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Sanchez-Garcia J, Lopez-Verdugo F, Shorti R, Krong J, Zendejas I, Contreras AG, Botha J, Rodriguez-Davalos MI. Training the Next Generation of Transplant Surgeons With a 3-Dimensional Trainer: A Pilot Study. Transplant Direct 2024; 10:e1691. [PMID: 39131239 PMCID: PMC11315563 DOI: 10.1097/txd.0000000000001691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/05/2024] [Accepted: 06/24/2024] [Indexed: 08/13/2024] Open
Abstract
Background In the United States, no published guidelines promote exposure to technical variants (ie, living donor or split liver) during transplant fellowship. Simulation with hands-on liver models may improve training in transplantation. This pilot study addressed 3 overall goals (material and model creation tools, recruitment rates and assessment of workload, and protocol adherence). Methods A patient-specific hands-on liver model was constructed from clinical imaging, and it needed to be resilient and realistic. Multiple types of materials were tested between January 2020 and August 2022. Participants were recruited stepwise. A left lateral segmentectomy simulation was conducted between August 2022 and December 2022 to assess protocol adherence. Results Digital anatomy 3-dimensional printing was considered the best option for the hands-on liver model. The recruitment rate was 100% and 47% for junior attendings and surgical residents, respectively. Ten participants were included and completed all the required surveys. Seven (70%) and 6 (60%) participants "agreed" that the overall quality of the model and the material were acceptable for surgical simulation. Five participants (50%) "agreed" that the training improved their surgical skills. Nine participants (90%) "strongly agreed" that similar sessions should be included in surgical training programs. Conclusions Three-dimensional hands-on liver models have the advantage of tactile feedback and were rated favorably as a potential training tool. Study enrollment for further studies is possible with the support of leadership. Rigorous multicenter designs should be developed to measure the actual impact of 3-dimensional hands-on liver models on surgical training.
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Affiliation(s)
- Jorge Sanchez-Garcia
- Liver Transplant Service, Intermountain Primary Children’s Hospital, Salt Lake City, UT
| | - Fidel Lopez-Verdugo
- Liver Transplant Service, Intermountain Primary Children’s Hospital, Salt Lake City, UT
| | - Rami Shorti
- Advanced Visualization Engineering, Intermountain Health, Salt Lake City, UT
| | - Jake Krong
- Transplant Research Department, Intermountain Medical Center, Salt Lake City, UT
| | - Ivan Zendejas
- Liver Transplant Service, Intermountain Primary Children’s Hospital, Salt Lake City, UT
| | - Alan G. Contreras
- Liver Transplant Service, Intermountain Primary Children’s Hospital, Salt Lake City, UT
| | - Jean Botha
- Liver Transplant Service, Intermountain Primary Children’s Hospital, Salt Lake City, UT
| | - Manuel I. Rodriguez-Davalos
- Liver Transplant Service, Intermountain Primary Children’s Hospital, Salt Lake City, UT
- Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah School of Medicine, Salt Lake City, UT
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Tirloni L, Bartolini I, Gazia C, Scarinci A, Grazi GL. A contemporary view on vascular resections and reconstruction during hepatectomies. Updates Surg 2024:10.1007/s13304-024-01934-z. [PMID: 39007995 DOI: 10.1007/s13304-024-01934-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
Oncological hepatic surgery carries the possibility to perform vascular reconstructions for advanced tumours with vessel invasion since surgery often represents the only potentially curative approach for these tumours. An extended review was conducted in an attempt to understand and clarify the latest trends in hepatectomies with vascular resections. We searched bibliographic databases including PubMed, Scopus, references from bibliographies and Cochrane Library. Information and outcomes from worldwide clinical trials were collected from qualified institutions performing hepatectomies with vascular resection and reconstruction. Careful patient selection and thorough preoperative imaging remain crucial for correct and safe surgical planning. A literature analysis shows that vascular resections carry different indications in different diseases. Despite significant advances made in imaging techniques and technical skills, reports of hepatectomies with vascular resections are still associated with high postoperative morbidity and mortality. The trend of complex liver resection with vascular resection is constantly on the increase, but more profound knowledge as well as further trials are required. Recent technological developments in multiple fields could surely provide novel approaches and enhance a new era of digital imaging and intelligent hepatic surgery.
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Affiliation(s)
- Luca Tirloni
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
| | - Ilenia Bartolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy.
| | - Carlo Gazia
- Hepatopancreatobiliary Surgery, IRCCS - Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Andrea Scarinci
- Hepatopancreatobiliary Surgery, IRCCS - Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Gian Luca Grazi
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
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Melillo A, Rachedi S, Caggianese G, Gallo L, Maiorano P, Gimigliano F, Lucidi F, De Pietro G, Guida M, Giordano A, Chirico A. Synchronization of a Virtual Reality Scenario to Uterine Contractions for Labor Pain Management: Development Study and Randomized Controlled Trial. Games Health J 2024. [PMID: 38860400 DOI: 10.1089/g4h.2023.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
Background: Labor is described as one of the most painful events women can experience through their lives, and labor pain shows unique features and rhythmic fluctuations. Purpose: The present study aims to evaluate virtual reality (VR) analgesic interventions for active labor with biofeedback-based VR technologies synchronized to uterine activity. Materials and Methods: We developed a VR system modeled on uterine contractions by connecting it to cardiotocographic equipment. We conducted a randomized controlled trial on a sample of 74 cases and 80 controls during active labor. Results: Results of the study showed a significant reduction of pain scores compared with both preintervention scores and to control group scores; a significant reduction of anxiety levels both compared with preintervention assessment and to control group and significant reduction in fear of labor experience compared with controls. Conclusion: VR may be considered as an effective nonpharmacological analgesic technique for the treatment of pain and anxiety and fear of childbirth experience during labor. The developed system could improve personalization of care, modulating the multisensory stimulation tailored to labor progression. Further studies are needed to compare the synchronized VR system to uterine activity and unsynchronized VR interventions.
