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Yoshiaki M, Minagawa N, Kato T, Okada N, Suzuki T, Ishizuka C, Fukuda A, Mori Y. Laparoscopic Resection of Transverse Colon Cancer with an Anomaly of the Middle Colic Artery Originating from the Splenic Artery: A Case Report. Case Rep Gastroenterol 2024; 18:105-109. [PMID: 38439819 PMCID: PMC10911783 DOI: 10.1159/000536672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction We encountered a colon cancer case with a very rare anomaly of the middle colic artery (MCA) originating from the splenic artery (SA). Case Presentation A woman was referred to our hospital for transverse colon cancer. Three-dimensional computed tomography (3D-CT) angiography showed an anomalous MCA originating from the SA rather than from the superior mesenteric artery (SMA) as is typical. Laparoscopic left hemicolectomy with D3 lymph node dissection was performed. The lymph nodes around the SMA were dissected from the caudal view, confirming the absence of a typical MCA. An anomalous SA-originating MCA was identified just below the pancreas, where it was clipped and ligated; subsequently, total mesenteric excision was achieved. Conclusion As D3 lymph node dissection for transverse colon cancer is technically difficult, 3D-CT angiography is useful for identifying vascular anomalies preoperatively, thereby avoiding intraoperative injury. This is the first case report of laparoscopic colectomy associated with a SA-originating MCA anomaly.
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Affiliation(s)
- Maeda Yoshiaki
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Nozomi Minagawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Takuya Kato
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Naoki Okada
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Takuto Suzuki
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Chihiro Ishizuka
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Akihisa Fukuda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Yoichi Mori
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
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Carbone M, Viglialoro RM, Stagnari S, Condino S, Gesi M, Scaglione M, Parchi PD. Design, Fabrication, and Preliminary Validation of Patient-Specific Spine Section Phantoms for Use in Training Spine Surgeons Outside the Operating Room/Theatre. Bioengineering (Basel) 2023; 10:1345. [PMID: 38135936 PMCID: PMC10740604 DOI: 10.3390/bioengineering10121345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Pedicle screw fixation (PSF) demands rigorous training to mitigate the risk of severe neurovascular complications arising from screw misplacement. This paper introduces a patient-specific phantom designed for PSF training, extending a portion of the learning process beyond the confines of the surgical room. Six phantoms of the thoracolumbar region were fabricated from radiological datasets, combining 3D printing and casting techniques. The phantoms were employed in three training sessions by a fifth-year resident who performed full training on all six phantoms; he/she placed a total of 57 pedicle screws. Analysis of the learning curve, focusing on time per screw and positioning accuracy, revealed attainment of an asymptotic performance level (around 3 min per screw) after 40 screws. The phantom's efficacy was evaluated by three experts and six residents, each inserting a minimum of four screws. Initial assessments confirmed face, content, and construct validity, affirming the patient-specific phantoms as a valuable training resource. These proposed phantoms exhibit great promise as an essential tool in surgical training as they exhibited a demonstrable learning effect on the PSF technique. This study lays the foundation for further exploration and underscores the potential impact of these patient-specific phantoms on the future of spinal surgical education.
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Affiliation(s)
- Marina Carbone
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Rosanna Maria Viglialoro
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Sara Stagnari
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Sara Condino
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Marco Gesi
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, 56121 Pisa, Italy;
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Michelangelo Scaglione
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Paolo Domenico Parchi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
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3
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Architecture of a Hybrid Video/Optical See-through Head-Mounted Display-Based Augmented Reality Surgical Navigation Platform. INFORMATION 2022. [DOI: 10.3390/info13020081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In the context of image-guided surgery, augmented reality (AR) represents a ground-breaking enticing improvement, mostly when paired with wearability in the case of open surgery. Commercially available AR head-mounted displays (HMDs), designed for general purposes, are increasingly used outside their indications to develop surgical guidance applications with the ambition to demonstrate the potential of AR in surgery. The applications proposed in the literature underline the hunger for AR-guidance in the surgical room together with the limitations that hinder commercial HMDs from being the answer to such a need. The medical domain demands specifically developed devices that address, together with ergonomics, the achievement of surgical accuracy objectives and compliance with medical device regulations. In the framework of an EU Horizon2020 project, a hybrid video and optical see-through augmented reality headset paired with a software architecture, both specifically designed to be seamlessly integrated into the surgical workflow, has been developed. In this paper, the overall architecture of the system is described. The developed AR HMD surgical navigation platform was positively tested on seven patients to aid the surgeon while performing Le Fort 1 osteotomy in cranio-maxillofacial surgery, demonstrating the value of the hybrid approach and the safety and usability of the navigation platform.
