D-COMPASS

Research beta · expert validation only · 0.9.1 beta — expert validation only / rules 0.9.1-expert-validation-only

DefectClosureOverlapMeshPlaneAccessSeparationStability
0.9.1 beta — expert validation only. This research prototype is intended to compare transparent algorithm outputs with independent expert judgement. It is not clinically validated and must not be used as an autonomous recommendation or as a substitute for surgeon assessment.
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 expert-validation output

Transparent domain-by-domain algorithm result for independent expert comparison.

Standardscore 0 · confidence 100%
Result statusCOMPLETE

All D-COMPASS domains were generated; independent surgeon review remains mandatory.

EHSM2–M4 W2
BMI27.7
Mesh required18.0 × 20.0 cm
Algorithmic planVentral TAPP
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
Matched postoperative scar
none reported
Matched scar axis
none
Scar-to-defect relation
no scar intersects or lies within the proximity threshold
Bulging/deformation axis
not assessed
Planned suture axis
longitudinal
Perpendicular dimension
8.0 cm
Total rectus width at defect level
16.0 cm
Rectus-to-defect ratio (RDR)
2.0 — favorable
RDR reference release frequency
10.8% in the published RDR stratum; not an individual probability
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.
  • RDR at least 2 is proportionally favorable, although it does not cancel the absolute-width risk; the published cohort required additional release in approximately 10.8% of cases.
  • 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.
  • RDR = (right + left rectus width) / perpendicular defect dimension = 2.0. Category: favorable; published reference frequency of additional release in this stratum: 10.8%.
  • 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 before Stability
18.0 × 20.0 cm
Final planned mesh after fixed-anchor check
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

Preperitoneal plane

Right side
preperitoneal
Midline
preperitoneal
Left side
preperitoneal
Right extension
none
Right TAR extent
none
Right TAR indication
not required
Left extension
none
Left TAR extent
none
Left TAR indication
not required
TAR role
not required
Preperitoneal pocket assessment
sufficient
Plane hierarchy
preperitoneal default for the complete required mesh
  • The complete required implant and overlap are judged feasible in a continuous preperitoneal pocket; preperitoneal remains the default plane.
  • Preperitoneal is the default because the complete required implant and overlap are judged feasible in a continuous preperitoneal pocket.
  • Plane is reported segment by segment: right side, midline, left side and any TAR extension.
A

Access

Minimally invasive ventral TAPP

  • Access was selected after the implant plane by the external rule set.
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

No routine mesh fixation

Overlap deficit present
no
Additional stability compensation
no
Fixation
not routinely required
Fixation-anchor model
Cooper and xiphoid remain fixed to anatomy; they never translate with the mesh.
  • With appropriate closure, overlap, implant size and plane, routine fixation is not necessary.
  • Adequate closure, overlap, implant size and extraperitoneal plane permit a no-fixation strategy.

Warnings requiring surgeon review

  • The current values are interface examples; the generated output is illustrative.
Validation and audit metadata
Intended use
Expert validation only
Rules version
0.9.1-expert-validation-only
Rules SHA-256
5a408234294c6680435cfd9b7cb3a78e06203f6d93115159c3d56d7a3498e4ce
Input SHA-256
c31ff5daf944d60d1a6ec5c90363ddc15969f1e87d2c35ffab9527314df48788
Decision trace
91 matched rule assignments; full trace and source registry are included in JSON.
Confidence meaning
Data/rule confidence for expert validation; not a probability of clinical success.
3

Anatomical sketch

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

4

Algorithmic operative plan — requires surgeon review

Research output for expert comparison; not a validated clinical recommendation.

Algorithmic procedure

Ventral TAPP

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

Patient position

Supine; both arms positioned according to anaesthetic and robotic/laparoscopic setup.

Access

Minimally invasive ventral TAPP

Segmental mesh plane

  • Right: preperitoneal
  • Midline: preperitoneal
  • Left: preperitoneal
  • Right Extension: none
  • Left Extension: none

Trocar plan

  1. Camera trocar on the side opposite the shortest working field, outside the calculated mesh footprint.
  2. Two working trocars arranged in a shallow arc, normally 6–10 cm apart, preserving triangulation toward the defect.
  3. When the calculated field extends caudally behind the pubis, keep ports cranial enough to permit Retzius dissection.

Step-by-step

  1. Complete preoperative BTA, then reassess the expected closure deficit using the conservative gain range before surgery.
  2. Establish intraperitoneal access away from previous scars and the hernia sac.
  3. Inspect adhesions, sac contents and the planned peritoneal flap limits.
  4. Create the peritoneal flap outside the future mesh margin.
  5. Reduce the sac under direct vision and protect bladder, bowel and epigastric vessels.
  6. Develop the complete preperitoneal pocket; extend to Retzius/Bogros when required by the calculated implant footprint and anatomical boundaries.
  7. Close the fascial defect in the direction that restores anatomy with acceptable tension.
  8. Measure the reconstructed field after closure and verify the calculated overlap in all directions.
  9. Place the mesh flat without folds; use selective fixation only if the pocket does not provide stability.
  10. Close the peritoneal flap continuously and inspect for gaps exposing the implant.

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

  • Do not start the flap too close to the calculated implant edge.
  • If the caudal field approaches the bladder or Retzius, identify and protect the bladder before mesh positioning.
  • Round-ligament division or other structure management is case-specific, not automatic.

Fallback strategy

  • Convert to a retromuscular or open reconstruction if the peritoneal layer cannot be closed safely.
  • Enlarge the extraperitoneal field rather than accepting inadequate overlap.