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Affiliation(s)
- Antonio Melillo
- Department of Mental and Physical Health and Preventive Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Sarah Rachedi
- Department of Neuroscience, Reproductive and Dentistry Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Caggianese
- Institute for High Performance Computing and Networking, National Research Council of Italy (ICAR-CNR), Naples, Italy
| | - Luigi Gallo
- Institute for High Performance Computing and Networking, National Research Council of Italy (ICAR-CNR), Naples, Italy
| | - Patrizia Maiorano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Fabio Lucidi
- Department of Social and Developmental Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe De Pietro
- Institute for High Performance Computing and Networking, National Research Council of Italy (ICAR-CNR), Naples, Italy
| | - Maurizio Guida
- Department of Neuroscience, Reproductive and Dentistry Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Andrea Chirico
- Department of Social and Developmental Psychology, "Sapienza" University of Rome, Rome, Italy
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4
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Yin H, Eimen R, Moyer D, Bowden AK. SpecReFlow: an algorithm for specular reflection restoration using flow-guided video completion. J Med Imaging (Bellingham) 2024; 11:024012. [PMID: 38666040 PMCID: PMC11042492 DOI: 10.1117/1.jmi.11.2.024012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/04/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Purpose Specular reflections (SRs) are highlight artifacts commonly found in endoscopy videos that can severely disrupt a surgeon's observation and judgment. Despite numerous attempts to restore SR, existing methods are inefficient and time consuming and can lead to false clinical interpretations. Therefore, we propose the first complete deep-learning solution, SpecReFlow, to detect and restore SR regions from endoscopy video with spatial and temporal coherence. Approach SpecReFlow consists of three stages: (1) an image preprocessing stage to enhance contrast, (2) a detection stage to indicate where the SR region is present, and (3) a restoration stage in which we replace SR pixels with an accurate underlying tissue structure. Our restoration approach uses optical flow to seamlessly propagate color and structure from other frames of the endoscopy video. Results Comprehensive quantitative and qualitative tests for each stage reveal that our SpecReFlow solution performs better than previous detection and restoration methods. Our detection stage achieves a Dice score of 82.8% and a sensitivity of 94.6%, and our restoration stage successfully incorporates temporal information with spatial information for more accurate restorations than existing techniques. Conclusions SpecReFlow is a first-of-its-kind solution that combines temporal and spatial information for effective detection and restoration of SR regions, surpassing previous methods relying on single-frame spatial information. Future work will look to optimizing SpecReFlow for real-time applications. SpecReFlow is a software-only solution for restoring image content lost due to SR, making it readily deployable in existing clinical settings to improve endoscopy video quality for accurate diagnosis and treatment.
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Affiliation(s)
- Haoli Yin
- Vanderbilt University, Department of Computer Science, Nashville, Tennessee, United States
| | - Rachel Eimen
- Vanderbilt University, Vanderbilt Biophotonics Center, Nashville, Tennessee, United States
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Daniel Moyer
- Vanderbilt University, Department of Computer Science, Nashville, Tennessee, United States
| | - Audrey K. Bowden
- Vanderbilt University, Vanderbilt Biophotonics Center, Nashville, Tennessee, United States
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, Tennessee, United States
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Sanchez-Garcia J, Lopez-Verdugo F, Shorti R, Krong J, Kastenberg ZJ, Walters S, Gagnon A, Paci P, Zendejas I, Alonso D, Fujita S, Contreras AG, Botha J, Esquivel CO, Rodriguez-Davalos MI. Three-dimensional Liver Model Application for Liver Transplantation. Transplantation 2024; 108:464-472. [PMID: 38259179 DOI: 10.1097/tp.0000000000004730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Children are removed from the liver transplant waitlist because of death or progressive illness. Size mismatch accounts for 30% of organ refusal. This study aimed to demonstrate that 3-dimensional (3D) technology is a feasible and accurate adjunct to organ allocation and living donor selection process. METHODS This prospective multicenter study included pediatric liver transplant candidates and living donors from January 2020 to February 2023. Patient-specific, 3D-printed liver models were used for anatomic planning, real-time evaluation during organ procurement, and surgical navigation. The primary outcome was to determine model accuracy. The secondary outcome was to determine the impact of outcomes in living donor hepatectomy. Study groups were analyzed using propensity score matching with a retrospective cohort. RESULTS Twenty-eight recipients were included. The median percentage error was -0.6% for 3D models and had the highest correlation to the actual liver explant (Pearson's R = 0.96, P < 0.001) compared with other volume calculation methods. Patient and graft survival were comparable. From 41 living donors, the median percentage error of the allograft was 12.4%. The donor-matched study group had lower central line utilization (21.4% versus 75%, P = 0.045), shorter length of stay (4 versus 7 d, P = 0.003), and lower mean comprehensive complication index (3 versus 21, P = 0.014). CONCLUSIONS Three-dimensional volume is highly correlated with actual liver explant volume and may vary across different allografts for living donation. The addition of 3D-printed liver models during the transplant evaluation and organ procurement process is a feasible and safe adjunct to the perioperative decision-making process.
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Affiliation(s)
- Jorge Sanchez-Garcia
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Fidel Lopez-Verdugo
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Rami Shorti
- Emerging Technologies, Intermountain Health, Murray, UT
| | - Jake Krong
- Transplant Research Department, Intermountain Medical Center, Murray, UT
| | - Zachary J Kastenberg
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Shannon Walters
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Andrew Gagnon
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Philippe Paci
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Ivan Zendejas
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Diane Alonso
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Shiro Fujita
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Alan G Contreras
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Jean Botha
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Carlos O Esquivel
- Division of Abdominal Transplantation, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA
| | - Manuel I Rodriguez-Davalos
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Division of Transplant Surgery, University of Utah School of Medicine, Salt Lake City, UT
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6
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Yi WS, Rouhi AD, Duffy CC, Ghanem YK, Williams NN, Dumon KR. A Systematic Review of Immersive Virtual Reality for Nontechnical Skills Training in Surgery. JOURNAL OF SURGICAL EDUCATION 2024; 81:25-36. [PMID: 38036388 DOI: 10.1016/j.jsurg.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Immersive virtual reality (IVR) can be utilized to provide low cost and easily accessible simulation on all aspects of surgical education. In addition to technical skills training in surgery, IVR simulation has been utilized for nontechnical skills training in domains such as clinical decision-making and pre-operative planning. This systematic review examines the current literature on the effectiveness of IVR for nontechnical skill acquisition in surgical education. DESIGN A literature search was performed using MEDLINE, EMBASE, and Web of Science for primary studies published between January 1, 1995 and February 9, 2022. Four reviewers screened titles, abstracts, full texts, extracted data, and analyzed included studies to answer 5 key questions: How is IVR being utilized in nontechnical skills surgical education? What is the methodological quality of studies? What technologies are being utilized? What metrics are reported? What are the findings of these studies? RESULTS The literature search yielded 2340 citations, with 12 articles included for qualitative synthesis. Of included articles, 33% focused on clinical decision-making and 67% on anatomy/pre-operative planning. Motion sickness was a recorded metric in 25% of studies, with an aggregate incidence of 13% (11/87). An application score was reported in 33% and time to completion in 16.7%. A commercially developed application was utilized in 25%, while 75% employed a noncommercial application. The Oculus Rift was used in 41.7% of studies, HTC Vive in 25%, Samsung Gear in 16.7% of studies, Google Daydream in 8%, and 1 study did not report. The mean Medical Education Research Quality Instrument (MERSQI) score was 10.3 ± 2.3 (out of 18). In all studies researching clinical decision-making, participants preferred IVR to conventional teaching methods and in a nonrandomized control study it was found to be more effective. Averaged across all studies, mean scores were 4.33 for enjoyment, 4.16 for utility, 4.11 for usability, and 3.73 for immersion on a 5-point Likert scale. CONCLUSIONS The IVR nontechnical skills applications for surgical education are designed for clinical decision-making or anatomy/pre-operative planning. These applications are primarily noncommercially produced and rely upon a diverse array of HMDs for content delivery, suggesting that development is primarily coming from within academia and still without clarity on optimal utilization of the technology. Excitingly, users find these applications to be immersive, enjoyable, usable, and of utility in learning. Although a few studies suggest that IVR is additive or superior to conventional teaching or imaging methods, the data is mixed and derived from studies with weak design. Motion sickness with IVR remains a complication of IVR use needing further study to determine the cause and means of mitigation.