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Huang B, Lin X, Shen J, Chen X, Chen J, Li ZP, Wang M, Yuan C, Diao XF, Luo Y, Feng ST. Accurate and Feasible Deep Learning Based Semi-Automatic Segmentation in CT for Radiomics Analysis in Pancreatic Neuroendocrine Neoplasms. IEEE J Biomed Health Inform 2021; 25:3498-3506. [PMID: 33798088 DOI: 10.1109/jbhi.2021.3070708] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Current clinical practice or radiomics studies of pancreatic neuroendocrine neoplasms (pNENs) require manual delineation of the lesions in computed tomography (CT) images, which is time-consuming and subjective. We used a semi-automatic deep learning (DL) method for segmentation of pNENs and verified its feasibility in radiomics analysis. This retrospective study included two datasets: Dataset 1, contrast-enhanced CT images (CECT) of 80 and 18 patients respectively collected from two centers; and Dataset 2, CECT of 56 and 16 patients respectively from two centers. A DL-based semi-automatic segmentation model was developed and validated with Dataset 1 and Dataset 2, and the segmentation results were used for radiomics analysis from which the performance was compared against that based on manual segmentation. The mean Dice similarity coefficient of the trained segmentation model was 81.8% and 74.8% for external validation with Dataset 1 and Dataset 2 respectively. Four classifiers frequently used in radiomics studies were trained and tested with leave-one-out cross-validation strategy. For pathological grading prediction with Dataset 1, the area under the receiver operating characteristic curve (AUC) with semi-automatic segmentation was up to 0.76 and 0.87 respectively for internal and external validation. For recurrence study with Dataset 2, the AUC with semi-automatic segmentation was up to 0.78. All these AUCs were not statistically significant from the corresponding results based on manual segmentation. Our study showed that DL-based semi-automatic segmentation is accurate and feasible for the radiomics analysis in pNENs.
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Comprehensive Review of 3D Segmentation Software Tools for MRI Usable for Pelvic Surgery Planning. J Digit Imaging 2021; 33:99-110. [PMID: 31236743 DOI: 10.1007/s10278-019-00239-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Patient-specific 3D modeling is the first step towards image-guided surgery, the actual revolution in surgical care. Pediatric and adolescent patients with rare tumors and malformations should highly benefit from these latest technological innovations, allowing personalized tailored surgery. This study focused on the pelvic region, located at the crossroads of the urinary, digestive, and genital channels with important vascular and nervous structures. The aim of this study was to evaluate the performances of different software tools to obtain patient-specific 3D models, through segmentation of magnetic resonance images (MRI), the reference for pediatric pelvis examination. Twelve software tools freely available on the Internet and two commercial software tools were evaluated using T2-w MRI and diffusion-weighted MRI images. The software tools were rated according to eight criteria, evaluated by three different users: automatization degree, segmentation time, usability, 3D visualization, presence of image registration tools, tractography tools, supported OS, and potential extension (i.e., plugins). A ranking of software tools for 3D modeling of MRI medical images, according to the set of predefined criteria, was given. This ranking allowed us to elaborate guidelines for the choice of software tools for pelvic surgical planning in pediatric patients. The best-ranked software tools were Myrian Studio, ITK-SNAP, and 3D Slicer, the latter being especially appropriate if nerve fibers should be included in the 3D patient model. To conclude, this study proposed a comprehensive review of software tools for 3D modeling of the pelvis according to a set of eight criteria and delivered specific conclusions for pediatric and adolescent patients that can be directly applied to clinical practice.
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6
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Cercenelli L, Carbone M, Condino S, Cutolo F, Marcelli E, Tarsitano A, Marchetti C, Ferrari V, Badiali G. The Wearable VOSTARS System for Augmented Reality-Guided Surgery: Preclinical Phantom Evaluation for High-Precision Maxillofacial Tasks. J Clin Med 2020; 9:jcm9113562. [PMID: 33167432 PMCID: PMC7694536 DOI: 10.3390/jcm9113562] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In the context of guided surgery, augmented reality (AR) represents a groundbreaking improvement. The Video and Optical See-Through Augmented Reality Surgical System (VOSTARS) is a new AR wearable head-mounted display (HMD), recently developed as an advanced navigation tool for maxillofacial and plastic surgery and other non-endoscopic surgeries. In this study, we report results of phantom tests with VOSTARS aimed to evaluate its feasibility and accuracy in performing maxillofacial surgical tasks. METHODS An early prototype of VOSTARS was used. Le Fort 1 osteotomy was selected as the experimental task to be performed under VOSTARS guidance. A dedicated set-up was prepared, including the design of a maxillofacial phantom, an ad hoc tracker anchored to the occlusal splint, and cutting templates for accuracy assessment. Both qualitative and quantitative assessments were carried out. RESULTS VOSTARS, used in combination with the designed maxilla tracker, showed excellent tracking robustness under operating room lighting. Accuracy tests showed that 100% of Le Fort 1 trajectories were traced with an accuracy of ±1.0 mm, and on average, 88% of the trajectory's length was within ±0.5 mm accuracy. CONCLUSIONS Our preliminary results suggest that the VOSTARS system can be a feasible and accurate solution for guiding maxillofacial surgical tasks, paving the way to its validation in clinical trials and for a wide spectrum of maxillofacial applications.
