cover the estimated bilateral mobility deficit and is the least invasive closure manoeuvre candidate.
  • Preferred closure axis: longitudinal; selection basis: fascial defect geometry proxy.
  • Dimension perpendicular to the suture axis: 8.0 cm.
  • Estimated symmetric translation: right edge 4.0 cm and left edge 4.0 cm.
  • Tanaka index / LoD: 0.0%. Content reduction is assessed as likely safe.
  • BTA: medialisation 2.0–4.0 cm per side, total 4.0–8.0 cm; estimated volume-preparation benefit 5.0–10.0%.
  • Unilateral TAR: medialisation 4.0–6.0 cm; bilateral TAR: total medialisation 8.0–12.0 cm; estimated volume-preparation benefit 10.0–20.0%.
  • Weight loss: no direct fascial-mobility gain; estimated volume-preparation benefit 0.0–5.0% for the current BMI category.
  • Omentectomy: no direct fascial-mobility gain; estimated content-volume reduction 0.5–2.0 L and effective volume-preparation benefit 5.0–15.0%.
  • Best manoeuvre candidates: BTA — required preoperative preparation.
O

Overlap

Required from original defect: 5.0 cm in every direction; anatomically achievable

Right
required 5.0 cm; available 5.0 cm; planned 5.0 cm; deficit 0.0 cm
Left
required 5.0 cm; available 5.0 cm; planned 5.0 cm; deficit 0.0 cm
Cranial
required 5.0 cm; available 18.0 cm; planned 5.0 cm; deficit 0.0 cm
Caudal
required 5.0 cm; available 15.0 cm; planned 5.0 cm; deficit 0.0 cm
Required mesh
18.0 × 20.0 cm
Anatomically planned mesh
18.0 × 20.0 cm
  • A minimum overlap of 5 cm is assumed for an incisional hernia.
  • Coverage measured from the suture line after longitudinal closure is geometric information only and does not reduce the required mesh width.
  • Minimal overlap is calculated from the original defect boundaries; post-closure coverage does not reduce the required mesh size.
  • Right: required 5.0 cm, planned 5.0 cm (lateral anatomical limit not defined at this stage).
  • Left: required 5.0 cm, planned 5.0 cm (lateral anatomical limit not defined at this stage).
  • Cranial: required 5.0 cm, planned 5.0 cm (available 18.0 cm).
  • Caudal: required 5.0 cm, planned 5.0 cm (available 15.0 cm).
  • Informational coverage from the suture line after closure: right 9.0 cm, left 9.0 cm, cranial 5.0 cm, caudal 5.0 cm.
  • Any overlap deficit is only identified in O; the compensation strategy is selected later in Stability.
M

Mesh

18.0 × 20.0 cm required from original defect

Required mesh
18.0 × 20.0 cm
Anatomically planned mesh
18.0 × 20.0 cm
Calculation basis
Original defect + directional required/planned overlap
  • The required implant is calculated from the original defect dimensions, not from the reduced width or length after fascial closure.
P

Plane / Position

Bilateral retrorectus plane

Right side
retrorectus
Midline
retromuscular crossover
Left side
retrorectus
Right extension
none
Right TAR indication
not required
Left extension
none
Left TAR indication
not required
TAR role
not required
  • The external rules selected the plane from the required implant field and available anatomy.
  • Plane is reported segment by segment: right side, midline, left side and any TAR extension.
A

Access

Minimally invasive eTEP retromuscular access

  • eTEP is indicated when the implant must span both retrorectus spaces.
S1

Separation

Preoperative: BTA.

BTA — required preoperative preparation

Why: bilateral fascial-mobility deficit

Estimated effect: BTA: medialisation 2.0–4.0 cm per side, total 4.0–8.0 cm; estimated volume-preparation benefit 5.0–10.0%.