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Affiliation(s)
- William S Yi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgical Education, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Clinical Simulation Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Armaun D Rouhi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caoimhe C Duffy
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yazid K Ghanem
- Department of Surgery, Cooper University Hospital, Camden, New Jersey
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgical Education, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Clinical Simulation Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgical Education, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Clinical Simulation Center, University of Pennsylvania, Philadelphia, Pennsylvania.
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7
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Würstle S, Spanke LM, Mehlhase N, Stanley G, Koff J, Dimitriadis S, König S, Hann A. Evaluation of a Virtual Reality-Based Open Educational Resource Software. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241242220. [PMID: 38572090 PMCID: PMC10989036 DOI: 10.1177/23821205241242220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/28/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Virtual reality (VR) teaching methods have potential to support medical students acquire increasing amounts of knowledge. EVENT (Easy VR EducatioN Tool) is an open educational resource software for immersive VR environments, which is designed for use without programming skills. In this work, EVENT was used in a medical student VR course on pancreatic cancer. METHODS Medical students were invited to participate in the course. Before and after VR simulation, participants completed a multiple-choice knowledge assessment, with a maximum score of 10, and a VR experience questionnaire. The primary endpoint compared pre- and post-VR simulation test scores. Secondary endpoints included usability and factors that could affect learning growth and test results. RESULTS Data from 117 of the 135 participating students was available for analysis. Student test scores improved by an average of 3.4 points (95% CI 3.1-3.7, P < 0.001) after VR course. The secondary endpoints of gender, age, prior knowledge regarding the medical subject, professional training completed in the medical field, video game play, three-dimensional imagination skills, or cyber-sickness had no major impact on test scores or final ranking (top or bottom 25%). The 27 students whose post-VR simulation test scores ranked in the top 25% had no prior experience with VR. The average System Usability Scale score was 86.1, which corresponds to an excellent outcome for user-friendliness. Questionnaire responses post-VR simulation show students (81.2% [95/117]) interest in more VR options in medical school. CONCLUSIONS We present a freely available software that allows for the development of VR teaching lessons without programming skills.
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Affiliation(s)
- Silvia Würstle
- Department of Internal Medicine II, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lisa-Marie Spanke
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, Gastroenterology, University Hospital Würzburg, Würzburg, Germany
- Institute of Medical Teaching and Medical Education Research, University Hospital Würzburg, Würzburg, Germany
| | - Niklas Mehlhase
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, Gastroenterology, University Hospital Würzburg, Würzburg, Germany
| | - Gail Stanley
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Jonathan Koff
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Stavros Dimitriadis
- Department of Gastroenterology, University Hospital Coventry and Warwickshire, Coventry, CV2 2DX, UK
| | - Sarah König
- Institute of Medical Teaching and Medical Education Research, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Hann
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, Gastroenterology, University Hospital Würzburg, Würzburg, Germany
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Bao G, Yang P, Yi J, Peng S, Liang J, Li Y, Guo D, Li H, Ma K, Yang Z. Full-sized realistic 3D printed models of liver and tumour anatomy: a useful tool for the clinical medicine education of beginning trainees. BMC MEDICAL EDUCATION 2023; 23:574. [PMID: 37582729 PMCID: PMC10428657 DOI: 10.1186/s12909-023-04535-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/24/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Simulation-based medical education (SBME) and three-dimensional printed (3DP) models are increasingly used in continuing medical education and clinical training. However, our understanding of their role and value in improving trainees' understanding of the anatomical and surgical procedures associated with liver surgery remains limited. Furthermore, gender bias is also a potential factor in the evaluation of medical education. Therefore, the aim of this study was to evaluate the educational benefits trainees receive from the use of novel 3DP liver models while considering trainees' experience and gender. METHODS Full-sized 3DP liver models were developed and printed using transparent material based on anonymous CT scans. We used printed 3D models and conventional 2D CT scans of the liver to investigate thirty trainees with various levels of experience and different genders in the context of both small group teaching and formative assessment. We adopted a mixed methods approach involving both questionnaires and focus groups to collect the views of different trainees and monitors to assess trainees' educational benefits and perceptions after progressing through different training programs. We used Objective Structured Clinical Examination (OSCE) and Likert scales to support thematic analysis of the responses to the questionnaires by trainees and monitors, respectively. Descriptive analyses were conducted using SPSS statistical software version 21.0. RESULTS Overall, a 3DP model of the liver is of great significance for improving trainees' understanding of surgical procedures and cooperation during operation. After viewing the personalized full-sized 3DP liver model, all trainees at the various levels exhibited significant improvements in their understanding of the key points of surgery (p < 0.05), especially regarding the planned surgical procedure and key details of the surgical procedures. More importantly, the trainees exhibited higher levels of satisfaction and self-confidence during the operation regardless of gender. However, with regard to gender, the results showed that the improvement of male trainees after training with the 3DP liver model was more significant than that of female trainees in understanding and cooperation during the surgical procedure, while no such trend was found with regard to their understanding of the base knowledge. CONCLUSION Trainees and monitors agreed that the use of 3DP liver models was acceptable. The improvement of the learning effect for practical skills and theoretical understanding after training with the 3DP liver models was significant. This study also indicated that training with personalized 3DP liver models can improve all trainees' presurgical understanding of liver tumours and surgery and males show more advantage in understanding and cooperation during the surgical procedure as compared to females. Full-sized realistic 3DP models of the liver are an effective auxiliary teaching tool for SBME teaching in Chinese continuing medical education.
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Affiliation(s)
- Guoqiang Bao
- Department of General Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, 710038, China
| | - Ping Yang
- Department of General Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, 710038, China
| | - Jiangpu Yi
- 3D Printing Research Center of Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Shujia Peng
- Department of General Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, 710038, China
| | - Jiahe Liang
- 3D Printing Research Center of Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yajie Li
- Xi 'an Ma Ke Medical Technology Ltd, Room 21516, Block C, Chaoyang International Plaza, Xi'an, Shaanxi, China
| | - Dian Guo
- Xi 'an Ma Ke Medical Technology Ltd, Room 21516, Block C, Chaoyang International Plaza, Xi'an, Shaanxi, China
| | - Haoran Li
- Department of General Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, 710038, China
| | - Kejun Ma
- Xi 'an Ma Ke Medical Technology Ltd, Room 21516, Block C, Chaoyang International Plaza, Xi'an, Shaanxi, China
| | - Zhenyu Yang
- Department of General Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, 710038, China.