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Affiliation(s)
- Laura Cercenelli
- eDIMES Lab—Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy;
- Correspondence: ; Tel.: +39-0516364603
| | - Marina Carbone
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (M.C.); (S.C.); (F.C.); (V.F.)
| | - Sara Condino
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (M.C.); (S.C.); (F.C.); (V.F.)
| | - Fabrizio Cutolo
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (M.C.); (S.C.); (F.C.); (V.F.)
| | - Emanuela Marcelli
- eDIMES Lab—Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy;
| | - Achille Tarsitano
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy; (A.T.); (C.M.); (G.B.)
| | - Claudio Marchetti
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy; (A.T.); (C.M.); (G.B.)
| | - Vincenzo Ferrari
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (M.C.); (S.C.); (F.C.); (V.F.)
| | - Giovanni Badiali
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy; (A.T.); (C.M.); (G.B.)
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7
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Condino S, Piazza R, Viglialoro RM, Mocellin DM, Turini G, Berchiolli RN, Micheletti F, Rossi F, Pini R, Ferrari V, Ferrari M. Novel EM Guided Endovascular Instrumentation for In Situ Endograft Fenestration. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2020; 8:1900208. [PMID: 32219042 PMCID: PMC7082146 DOI: 10.1109/jtehm.2020.2973973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/20/2019] [Accepted: 01/27/2020] [Indexed: 01/28/2023]
Abstract
Objective: This work aims at providing novel endovascular instrumentation to overcome current technical limitations of in situ endograft fenestration including challenges in targeting the fenestration site under fluoroscopic control and supplying mechanical support during endograft perforation. Technology: Novel electromagnetically trackable instruments were developed to facilitate the navigation of the fenestration device and its stabilization at the target site. In vitro trials were performed to preliminary evaluate the proposed instrumentation for the antegrade in situ fenestration of an aortic endograft, using a laser guidewire designed ad hoc and the sharp end of a commercial endovascular guidewire. Results: In situ fenestration was successfully performed in 22 trials. A total of two laser tools were employed since an over bending of laser guidewire tip, due to its manufacturing, caused the damage of the sensor in the first device used. Conclusions: Preliminary in vitro trials demonstrate the feasibility of the proposed instrumentation which could widespread the procedure for in situ fenestration. The results obtained should be validated performing animal studies. Clinical Impact: The proposed instrumentation has the potential to expand indications for standard endovascular aneurysm repair to cases of acute syndromes.
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Affiliation(s)
- S Condino
- 1Information Engineering DepartmentUniversity of Pisa56122PisaItaly.,2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly
| | - R Piazza
- 1Information Engineering DepartmentUniversity of Pisa56122PisaItaly.,2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly
| | - R M Viglialoro
- 2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly
| | - D M Mocellin
- 3Vascular Surgery UnitCisanello University Hospital AOUP56126PisaItaly
| | - G Turini
- 2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly.,4Computer Science DepartmentKettering UniversityFlintMI48504USA
| | - R N Berchiolli
- 2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly.,3Vascular Surgery UnitCisanello University Hospital AOUP56126PisaItaly
| | - F Micheletti
- 5Institute of Applied Physics "Nello Carrara," National Research Council50019Sesto FiorentinoItaly
| | - F Rossi
- 5Institute of Applied Physics "Nello Carrara," National Research Council50019Sesto FiorentinoItaly
| | - R Pini
- 5Institute of Applied Physics "Nello Carrara," National Research Council50019Sesto FiorentinoItaly
| | - V Ferrari
- 1Information Engineering DepartmentUniversity of Pisa56122PisaItaly.,2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly
| | - M Ferrari
- 2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly.,3Vascular Surgery UnitCisanello University Hospital AOUP56126PisaItaly
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Condino S, Fida B, Carbone M, Cercenelli L, Badiali G, Ferrari V, Cutolo F. Wearable Augmented Reality Platform for Aiding Complex 3D Trajectory Tracing. SENSORS (BASEL, SWITZERLAND) 2020; 20:E1612. [PMID: 32183212 PMCID: PMC7146390 DOI: 10.3390/s20061612] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 01/28/2023]
Abstract
Augmented reality (AR) Head-Mounted Displays (HMDs) are emerging as the most efficient output medium to support manual tasks performed under direct vision. Despite that, technological and human-factor limitations still hinder their routine use for aiding high-precision manual tasks in the peripersonal space. To overcome such limitations, in this work, we show the results of a user study aimed to validate qualitatively and quantitatively a recently developed AR platform specifically conceived for guiding complex 3D trajectory tracing tasks. The AR platform comprises a new-concept AR video see-through (VST) HMD and a dedicated software framework for the effective deployment of the AR application. In the experiments, the subjects were asked to perform 3D trajectory tracing tasks on 3D-printed replica of planar structures or more elaborated bony anatomies. The accuracy of the trajectories traced by the subjects was evaluated by using templates designed ad hoc to match the surface of the phantoms. The quantitative results suggest that the AR platform could be used to guide high-precision tasks: on average more than 94% of the traced trajectories stayed within an error margin lower than 1 mm. The results confirm that the proposed AR platform will boost the profitable adoption of AR HMDs to guide high precision manual tasks in the peripersonal space.
