D-COMPASS

D-COMPASS

Research beta · expert validation only · 0.9.3 beta — rules-first expert validation only / rules 0.9.3-rules-first-expert-validation-only

DefectClosureOverlapMeshPlaneAccessSeparationStability
0.9.3 beta — rules-first 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 planeTEP 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 expected to be possible without a default release

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
possible
Tanaka index / LoD
0.0%
Content reduction
likely safe
Tissue quality
not directly measured no major risk flag
Missing mobility
0.0–0.0 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
No additional closure or capacity manoeuvre is currently required.
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
  • 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.
  • 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: No additional closure or capacity manoeuvre is currently required.
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

Bilateral retrorectus plane

Right side
retrorectus
Midline
retromuscular crossover
Left side
retrorectus
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
outside or too large for preperitoneal fat zone
Preperitoneal fat zone
outside or too large for modelled preperitoneal fat zone
Central preperitoneal limit
5.0 cm on each side of the midline
Preperitoneal preparation
not selected as the implant plane
Plane hierarchy
minimum necessary retrorectus/segmental-TAR alternative because the required mesh does not fit an available preperitoneal fat zone
  • The required implant lies outside or is too wide for the modelled preperitoneal-fat zone; use the minimum necessary retrorectus/segmental-TAR alternative.
  • The complete required implant does not fit an available preperitoneal-fat zone; the external rules selected the minimum necessary retrorectus/segmental-TAR alternative.
  • 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

No additional separation or volume-preparation manoeuvre is recommended.

No additional manoeuvre is currently indicated.

Estimated combined effect of the complete prescription

Fascial medialisation / lateral-wall gain

0.0–0.0 cm total

Required for assured closure: 0.0 cm
Estimated volume-preparation gain

0.0–0.0%

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
0.9.3-rules-first-expert-validation-only
Rules SHA-256
0478e1c5552d2a15152eddb551b6f632ddba6edb24da9fe7c8f47960a5a5bc40
Input SHA-256
5a8cf397b60cc8bcb56e5cb9cc0f888e176af7c09ae3d172d890e2b835b29270
Decision trace
103 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

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 6.0–10.0 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. Enter and develop the initial retrorectus space.
  2. Insert the remaining ports under direct vision after a stable working chamber has been created.
  3. Perform crossover through intact linea alba and develop the contralateral retrorectus space.
  4. Dissect and reduce the hernia sac; repair posterior-layer defects when practical.
  5. Extend caudally into Retzius/Bogros or cranially according to the calculated implant field.
  6. Close the anterior fascial defect; add tension-reducing manoeuvres only when the planned closure is not achievable.
  7. Close the posterior layer completely.
  8. Measure the final field and compare it with the calculated mesh size.
  9. Introduce and unfold the mesh; avoid routine fixation when the closed pocket provides stability.
  10. Desufflate under vision and confirm that the mesh remains flat and centred.

Preoperative prescription

No preoperative manoeuvre required.

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: 0.0 cm for an estimated need of 0.0 cm.

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

Critical points

  • TAR used only for implant deployment is segmental. Full TAR is reserved for closure/medialisation or residual Tanaka/LoD capacity need.
  • Posterior-layer integrity is mandatory before permanent mesh placement.
  • A limited 3.0–4.0 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.