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Montalti R, Rompianesi G, Cassese G, Pegoraro F, Giglio MC, De Simone G, Rashidian N, Venetucci P, Troisi RI. Role of preoperative 3D rendering for minimally invasive parenchyma sparing liver resections. HPB (Oxford) 2023:S1365-182X(23)00125-9. [PMID: 37149483 DOI: 10.1016/j.hpb.2023.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/23/2023] [Accepted: 04/13/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND 3D rendering (3DR) represents a promising approach to plan surgical strategies. The study aimed to compare the results of minimally invasive liver resections (MILS) in patients with 3DR versus conventional 2D CT-scan. METHODS We performed 118 3DR for various indications; the patients underwent a preoperative tri-phasic CT-scan and rendered with Synapse3D® Software. Fifty-six patients undergoing MILS with pre-operative 3DR were compared to a similar cohort of 127 patients undergoing conventional pre-operative 2D CT-scan using the propensity score matching (PSM) analysis. RESULTS The 3DR mandated pre-operative surgical plan variations in 33.9% cases, contraindicated surgery in 12.7%, providing a new surgical indication in 5.9% previously excluded cases. PSM identified 39 patients in both groups with comparable results in terms of conversion rates, blood loss, blood transfusions, parenchymal R1-margins, grade ≥3 Clavien-Dindo complications, 90-days mortality, and hospital stay respectively in 3DR and conventional 2D. Operative time was significantly increased in the 3DR group (402 vs. 347 min, p = 0.020). Vascular R1 resections were 25.6% vs 7.7% (p = 0.068), while the conversion rate was 0% vs 10.2% (p = 0.058), respectively, for 3DR group vs conventional 2D. CONCLUSION 3DR may help in surgical planning increasing resectability rate while reducing conversion rates, allowing the precise identification of anatomical landmarks in minimally invasive parenchyma-preserving liver resections.
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Affiliation(s)
- Roberto Montalti
- Department of Public Health, Federico II University, Naples, Italy; Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Renal Transplant Service, Federico II University, Naples, Italy
| | - Gianluca Rompianesi
- Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Renal Transplant Service, Federico II University, Naples, Italy
| | - Gianluca Cassese
- Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Renal Transplant Service, Federico II University, Naples, Italy
| | - Francesca Pegoraro
- Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Renal Transplant Service, Federico II University, Naples, Italy
| | - Mariano C Giglio
- Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Renal Transplant Service, Federico II University, Naples, Italy
| | - Giuseppe De Simone
- Department of Anesthesiology and Intensive Care, Federico II University, Naples, Italy
| | - Nikdokht Rashidian
- Department of Hepatobiliary and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Pietro Venetucci
- Division of Medical Imaging and Radiotherapy, Department of Onco-Hematology, Diagnostic and Morphologic Imaging, and Forensic Medicine, Federico II University, Naples, Italy
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Renal Transplant Service, Federico II University, Naples, Italy.
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10
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Valls-Esteve A, Tejo-Otero A, Lustig-Gainza P, Buj-Corral I, Fenollosa-Artés F, Rubio-Palau J, Barber-Martinez de la Torre I, Munuera J, Fondevila C, Krauel L. Patient-Specific 3D Printed Soft Models for Liver Surgical Planning and Hands-On Training. Gels 2023; 9:gels9040339. [PMID: 37102951 PMCID: PMC10138006 DOI: 10.3390/gels9040339] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/28/2023] Open
Abstract
Background: Pre-surgical simulation-based training with three-dimensional (3D) models has been intensively developed in complex surgeries in recent years. This is also the case in liver surgery, although with fewer reported examples. The simulation-based training with 3D models represents an alternative to current surgical simulation methods based on animal or ex vivo models or virtual reality (VR), showing reported advantages, which makes the development of realistic 3D-printed models an option. This work presents an innovative, low-cost approach for producing patient-specific 3D anatomical models for hands-on simulation and training. Methods: The article reports three paediatric cases presenting complex liver tumours that were transferred to a major paediatric referral centre for treatment: hepatoblastoma, hepatic hamartoma and biliary tract rhabdomyosarcoma. The complete process of the additively manufactured liver tumour simulators is described, and the different steps for the correct development of each case are explained: (1) medical image acquisition; (2) segmentation; (3) 3D printing; (4) quality control/validation; and (5) cost. A digital workflow for liver cancer surgical planning is proposed. Results: Three hepatic surgeries were planned, with 3D simulators built using 3D printing and silicone moulding techniques. The 3D physical models showed highly accurate replications of the actual condition. Additionally, they proved to be more cost-effective in comparison with other models. Conclusions: It is demonstrated that it is possible to manufacture accurate and cost-effective 3D-printed soft surgical planning simulators for treating liver cancer. The 3D models allowed for proper pre-surgical planning and simulation training in the three cases reported, making it a valuable aid for surgeons.
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Affiliation(s)
- Arnau Valls-Esteve
- Innovation Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Carrer de Casanova, 143, 08036 Barcelona, Spain
- 3D Unit (3D4H), Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
| | - Aitor Tejo-Otero
- Centre CIM, Universitat Politècnica de Catalunya (CIM UPC), Carrer de Llorens i Artigas, 12, 08028 Barcelona, Spain
| | - Pamela Lustig-Gainza
- Centre CIM, Universitat Politècnica de Catalunya (CIM UPC), Carrer de Llorens i Artigas, 12, 08028 Barcelona, Spain
| | - Irene Buj-Corral
- Department of Mechanical Engineering, Barcelona School of Industrial Engineering (ETSEIB), Universitat Politècnica de Catalunya, Av. Diagonal, 647, 08028 Barcelona, Spain
| | - Felip Fenollosa-Artés
- Centre CIM, Universitat Politècnica de Catalunya (CIM UPC), Carrer de Llorens i Artigas, 12, 08028 Barcelona, Spain
- Department of Mechanical Engineering, Barcelona School of Industrial Engineering (ETSEIB), Universitat Politècnica de Catalunya, Av. Diagonal, 647, 08028 Barcelona, Spain
| | - Josep Rubio-Palau
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Carrer de Casanova, 143, 08036 Barcelona, Spain
- 3D Unit (3D4H), Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
- Pediatric Surgical Oncology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
- Maxillofacial Unit, Department of Pediatric Surgery, Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
| | | | - Josep Munuera
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Carrer de Casanova, 143, 08036 Barcelona, Spain
- 3D Unit (3D4H), Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
- Department of Diagnostic Imaging, Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
| | - Constantino Fondevila
- Hepatopancreatobiliary Surgery and Transplantation, General and Digestive Surgery, Metabolic and Digestive Diseases Institute (ICMDM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, 08950 Esplugues de Llobregat, Spain
| | - Lucas Krauel
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Carrer de Casanova, 143, 08036 Barcelona, Spain
- 3D Unit (3D4H), Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
- Pediatric Surgical Oncology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
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11
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Laparoscopic Microwave Ablation: Which Technologies Improve the Results. Cancers (Basel) 2023; 15:cancers15061814. [PMID: 36980701 PMCID: PMC10046461 DOI: 10.3390/cancers15061814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Liver resection is the best treatment for hepatocellular carcinoma (HCC) when resectable. Unfortunately, many patients with HCC cannot undergo liver resection. Percutaneous thermoablation represents a valid alternative for inoperable neoplasms and for small HCCs, but it is not always possible to accomplish it. In cases where the percutaneous approach is not feasible (not a visible lesion or in hazardous locations), laparoscopic thermoablation may be indicated. HCC diagnosis is commonly obtained from imaging modalities, such as CT and MRI, However, the interpretation of radiological images, which have a two-dimensional appearance, during the surgical procedure and in particular during laparoscopy, can be very difficult in many cases for the surgeon who has to treat the tumor in a three-dimensional environment. In recent years, more technologies have helped surgeons to improve the results after ablative treatments. The three-dimensional reconstruction of the radiological images has allowed the surgeon to assess the exact position of the tumor both before the surgery (virtual reality) and during the surgery with immersive techniques (augmented reality). Furthermore, indocyanine green (ICG) fluorescence imaging seems to be a valid tool to enhance the precision of laparoscopic thermoablation. Finally, the association with laparoscopic ultrasound with contrast media could improve the localization and characteristics of tumor lesions. This article describes the use of hepatic three-dimensional modeling, ICG fluorescence imaging and laparoscopic ultrasound examination, convenient for improving the preoperative surgical preparation for personalized laparoscopic approach.