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Affiliation(s)
- Sara Condino
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (B.F.); (M.C.); (V.F.)
| | - Benish Fida
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (B.F.); (M.C.); (V.F.)
| | - Marina Carbone
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (B.F.); (M.C.); (V.F.)
| | - Laura Cercenelli
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (L.C.); (G.B.)
| | - Giovanni Badiali
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (L.C.); (G.B.)
| | - Vincenzo Ferrari
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (B.F.); (M.C.); (V.F.)
| | - Fabrizio Cutolo
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (B.F.); (M.C.); (V.F.)
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9
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Semi-automated vs. manual 3D reconstruction of central mesenteric vascular models: the surgeon’s verdict. Surg Endosc 2019; 34:4890-4900. [DOI: 10.1007/s00464-019-07275-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/12/2019] [Indexed: 12/19/2022]
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10
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Ferrari V, Carbone M, Condino S, Cutolo F. Are augmented reality headsets in surgery a dead end? Expert Rev Med Devices 2019; 16:999-1001. [PMID: 31725347 DOI: 10.1080/17434440.2019.1693891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Vincenzo Ferrari
- Dipartimento di Ingegneria dell'Informazione, Università di Pisa, Pisa, Italy
| | - Marina Carbone
- Dipartimento di Ingegneria dell'Informazione, Università di Pisa, Pisa, Italy
| | - Sara Condino
- Dipartimento di Ingegneria dell'Informazione, Università di Pisa, Pisa, Italy
| | - Fabrizio Cutolo
- Dipartimento di Ingegneria dell'Informazione, Università di Pisa, Pisa, Italy
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Yiasemidou M, Glassman D, Jayne D, Miskovic D. Is patient-specific pre-operative preparation feasible in a clinical environment? A systematic review and meta-analysis. Comput Assist Surg (Abingdon) 2019; 23:57-68. [PMID: 30497290 DOI: 10.1080/24699322.2018.1495266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Technical difficulty of an operation is associated with patient and disease characteristics, indicating the necessity for surgeons to exercise patient-specific preparation. Such methods have been shown to be effective in the simulation suite, however, application in a real clinical environment has been sporadic. This systematic review attempts to answer if patient-specific preparation in challenging surgical procedures is feasible. A systematic review of OvidMedline, Embase and all Evidence Based Medicine review databases, was conducted in search of studies who described surgical rehearsals in all specialties. Following the application of defined inclusion and exclusion criteria relevant data were extracted and summarised. Descriptive synthesis was performed for all included studies and meta-analysis of data was applied when possible. Of fourty-nine studies included, thirty-seven were case-series, ten were non-randomised comparative trials and two randomised controlled trials. Accuracy of applied methods ranged from 66.7 to 100% and a good outcome was seen in 60-100% of operations. Meta-analysis of studies comparing rehearsals to real procedures (same patients) showed that simulated procedures were significantly faster than real ones (SMD = -1.56 [-2.19, -0.93] p < 0.00001) but were similar in other outcomes (fluoroscopy time: SMD = -0.1 [-0.63, 0.42] p = 0.7, fluoroscopy volume: SMD = -0.43[-0.97, 0.11], p = 0.12). Meta-analysis of studies comparing pre-operative rehearsals to standard treatment (two distinct groups of patients), demonstrated that real procedures were performed quicker if pre-operative rehearsal took place (SMD = -0.47 [-0.79, -0.16], P = 0.003) but the immediate clinical outcome was similar for practiced and not practiced operations (SMD =0.03[-0.23, 0.29], p = 0.82). Current evidence suggests that patient-specific pre-operative preparation is feasible and safe and decreases operational time.
