3D Modelling for Preoperative Planning, Intraoperative Navigation, and Training in Pancreatic Surgery: A Systematic Review.

OBJECTIVE

To systematically review the state of the art for 3-dimensional (3D) technologies in pancreatic surgery for preoperative planning, intraoperative navigation, and surgical training.

BACKGROUND

Three-dimensional modeling is currently routinely used in the standard preoperative work-up for liver surgery and is also increasingly adopted in pancreatic surgery to improve anatomical understanding, surgical planning, and intraoperative guidance. Recent advances have expanded these technologies toward augmented visualization and artificial intelligence-assisted workflows. The clinical impact, level of evidence, and real-world feasibility of these approaches are still under active investigation.

METHODS

A systematic review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 guidelines and registered in PROSPERO (CRD420251085091). PubMed and CENTRAL were searched through December 2025 to prioritize clinically oriented literature on patient-specific 3D applications in pancreatic surgery. Because of marked heterogeneity in study design, interventions, and outcome definitions, results were synthesized descriptively.

RESULTS

Fifty-eight studies met inclusion criteria and were grouped into 3 domains: preoperative planning (n = 40), intraoperative navigation (n = 7), and surgical training (n = 11). In preoperative planning, 28/40 studies demonstrated superior staging, vascular mapping, and resectability assessment compared with conventional imaging. In 6/7 studies investigating intraoperative navigation, correct alignment was achieved, and a reduction in operative time and intraoperative blood loss was reported in 2/7 studies employing augmented reality-assisted navigation. In surgical training, 9/11 studies showed improved anatomical comprehension and procedural performance using 3D printing, virtual reality, and 3D imaging, associated with reduced operative time and faster learning curves.

CONCLUSION

Three-dimensional technologies enhance anatomical visualization and support planning, navigation, and training in pancreatic surgery; however, consistent improvement in definitive perioperative or oncologic outcomes has not yet been demonstrated. Future studies should prioritize standardized outcomes, formal study-quality assessment, workflow feasibility, cost-effectiveness, and rigorous evaluation of artificial intelligence-enabled applications.