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12
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Manzie T, MacDougall H, Cheng K, Venchiarutti R, Fox R, Sharman A, Charters E, Seyfi D, Dunn M, Mukherjee P, Clark J. Virtual reality digital surgical planning for jaw reconstruction: a usability study. ANZ J Surg 2023; 93:1341-1347. [PMID: 36792539 DOI: 10.1111/ans.18307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/17/2023] [Accepted: 01/22/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Digital surgical planning (DSP) has revolutionized the preparation and execution of the management of complex head and neck pathologies. The addition of virtual reality (VR) allows the surgeon to have a three-dimensional experience with six degrees of freedom for visualizing and manipulating objects. This pilot study describes the participants experience with the first head and neck reconstructive VR-DSP platform. METHODS An original VR-DSP platform has been developed for planning the ablation and reconstruction of head and neck pathologies. A prospective trial utilizing this platform involving reconstructive surgeons was performed. Participants conducted a simulated VR-DSP planning session, pre- and post-questionnaire as well as audio recordings allowing for qualitative analysis. RESULTS Thirteen consultant reconstructive surgeons representing three surgical backgrounds with varied experience were recruited. The majority of surgeons had no previous experience with VR. Based on the system usability score, the VR-DSP platform was found to have above average usability. The qualitative analysis demonstrated the majority had a positive experience. Participants identified some perceived barriers to implementing the VR-DSP platform. CONCLUSIONS Virtual reality-digital surgical planning is usable and acceptable to reconstructive surgeons. Surgeons were able to perform the steps in an efficient time despite limited experience. The addition of VR offers additional benefits to current VSP platforms. Based on the results of this pilot study, it is likely that VR-DSP will be of benefit to the reconstructive surgeon.
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Affiliation(s)
- Timothy Manzie
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Hamish MacDougall
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kai Cheng
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Rebecca Venchiarutti
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Ashleigh Sharman
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Emma Charters
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Doruk Seyfi
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Masako Dunn
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Payal Mukherjee
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jonathan Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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13
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Rashidian N, Giglio MC, Van Herzeele I, Smeets P, Morise Z, Alseidi A, Troisi RI, Willaert W. Effectiveness of an immersive virtual reality environment on curricular training for complex cognitive skills in liver surgery: a multicentric crossover randomized trial. HPB (Oxford) 2022; 24:2086-2095. [PMID: 35961933 DOI: 10.1016/j.hpb.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/26/2022] [Accepted: 07/13/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Virtual reality (VR) is increasingly used in surgical education, but evidence of its benefits in complex cognitive training compared to conventional 3-dimensional (3D) visualization methods is lacking. The objective of this study is to assess the impact of 3D liver models rendered visible by VR or desktop interfaces (DIs) on residents' performance in clinical decision-making. METHOD From September 2020 to April 2021, a single-blinded, crossover randomized educational intervention trial was conducted at two university hospitals in Belgium and Italy. A proficiency-based stepwise curriculum for preoperative liver surgery planning was developed for general surgery residents. After completing the training, residents were randomized in one of two assessment sequences to evaluate ten real clinical scenarios. RESULTS Among the 50 participants, 46 (23 juniors/23 seniors) completed the training and were randomized. Forty residents (86.96%) achieved proficiency in decision-making. The accuracy of virtual surgical planning using VR was higher than that using DI in both groups A (8.43 ± 1.03 vs 6.86 ± 1.79, p < 0.001) and B (8.08 ± 0.9 vs 6.52 ± 1.37, p < 0.001). CONCLUSION Proficiency-based curricular training for liver surgery planning successfully resulted in the acquisition of complex cognitive skills. VR was superior to DI visualization of 3D models in decision-making. CLINICALTRIALS GOV ID NCT04959630.
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Affiliation(s)
- Nikdokht Rashidian
- Department of Human Structure and Repair, Ghent University Faculty of Medicine, Belgium.
| | - Mariano C Giglio
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | | | - Peter Smeets
- Department of Radiology, Ghent University Hospital, Belgium
| | - Zenichi Morise
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Roberto I Troisi
- Department of Human Structure and Repair, Ghent University Faculty of Medicine, Belgium; Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Wouter Willaert
- Department of Human Structure and Repair, Ghent University Faculty of Medicine, Belgium
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14
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Huber T, Huettl F, Hanke LI, Vradelis L, Heinrich S, Hansen C, Boedecker C, Lang H. Leberchirurgie 4.0 - OP-Planung, Volumetrie, Navigation und Virtuelle
Realität. Zentralbl Chir 2022; 147:361-368. [DOI: 10.1055/a-1844-0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ZusammenfassungDurch die Optimierung der konservativen Behandlung, die Verbesserung der
bildgebenden Verfahren und die Weiterentwicklung der Operationstechniken haben
sich das operative Spektrum sowie der Maßstab für die Resektabilität in Bezug
auf die Leberchirurgie in den letzten Jahrzehnten deutlich verändert.Dank zahlreicher technischer Entwicklungen, insbesondere der 3-dimensionalen
Segmentierung, kann heutzutage die präoperative Planung und die Orientierung
während der Operation selbst, vor allem bei komplexen Eingriffen, unter
Berücksichtigung der patientenspezifischen Anatomie erleichtert werden.Neue Technologien wie 3-D-Druck, virtuelle und augmentierte Realität bieten
zusätzliche Darstellungsmöglichkeiten für die individuelle Anatomie.