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Affiliation(s)
- Marina Yiasemidou
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
| | | | - David Jayne
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
| | - Danilo Miskovic
- a Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , Leeds , UK
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12
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Itayem DA, Anzalone CL, White JR, Pallanch JF, O'Brien EK. Increased Accuracy, Confidence, and Efficiency in Anterior Ethmoidal Artery Identification with Segmented Image Guidance. Otolaryngol Head Neck Surg 2019; 160:818-821. [PMID: 30691346 DOI: 10.1177/0194599818825454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether using image guidance technology with 3-dimensional image segmentation increases the endoscopic surgeon's accuracy, efficiency, and confidence in identifying the anterior ethmoidal artery. METHODS This is a cross-sectional study of attending physicians and residents at an academic medical center. Because identification of the anterior ethmoidal artery during image-guided surgery can be challenging, we studied the effect of anterior ethmoidal artery image segmentation (ie, partitioning and coloring) on surgeon test performance. A computerized test was administered to 16 surgeons who were asked to identify the anterior ethmoidal artery on multiplanar computed tomographic images and to answer multiple-choice questions. Half the questions showed segmented images of the anterior ethmoidal artery, and half showed images without segmentation. Efficiency and accuracy of identification and subjective surgeon confidence were determined for each question. Descriptive statistics were used to compare test performance for identification of the anterior ethmoidal artery on images with or without segmentation. RESULTS Percentage of correct answers ( P < .001), efficiency ( P < .001), and confidence ( P < .001) in identification of the anterior ethmoidal artery were significantly better with segmented computed tomographic images. DISCUSSION We demonstrated that use of segmented images improves surgeons' accuracy, confidence, and efficiency for identification of the anterior ethmoidal artery. IMPLICATIONS FOR PRACTICE We describe how segmentation can allow surgeons to improve the surgical course by increasing their accuracy, confidence, and efficiency in identifying the anterior ethmoidal artery.
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Affiliation(s)
- Deeyar A Itayem
- 1 Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - C Lane Anzalone
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - James R White
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John F Pallanch
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin K O'Brien
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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13
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Vertemati M, Cassin S, Rizzetto F, Vanzulli A, Elli M, Sampogna G, Gallieni M. A Virtual Reality Environment to Visualize Three-Dimensional Patient-Specific Models by a Mobile Head-Mounted Display. Surg Innov 2019; 26:359-370. [PMID: 30632462 DOI: 10.1177/1553350618822860] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION With the availability of low-cost head-mounted displays (HMDs), virtual reality environments (VREs) are increasingly being used in medicine for teaching and clinical purposes. Our aim was to develop an interactive, user-friendly VRE for tridimensional visualization of patient-specific organs, establishing a workflow to transfer 3-dimensional (3D) models from imaging datasets to our immersive VRE. MATERIALS AND METHODS This original VRE model was built using open-source software and a mobile HMD, Samsung Gear VR. For its validation, we enrolled 33 volunteers: morphologists (n = 11), trainee surgeons (n = 15), and expert surgeons (n = 7). They tried our VRE and then filled in an original 5-point Likert-type scale 6-item questionnaire, considering the following parameters: ease of use, anatomy comprehension compared with 2D radiological imaging, explanation of anatomical variations, explanation of surgical procedures, preoperative planning, and experience of gastrointestinal/neurological disorders. Results in the 3 groups were statistically compared using analysis of variance. RESULTS Using cross-sectional medical imaging, the developed VRE allowed to visualize a 3D patient-specific abdominal scene in 1 hour. Overall, the 6 items were evaluated positively by all groups; only anatomy comprehension was statistically significant different among the 3 groups. CONCLUSIONS Our approach, based on open-source software and mobile hardware, proved to be a valid and well-appreciated system to visualize 3D patient-specific models, paving the way for a potential new tool for teaching and preoperative planning.
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Affiliation(s)
| | | | | | | | - Marco Elli
- 1 Università degli Studi di Milano, Milan, Italy
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Maeda Y, Shinohara T, Futakawa N, Minagawa N, Sunahara M, Koyama R, Nagatsu A, Hamada T. The Oncologic Outcomes of Inferior Mesenteric Artery-Preserving Laparoscopic Lymph Node Dissection for Upper-Rectal or Sigmoid Colon Cancer. J Laparoendosc Adv Surg Tech A 2018; 28:1352-1358. [PMID: 30192168 DOI: 10.1089/lap.2018.0201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The standard procedure of lymph node (LN) dissection for rectal or sigmoid colon cancer remains controversial. Many laparoscopic surgeons cut the inferior mesenteric artery (IMA) at the root; however, this may cause bowel ischemia around the site of anastomosis. We performed D3 or D2 LN dissection with the preservation of the IMA. The aim of this study was to evaluate the oncologic outcomes of IMA-preserving LN dissection. PATIENTS AND METHODS We retrospectively analyzed 142 consecutive patients with upper-rectal or sigmoid colon cancer who underwent laparoscopic LN dissection with the preservation of the IMA. The number of LNs dissected and the overall and disease-free survival rates were retrospectively evaluated. RESULTS Laparoscopic D3 (n = 92) or D2 (n = 50) LN dissection were performed with the preservation of the IMA. The left colic artery was preserved in all cases, the superior rectal artery was also preserved in 30 cases. The mean number of LNs dissected was 19.6 in the D3 group and 12.9 in the D2 group. The median operative time was 230 minutes, and the median volume of blood loss was 17 mL. There was no treatment-related mortality. The estimated 5-year disease-free survival rates of the stage I, II, and III patients were 93%, 83%, and 74%, respectively. No patients developed LN recurrence. CONCLUSIONS Laparoscopic surgery with IMA-preserving LN dissection is an oncologically acceptable treatment strategy in patients with upper-rectal or sigmoid colon cancer.