Estimated combined effect of the complete prescription

Fascial medialisation / lateral-wall gain

4.0–8.0 cm total

Required for assured closure: 3.0 cm
Estimated volume-preparation gain

5.0–10.0%

Target from Tanaka/LoD: 0.0%

Closure: covered by conservative minimum-gain estimates. Volume preparation: covered by conservative minimum-gain estimates.

Combined ranges are additive planning estimates from the editable rules. Biological effects may overlap and are not a guarantee of the operative result.

S2

Stability

Selective fixation only if required for implant stability

Overlap deficit present
no
Additional stability compensation
no
Fixation
consider selectively
  • Fixation cannot replace the required overlap, but it may be part of a documented compensation strategy when anatomy prevents full overlap.

Warnings requiring surgeon review

  • The external rule set did not produce a complete D-COMPASS plan from the available data.
3

Anatomical sketch

Integrated latest sketch module, driven by the same CT geometry and calculated mesh dimensions.

4

Concrete operative recommendation

Procedure, access, plane, port concept and ordered operative steps.

Recommended procedure

eTEP Rives–Stoppa

PlaneBilateral retrorectus plane
Mesh18.0 × 20.0 cm required from the original defect; final dimensions after intraoperative measurement

Patient position

Supine; table neutral initially, with selective flexion/tilt to improve the working angle.

Access

Minimally invasive eTEP retromuscular access

Segmental mesh plane

  • Right: retrorectus
  • Midline: retromuscular crossover
  • Left: retrorectus
  • Right Extension: none
  • Left Extension: none

Trocar plan

  1. Enter the retrorectus space on the side with fewer scars and better rectus anatomy, away from the defect and previous mesh.
  2. Place the camera trocar first; create enough space before inserting two additional working trocars.
  3. Keep all ports outside the planned mesh footprint where feasible and maintain approximately 6–10 cm between working ports.
  4. Plan crossover cranial or caudal to the defect according to intact linea alba and scar distribution.

Step-by-step

  1. Complete preoperative BTA, then reassess the expected closure deficit using the conservative gain range before surgery.
  2. Enter and develop the initial retrorectus space.
  3. Insert the remaining ports under direct vision after a stable working chamber has been created.
  4. Perform crossover through intact linea alba and develop the contralateral retrorectus space.
  5. Dissect and reduce the hernia sac; repair posterior-layer defects when practical.
  6. Extend caudally into Retzius/Bogros or cranially according to the calculated implant field.
  7. Close the anterior fascial defect; add tension-reducing manoeuvres only when the planned closure is not achievable.
  8. Close the posterior layer completely.
  9. Measure the final field and compare it with the calculated mesh size.
  10. Introduce and unfold the mesh; avoid routine fixation when the closed pocket provides stability.
  11. Desufflate under vision and confirm that the mesh remains flat and centred.

Preoperative prescription

  1. BTA — required preoperative preparation: bilateral fascial-mobility deficit

Intraoperative prescription

No component separation currently planned.

Assurance check

Closure: covered by conservative minimum-gain estimates

LoD volume preparation: covered by conservative minimum-gain estimates

Conservative closure gain: 4.0 cm for an estimated need of 3.0 cm.

Conservative capacity gain: 5.0% for an estimated target of 0.0%.

Required and conditional manoeuvres

  • BTA — required preoperative preparation: bilateral fascial-mobility deficit. BTA: medialisation 2.0–4.0 cm per side, total 4.0–8.0 cm; estimated volume-preparation benefit 5.0–10.0%.

Critical points

  • TAR is indicated for closure, space creation, or both; do not perform it solely because the defect is wide.
  • Posterior-layer integrity is mandatory before permanent mesh placement.
  • A limited 3–4 cm crossover does not by itself mandate bilateral eTEP.

Fallback strategy

  • Use intraperitoneal visual control if sac contents, bladder or bowel cannot be assessed safely.
  • Convert to open reconstruction when wall plasty, skin resection, uncontrolled posterior-layer failure or unsafe adhesiolysis makes MIS inferior.