Verschiedene intraoperative Navigationsmöglichkeiten sollen die präoperative
Planung im Operationssaal verfügbar machen, um so die Patientensicherheit zu
erhöhen.Dieser Übersichtsartikel soll einen Überblick über den gegenwärtigen Stand der
verfügbaren Technologien sowie einen Ausblick in den Operationssaal der Zukunft
geben.
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Affiliation(s)
- Tobias Huber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Florentine Huettl
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Laura Isabel Hanke
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Lukas Vradelis
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Stefan Heinrich
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Christian Hansen
- Fakultät für Informatik, Otto von Guericke Universität
Magdeburg, Magdeburg, Deutschland
| | - Christian Boedecker
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Hauke Lang
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
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15
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Ahmed F, Jahagirdar V, Gudapati S, Mouchli M. Three-dimensional visualization and virtual reality simulation role in hepatic surgery: Further research warranted. World J Gastrointest Surg 2022; 14:723-726. [PMID: 36158284 PMCID: PMC9353753 DOI: 10.4240/wjgs.v14.i7.723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/05/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) is the study of algorithms that enable machines to analyze and execute cognitive activities including problem solving, object and word recognition, reduce the inevitable errors to improve the diagnostic accuracy, and decision-making. Hepatobiliary procedures are technically complex and the use of AI in perioperative management can improve patient outcomes as discussed below. Three-dimensional (3D) reconstruction of images obtained via ultrasound, computed tomography scan or magnetic resonance imaging, can help surgeons better visualize the surgical sites with added depth perception. Pre-operative 3D planning is associated with lesser operative time and intraoperative complications. Also, a more accurate assessment is noted, which leads to fewer operative complications. Images can be converted into physical models with 3D printing technology, which can be of educational value to students and trainees. 3D images can be combined to provide 3D visualization, which is used for preoperative navigation, allowing for more precise localization of tumors and vessels. Nevertheless, AI enables surgeons to provide better, personalized care for each patient.
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Affiliation(s)
- Faiza Ahmed
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, FL 33143, United States
| | - Vinay Jahagirdar
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, United States
| | - Sravya Gudapati
- Department of Gastroenterology, The Illinois Center for Digestive and Liver Health, Chicago, IL 60660, United States
| | - Mohamad Mouchli
- Department of Gastroenterology, Cleveland Clinic, Cleveland, OH 44195, United States
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16
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Influence of Three-Dimensional Visual Reconstruction Technology Combined with Virtual Surgical Planning of CTA Images on Precise Resection of Liver Cancer in Hepatobiliary Surgery. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4376654. [PMID: 35844455 PMCID: PMC9283065 DOI: 10.1155/2022/4376654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/20/2022]
Abstract
Hepatobiliary malignancies, such as hepatocellular carcinoma (HCC) and biliary tract cancers, namely, gallbladder carcinoma and cholangiocarcinoma, are linked to a high rate of morbidity and mortality, depending on the phase of the disease. The intricate hepatobiliary anatomy and the need for accurate peroperative management, especially in patients with advanced liver disease, make these tumors difficult to treat. Surgical resection is a notable therapy for hepatobiliary cancers. Unnecessary or excessive liver excision influences patient rehabilitation, normal liver function, and postoperative complications. Hepatobiliary operations must therefore include accurate liver removal. The present advancements in imaging technology are aimed at improving the diagnostic efficacy of liver injury even more. Three-dimensional visual reconstruction is becoming more important in the diagnosis as well as treatment of a variety of disorders. In this paper, we proposed a novel three-dimensional visual reconstruction technology using enhanced nonuniform rational basis spline (ENURBS) combined with virtual surgical planning of Computed Tomography Angiography (CTA) images for precise liver cancer resection. The purpose of this project is to rebuild 2D CTA scan images of liver cancer into a 3D reconstructed model for efficient visualization and diagnosis of liver cancer and to prepare an effective preoperative surgical plan for precise liver excision based on a 3D recreated liver model. This method's performance is compared to that of 2D planning in terms of accuracy and time taken to complete the plan. It is concluded that our proposed technique outperforms the planning technique based on 2D images.
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17
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Huber T, Hanke LI, Boedecker C, Vradelis L, Baumgart J, Heinrich S, Bartsch F, Mittler J, Schulze A, Hansen C, Hüttl F, Lang H. Patient-individualized resection planning in liver surgery using 3D print and virtual reality (i-LiVR)-a study protocol for a prospective randomized controlled trial. Trials 2022; 23:403. [PMID: 35562806 PMCID: PMC9100295 DOI: 10.1186/s13063-022-06347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background A multitude of different diseases—benign and malign—can require surgery of the liver. The liver is an especially challenging organ for resection planning due to its unique and interindividually variable anatomy. This demands a high amount of mental imagination from the surgeon in order to plan accordingly - a skill, which takes years of training to acquire and which is difficult to teach. Since the volume of the functional remnant liver is of great importance, parenchyma sparing resections are favoured. 3D reconstructions of computed tomography imaging enable a more precise understanding of anatomy and facilitate resection planning. The modality of presentation of these 3D models ranges from 2D monitors to 3D prints and virtual reality applications. Methods The presented trial compares three different modes of demonstration of a 3D reconstruction of CT scans of the liver, which are 3D print, a demonstration on a regular computer screen or using a head-mounted virtual reality headset, with the current gold standard of viewing the CT scan on a computer screen. The group size was calculated with n=25 each. Patients with major liver resections in a laparoscopic or open fashion are eligible for inclusion. Main endpoint is the comparison of the quotient between planned resection volume and actual resection volume between these groups. Secondary endpoints include usability for the surgical team as well as patient specifics and perioperative outcome measures and teaching issues. Discussion The described study will give insight in systematic planning of liver resections and the comparison of different demonstration modalities of 3D reconstruction of preoperative CT scans and the preference of technology. Especially teaching of these demanding operations is underrepresented in prior investigations. Trial registration Prospective trials registration at the German Clinical Trials register with the registration number DRKS00027865. Registration Date: January 24, 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06347-0.