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Affiliation(s)
- Yoshiaki Maeda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center , Sapporo, Japan
| | - Toshiki Shinohara
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center , Sapporo, Japan
| | - Noriaki Futakawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center , Sapporo, Japan
| | - Nozomi Minagawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center , Sapporo, Japan
| | - Masao Sunahara
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center , Sapporo, Japan
| | - Ryota Koyama
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center , Sapporo, Japan
| | - Akihisa Nagatsu
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center , Sapporo, Japan
| | - Tomonori Hamada
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center , Sapporo, Japan
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Computed-tomography image segmentation and 3D-reconstruction of the female pelvis for the preoperative planning of sacrocolpopexy: preliminary data. Int Urogynecol J 2018; 30:725-731. [DOI: 10.1007/s00192-018-3706-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
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Boudissa M, Courvoisier A, Chabanas M, Tonetti J. Computer assisted surgery in preoperative planning of acetabular fracture surgery: state of the art. Expert Rev Med Devices 2017; 15:81-89. [PMID: 29206497 DOI: 10.1080/17434440.2017.1413347] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The development of imaging modalities and computer technology provides a new approach in acetabular surgery. AREAS COVERED This review describes the role of computer-assisted surgery (CAS) in understanding of the fracture patterns, in the virtual preoperative planning of the surgery and in the use of custom-made plates in acetabular fractures with or without 3D printing technologies. A Pubmed internet research of the English literature of the last 20 years was carried out about studies concerning computer-assisted surgery in acetabular fractures. The several steps for CAS in acetabular fracture surgery are presented and commented by the main author regarding to his personal experience. EXPERT COMMENTARY Computer-assisted surgery in acetabular fractures is still initial experiences with promising results. Patient-specific biomechanical models considering soft tissues should be developed to allow a more realistic planning.
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Affiliation(s)
- Mehdi Boudissa
- b Grenoble Alpes University , Grenoble , France.,c TIMC-IMAG Lab , Univ. Grenoble Alpes, CNRS UMR , Grenoble , France.,d Orthopedic and Traumatology Surgery Department , Grenoble University Hospitals, Northern Hospital, Joseph Fourier University , Grenoble , France
| | - Aurélien Courvoisier
- a Pediatric Orthopedics , Grenoble University Hospitals, Northern Hospital, Joseph Fourier University , Grenoble , France.,b Grenoble Alpes University , Grenoble , France.,c TIMC-IMAG Lab , Univ. Grenoble Alpes, CNRS UMR , Grenoble , France
| | - Matthieu Chabanas
- b Grenoble Alpes University , Grenoble , France.,c TIMC-IMAG Lab , Univ. Grenoble Alpes, CNRS UMR , Grenoble , France.,d Orthopedic and Traumatology Surgery Department , Grenoble University Hospitals, Northern Hospital, Joseph Fourier University , Grenoble , France
| | - Jérôme Tonetti
- b Grenoble Alpes University , Grenoble , France.,c TIMC-IMAG Lab , Univ. Grenoble Alpes, CNRS UMR , Grenoble , France.,d Orthopedic and Traumatology Surgery Department , Grenoble University Hospitals, Northern Hospital, Joseph Fourier University , Grenoble , France
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Boudissa M, Orfeuvre B, Chabanas M, Tonetti J. Does semi-automatic bone-fragment segmentation improve the reproducibility of the Letournel acetabular fracture classification? Orthop Traumatol Surg Res 2017; 103:633-638. [PMID: 28428032 DOI: 10.1016/j.otsr.2017.03.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/12/2017] [Accepted: 03/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Letournel classification of acetabular fracture shows poor reproducibility in inexperienced observers, despite the introduction of 3D imaging. We therefore developed a method of semi-automatic segmentation based on CT data. The present prospective study aimed to assess: (1) whether semi-automatic bone-fragment segmentation increased the rate of correct classification; (2) if so, in which fracture types; and (3) feasibility using the open-source itksnap 3.0 software package without incurring extra cost for users. HYPOTHESIS Semi-automatic segmentation of acetabular fractures significantly increases the rate of correct classification by orthopedic surgery residents. METHODS Twelve orthopedic surgery residents classified 23 acetabular fractures. Six used conventional 3D reconstructions provided by the center's radiology department (conventional group) and 6 others used reconstructions obtained by semi-automatic segmentation using the open-source itksnap 3.0 software package (segmentation group). Bone fragments were identified by specific colors. Correct classification rates were compared between groups on Chi2 test. Assessment was repeated 2 weeks later, to determine intra-observer reproducibility. RESULTS Correct classification rates were significantly higher in the "segmentation" group: 114/138 (83%) versus 71/138 (52%); P<0.0001. The difference was greater for simple (36/36 (100%) versus 17/36 (47%); P<0.0001) than complex fractures (79/102 (77%) versus 54/102 (53%); P=0.0004). Mean segmentation time per fracture was 27±3min [range, 21-35min]. The segmentation group showed excellent intra-observer correlation coefficients, overall (ICC=0.88), and for simple (ICC=0.92) and complex fractures (ICC=0.84). CONCLUSION Semi-automatic segmentation, identifying the various bone fragments, was effective in increasing the rate of correct acetabular fracture classification on the Letournel system by orthopedic surgery residents. It may be considered for routine use in education and training. LEVEL OF EVIDENCE III: prospective case-control study of a diagnostic procedure.