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Affiliation(s)
- Tobias Huber
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany.
| | - Laura Isabel Hanke
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Christian Boedecker
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Lukas Vradelis
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Janine Baumgart
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Stefan Heinrich
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Fabian Bartsch
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Jens Mittler
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Alicia Schulze
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Christian Hansen
- Institute of Simulation and Graphics, Faculty of Informatics, University Magdeburg, Magdeburg, Germany
| | - Florentine Hüttl
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
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18
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eSurgery—digital transformation in surgery, surgical education and training: survey analysis of the status quo in Germany. Eur Surg 2022. [DOI: 10.1007/s10353-022-00747-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Saito Y, Shimada M, Morine Y, Yamada S, Sugimoto M. Essential updates 2020/2021: Current topics of simulation and navigation in hepatectomy. Ann Gastroenterol Surg 2022; 6:190-196. [PMID: 35261944 PMCID: PMC8889864 DOI: 10.1002/ags3.12542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/26/2021] [Accepted: 12/14/2021] [Indexed: 01/01/2023] Open
Abstract
With the development of three-dimensional (3D) simulation software, preoperative simulation technology is almost completely established. The remaining issue is how to recognize anatomy three-dimensionally. Extended reality is a newly developed technology with several merits for surgical application: no requirement for a sterilized display monitor, better spatial awareness, and the ability to share 3D images among all surgeons. Various technology or devices for intraoperative navigation have also been developed to support the safety and certainty of liver surgery. Consensus recommendations regarding indocyanine green fluorescence were determined in 2021. Extended reality has also been applied to intraoperative navigation, and artificial intelligence (AI) is one of the topics of real-time navigation. AI might overcome the problem of liver deformity with automatic registration. Including the issues described above, this article focuses on recent advances in simulation and navigation in liver surgery from 2020 to 2021.
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Affiliation(s)
- Yu Saito
- Department of SurgeryTokushima UniversityTokushimaJapan
| | | | - Yuji Morine
- Department of SurgeryTokushima UniversityTokushimaJapan
| | | | - Maki Sugimoto
- Department of SurgeryTokushima UniversityTokushimaJapan
- Okinaga Research InstituteTeikyo UniversityChiyoda‐kuJapan
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20
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Reinschluessel AV, Muender T, Salzmann D, Döring T, Malaka R, Weyhe D. Virtual Reality for Surgical Planning – Evaluation Based on Two Liver Tumor Resections. Front Surg 2022; 9:821060. [PMID: 35296126 PMCID: PMC8919284 DOI: 10.3389/fsurg.2022.821060] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose For complex cases, preoperative surgical planning is a standard procedure to ensure patient safety and keep the surgery time to a minimum. Based on the available information, such as MRI or CT images, and prior anatomical knowledge the surgeons create their own mental 3D model of the organ of interest. This is challenging, requires years of training and an inherent uncertainty remains even for experienced surgeons. Goal Virtual reality (VR) is by nature excellent in showing spatial relationships through its stereoscopic displays. Therefore, it is well suited to be used to support the understanding of individual anatomy of patient-specific 3D organ models generated from MRI or CT data. Utilizing this potential, we developed a VR surgical planning tool that provides a 3D view of the medical data for better spatial understanding and natural interaction with the data in 3D space. Following a user-centered design process, in this first user study, we focus on usability, usefulness, and target audience feedback. Thereby, we also investigate the individual impact the tool and the 3D presentation of the organ have on the understanding of the 3D structures for the surgical team. Methods We employed the VR prototype for surgical planning using a standard VR setup to two real cases of patients with liver tumors who were scheduled for surgery at a University Hospital for Visceral Surgery. Surgeons (N = 4) used the VR prototype before the surgery to plan the procedure in addition to their regular planning process. We used semi-structured interviews before and after the surgery to explore the benefits and pitfalls of VR surgical planning. Results The participants used on average 14.3 min (SD = 3.59) to plan the cases in VR. The reported usability was good. Results from the interviews and observations suggest that planning in VR can be very beneficial for surgeons. They reported an improved spatial understanding of the individual anatomical structures and better identification of anatomical variants. Additionally, as the surgeons mentioned an improved recall of the information and better identification of surgical relevant structures, the VR tool has the potential to improve the surgery and patient safety.
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Affiliation(s)
- Anke V. Reinschluessel
- Digital Media Lab, University of Bremen, Bremen, Germany
- *Correspondence: Anke V. Reinschluessel
| | - Thomas Muender
- Digital Media Lab, University of Bremen, Bremen, Germany
- Thomas Muender
| | - Daniela Salzmann
- University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Tanja Döring
- Digital Media Lab, University of Bremen, Bremen, Germany
- Tanja Döring
| | - Rainer Malaka
- Digital Media Lab, University of Bremen, Bremen, Germany
- Rainer Malaka
| | - Dirk Weyhe
- University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
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21
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Guérinot C, Marcon V, Godard C, Blanc T, Verdier H, Planchon G, Raimondi F, Boddaert N, Alonso M, Sailor K, Lledo PM, Hajj B, El Beheiry M, Masson JB. New Approach to Accelerated Image Annotation by Leveraging Virtual Reality and Cloud Computing. FRONTIERS IN BIOINFORMATICS 2022; 1:777101. [PMID: 36303792 PMCID: PMC9580868 DOI: 10.3389/fbinf.2021.777101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/15/2021] [Indexed: 01/02/2023] Open
Abstract
Three-dimensional imaging is at the core of medical imaging and is becoming a standard in biological research. As a result, there is an increasing need to visualize, analyze and interact with data in a natural three-dimensional context. By combining stereoscopy and motion tracking, commercial virtual reality (VR) headsets provide a solution to this critical visualization challenge by allowing users to view volumetric image stacks in a highly intuitive fashion. While optimizing the visualization and interaction process in VR remains an active topic, one of the most pressing issue is how to utilize VR for annotation and analysis of data. Annotating data is often a required step for training machine learning algorithms. For example, enhancing the ability to annotate complex three-dimensional data in biological research as newly acquired data may come in limited quantities. Similarly, medical data annotation is often time-consuming and requires expert knowledge to identify structures of interest correctly. Moreover, simultaneous data analysis and visualization in VR is computationally demanding. Here, we introduce a new procedure to visualize, interact, annotate and analyze data by combining VR with cloud computing. VR is leveraged to provide natural interactions with volumetric representations of experimental imaging data. In parallel, cloud computing performs costly computations to accelerate the data annotation with minimal input required from the user. We demonstrate multiple proof-of-concept applications of our approach on volumetric fluorescent microscopy images of mouse neurons and tumor or organ annotations in medical images.