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Affiliation(s)
- M Boudissa
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; CNRS UMR 5525, laboratoire TIMC-IMAG, pavillon Taillefer, université Grenoble Alpes, 38700 La Tronche, France.
| | - B Orfeuvre
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - M Chabanas
- CNRS UMR 5525, laboratoire TIMC-IMAG, pavillon Taillefer, université Grenoble Alpes, 38700 La Tronche, France
| | - J Tonetti
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; CNRS UMR 5525, laboratoire TIMC-IMAG, pavillon Taillefer, université Grenoble Alpes, 38700 La Tronche, France
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Giannini A, Iodice V, Picano E, Russo E, Zampa V, Ferrari V, Simoncini T. Magnetic Resonance Imaging–Based Three Dimensional Patient-Specific Reconstruction of Uterine Fibromatosis: Impact on Surgery. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Italy
| | - Veronica Iodice
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Italy
- Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Eugenia Picano
- Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Eleonora Russo
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Italy
| | - Virna Zampa
- Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Vincenzo Ferrari
- EndoCAS, Center for Computer Assisted Surgery, University of Pisa, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Italy
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Cutolo F, Meola A, Carbone M, Sinceri S, Cagnazzo F, Denaro E, Esposito N, Ferrari M, Ferrari V. A new head-mounted display-based augmented reality system in neurosurgical oncology: a study on phantom. Comput Assist Surg (Abingdon) 2017; 22:39-53. [PMID: 28754068 DOI: 10.1080/24699322.2017.1358400] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Fabrizio Cutolo
- Department of Translational Research and New Technologies in Medicine and Surgery, EndoCAS Center, University of Pisa, Pisa, Italy
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Antonio Meola
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marina Carbone
- Department of Translational Research and New Technologies in Medicine and Surgery, EndoCAS Center, University of Pisa, Pisa, Italy
| | - Sara Sinceri
- Department of Translational Research and New Technologies in Medicine and Surgery, EndoCAS Center, University of Pisa, Pisa, Italy
| | | | - Ennio Denaro
- Department of Translational Research and New Technologies in Medicine and Surgery, EndoCAS Center, University of Pisa, Pisa, Italy
| | - Nicola Esposito
- Department of Translational Research and New Technologies in Medicine and Surgery, EndoCAS Center, University of Pisa, Pisa, Italy
| | - Mauro Ferrari
- Department of Translational Research and New Technologies in Medicine and Surgery, EndoCAS Center, University of Pisa, Pisa, Italy
- Department of Vascular Surgery, Pisa University Medical School, Pisa, Italy
| | - Vincenzo Ferrari
- Department of Translational Research and New Technologies in Medicine and Surgery, EndoCAS Center, University of Pisa, Pisa, Italy
- Department of Information Engineering, University of Pisa, Pisa, Italy
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Sampogna G, Pugliese R, Elli M, Vanzulli A, Forgione A. Routine clinical application of virtual reality in abdominal surgery. MINIM INVASIV THER 2017; 26:135-143. [PMID: 28084141 DOI: 10.1080/13645706.2016.1275016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The advantages of 3D reconstruction, immersive virtual reality (VR) and 3D printing in abdominal surgery have been enunciated for many years, but still today their application in routine clinical practice is almost nil. We investigate their feasibility, user appreciation and clinical impact. MATERIAL AND METHODS Fifteen patients undergoing pancreatic, hepatic or renal surgery were studied realizing a 3D reconstruction of target anatomy. Then, an immersive VR environment was developed to import 3D models, and some details of the 3D scene were printed. All the phases of our workflow employed open-source software and low-cost hardware, easily implementable by other surgical services. A qualitative evaluation of the three approaches was performed by 20 surgeons, who filled in a specific questionnaire regarding a clinical case for each organ considered. RESULTS Preoperative surgical planning and intraoperative guidance was feasible for all patients included in the study. The vast majority of surgeons interviewed scored their quality and usefulness as very good. CONCLUSIONS Despite extra time, costs and efforts necessary to implement these systems, the benefits shown by the analysis of questionnaires recommend to invest more resources to train physicians to adopt these technologies routinely, even if further and larger studies are still mandatory.