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Affiliation(s)
- Corentin Guérinot
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
- Sorbonne Université, Collège Doctoral, Paris, France
| | - Valentin Marcon
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Charlotte Godard
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- École Doctorale Physique en Île-de-France, PSL University, Paris, France
| | - Thomas Blanc
- Sorbonne Université, Collège Doctoral, Paris, France
- Laboratoire Physico-Chimie, Institut Curie, PSL Research University, CNRS UMR168, Paris, France
| | - Hippolyte Verdier
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Histopathology and Bio-Imaging Group, Sanofi R&D, Vitry-Sur-Seine, France
- Université de Paris, UFR de Physique, Paris, France
| | - Guillaume Planchon
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Francesca Raimondi
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Malformations Cardiaques Congénitales Complexes M3C, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- Pediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- UMR-1163 Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- UMR-1163 Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Mariana Alonso
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Kurt Sailor
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Pierre-Marie Lledo
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Bassam Hajj
- Sorbonne Université, Collège Doctoral, Paris, France
- École Doctorale Physique en Île-de-France, PSL University, Paris, France
| | - Mohamed El Beheiry
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Jean-Baptiste Masson
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
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22
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Huettl F, Saalfeld P, Hansen C, Preim B, Poplawski A, Kneist W, Lang H, Huber T. Virtual reality and 3D printing improve preoperative visualization of 3D liver reconstructions-results from a preclinical comparison of presentation modalities and user's preference. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1074. [PMID: 34422986 PMCID: PMC8339861 DOI: 10.21037/atm-21-512] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 12/20/2022]
Abstract
Background Preoperative three-dimensional (3D) reconstructions for liver surgery planning have been shown to be effective in reduction of blood loss and operation time. However, the role of the ‘presentation modality’ is not well investigated. We present the first study to compare 3D PDFs, 3D printed models (PR) and virtual reality (VR) 3D models with regard to anatomical orientation and personal preferences in a high volume liver surgery center. Methods Thirty participants, 10 medical students, 10 residents, 5 fellows and 5 hepatopancreatobiliary (HPB) experts, assigned the tumor-bearing segments of 20 different patient’s individual liver reconstructions. Liver models were presented in a random order in all modalities. Time needed to specify the tumor location was recorded. In addition, a score was calculated factoring in correct, wrong and missing segment assignments. Furthermore, standardized test/questionnaires for spatial thinking and seeing, vegetative side effects and usability were completed. Results Participants named significantly more correct segments in VR (P=0.040) or PR (P=0.036) compared to PDF. Tumor assignment was significantly shorter with 3D PR models compared to 3D PDF (P<0.001) or VR application (P<0.001). Regardless of the modality, HPB experts were significantly faster (24±8 vs. 35±11 sec; P=0.014) and more often correct (0.87±0.12 vs. 0.83±0.15; P<0.001) than medical students. Test results for spatial thinking and seeing had no influence on time but on correctness of tumor assignment. Regarding usability and user experience the VR application achieved the highest scores without causing significant vegetative symptoms and was also the most preferred method (n=22, 73.3%) because of the multiple functions like scaling and change of transparency. Ninety percent (n=27) stated that this application can positively influence the operation planning. Conclusions 3D PR models and 3D VR models enable a better and partially faster anatomical orientation than reconstructions presented as 3D PDFs. User’s preferred the VR application over the PR models and PDF. A prospective trial is needed to evaluate the different presentation modalities regarding intra- and postoperative outcomes.
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Affiliation(s)
- Florentine Huettl
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Patrick Saalfeld
- Institute of Simulation and Graphics, Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Christian Hansen
- Institute of Simulation and Graphics, Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Bernhard Preim
- Institute of Simulation and Graphics, Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Alicia Poplawski
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Werner Kneist
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Department of General and Visceral Surgery, St. Georg Hospital, Eisenach, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tobias Huber
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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23
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Hattab G, Hatzipanayioti A, Klimova A, Pfeiffer M, Klausing P, Breucha M, Bechtolsheim FV, Helmert JR, Weitz J, Pannasch S, Speidel S. Investigating the utility of VR for spatial understanding in surgical planning: evaluation of head-mounted to desktop display. Sci Rep 2021; 11:13440. [PMID: 34188080 PMCID: PMC8241863 DOI: 10.1038/s41598-021-92536-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/11/2021] [Indexed: 02/06/2023] Open
Abstract
Recent technological advances have made Virtual Reality (VR) attractive in both research and real world applications such as training, rehabilitation, and gaming. Although these other fields benefited from VR technology, it remains unclear whether VR contributes to better spatial understanding and training in the context of surgical planning. In this study, we evaluated the use of VR by comparing the recall of spatial information in two learning conditions: a head-mounted display (HMD) and a desktop screen (DT). Specifically, we explored (a) a scene understanding and then (b) a direction estimation task using two 3D models (i.e., a liver and a pyramid). In the scene understanding task, participants had to navigate the rendered the 3D models by means of rotation, zoom and transparency in order to substantially identify the spatial relationships among its internal objects. In the subsequent direction estimation task, participants had to point at a previously identified target object, i.e., internal sphere, on a materialized 3D-printed version of the model using a tracked pointing tool. Results showed that the learning condition (HMD or DT) did not influence participants' memory and confidence ratings of the models. In contrast, the model type, that is, whether the model to be recalled was a liver or a pyramid significantly affected participants' memory about the internal structure of the model. Furthermore, localizing the internal position of the target sphere was also unaffected by participants' previous experience of the model via HMD or DT. Overall, results provide novel insights on the use of VR in a surgical planning scenario and have paramount implications in medical learning by shedding light on the mental model we make to recall spatial structures.
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Affiliation(s)
- Georges Hattab
- grid.461742.2Division of Translational Surgical Oncology (TSO), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
| | - Adamantini Hatzipanayioti
- grid.4488.00000 0001 2111 7257Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, 01062 Dresden, Germany ,grid.4488.00000 0001 2111 7257Unit of Lifespan Developmental Neuroscience, Faculty of Psychology, TU Dresden, 01062 Dresden, Germany
| | - Anna Klimova
- grid.4488.00000 0001 2111 7257Institute for Medical Informatics and Biometry (IMB), Faculty of Medicine, TU Dresden, 01307 Dresden, Germany ,grid.461742.2Core Unit for Data Management and Analytics, National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
| | - Micha Pfeiffer
- grid.461742.2Division of Translational Surgical Oncology (TSO), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
| | - Peter Klausing
- grid.461742.2Division of Translational Surgical Oncology (TSO), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
| | - Michael Breucha
- grid.461742.2Division of Translational Surgical Oncology (TSO), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany ,grid.412282.f0000 0001 1091 2917Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Felix von Bechtolsheim
- grid.4488.00000 0001 2111 7257Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, 01062 Dresden, Germany ,grid.412282.f0000 0001 1091 2917Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jens R. Helmert
- grid.4488.00000 0001 2111 7257Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, 01062 Dresden, Germany ,grid.4488.00000 0001 2111 7257Engineering Psychology and Applied Cognitive Research, Faculty of Psychology, TU Dresden, 01062 Dresden, Germany
| | - Jürgen Weitz
- grid.4488.00000 0001 2111 7257Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, 01062 Dresden, Germany ,grid.412282.f0000 0001 1091 2917Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Sebastian Pannasch
- grid.4488.00000 0001 2111 7257Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, 01062 Dresden, Germany ,grid.4488.00000 0001 2111 7257Engineering Psychology and Applied Cognitive Research, Faculty of Psychology, TU Dresden, 01062 Dresden, Germany
| | - Stefanie Speidel
- grid.461742.2Division of Translational Surgical Oncology (TSO), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany ,grid.4488.00000 0001 2111 7257Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, 01062 Dresden, Germany
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