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Affiliation(s)
- Gianluca Sampogna
- a Department of Biomedical and Clinical Sciences 'L. Sacco' , Università degli Studi di Milano , Milan , Italy.,b Advanced International Mini-invasive Surgery (AIMS) Academy, Ospedale Niguarda Ca' Granda , Milan , Italy
| | - Raffaele Pugliese
- b Advanced International Mini-invasive Surgery (AIMS) Academy, Ospedale Niguarda Ca' Granda , Milan , Italy.,c Department of General Surgical Oncology and Minimally Invasive Surgery , Ospedale Niguarda Ca' Granda , Milan , Italy
| | - Marco Elli
- a Department of Biomedical and Clinical Sciences 'L. Sacco' , Università degli Studi di Milano , Milan , Italy
| | - Angelo Vanzulli
- a Department of Biomedical and Clinical Sciences 'L. Sacco' , Università degli Studi di Milano , Milan , Italy.,d Department of Radiology , Ospedale Niguarda Ca' Granda , Milan , Italy
| | - Antonello Forgione
- b Advanced International Mini-invasive Surgery (AIMS) Academy, Ospedale Niguarda Ca' Granda , Milan , Italy.,c Department of General Surgical Oncology and Minimally Invasive Surgery , Ospedale Niguarda Ca' Granda , Milan , Italy
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Robust and Accurate Algorithm for Wearable Stereoscopic Augmented Reality with Three Indistinguishable Markers. ELECTRONICS 2016. [DOI: 10.3390/electronics5030059] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Parrini S, Cutolo F, Freschi C, Ferrari M, Ferrari V. Augmented reality system for freehand guide of magnetic endovascular devices. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2014:490-3. [PMID: 25570003 DOI: 10.1109/embc.2014.6943635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Magnetic guide of endovascular devices or magnetized therapeutic microparticles to the specific target in the arterial tree is increasingly studied, since it could improve treatment efficacy and reduce side effects. Most proposed systems use external permanent magnets attached to robotic manipulators or magnetic resonance imaging (MRI) systems to guide internal carriers to the region of treatment. We aim to simplify this type of procedures, avoiding or reducing the need of robotic arms and MRI systems in the surgical scenario. On account of this we investigated the use of a wearable stereoscopic video see-through augmented reality system to show the hidden vessel to the surgeon; in this way, the surgeon is able to freely move the external magnet, following the showed path, to lead the endovascular magnetic device towards the desired position. In this preliminary study, we investigated the feasibility of such an approach trying to guide a magnetic capsule inside a vascular mannequin. The high rate of success and the positive evaluation provided by the operators represent a good starting point for further developments of the system.
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Lo Presti G, Carbone M, Ciriaci D, Aramini D, Ferrari M, Ferrari V. Assessment of DICOM Viewers Capable of Loading Patient-specific 3D Models Obtained by Different Segmentation Platforms in the Operating Room. J Digit Imaging 2016; 28:518-27. [PMID: 25739346 DOI: 10.1007/s10278-015-9786-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patient-specific 3D models obtained by the segmentation of volumetric diagnostic images play an increasingly important role in surgical planning. Surgeons use the virtual models reconstructed through segmentation to plan challenging surgeries. Many solutions exist for the different anatomical districts and surgical interventions. The possibility to bring the 3D virtual reconstructions with native radiological images in the operating room is essential for fostering the use of intraoperative planning. To the best of our knowledge, current DICOM viewers are not able to simultaneously connect to the picture archiving and communication system (PACS) and import 3D models generated by external platforms to allow a straight integration in the operating room. A total of 26 DICOM viewers were evaluated: 22 open source and four commercial. Two DICOM viewers can connect to PACS and import segmentations achieved by other applications: Synapse 3D® by Fujifilm and OsiriX by University of Geneva. We developed a software network that converts diffuse visual tool kit (VTK) format 3D model segmentations, obtained by any software platform, to a DICOM format that can be displayed using OsiriX or Synapse 3D. Both OsiriX and Synapse 3D were suitable for our purposes and had comparable performance. Although Synapse 3D loads native images and segmentations faster, the main benefits of OsiriX are its user-friendly loading of elaborated images and it being both free of charge and open source.
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Affiliation(s)
- Giuseppe Lo Presti
- EndoCAS Center, Cisanello Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy. .,Scuola Superiore S'Anna di Studi Universitari e Perfezionamento, Pisa, Italy.
| | - Marina Carbone
- EndoCAS Center, Cisanello Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Damiano Ciriaci
- Faculty of Medicine and Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Aramini
- Faculty of Medicine and Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Mauro Ferrari
- EndoCAS Center, Cisanello Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Vincenzo Ferrari
- EndoCAS Center, Cisanello Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.,Department of Information Engineering, University of Pisa, Pisa, Italy
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Improving Endovascular Intraoperative Navigation with Real-Time Skeleton-Based Deformation of Virtual Vascular Structures. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-3-319-40651-0_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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25
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Application of a New Wearable Augmented Reality Video See-Through Display to Aid Percutaneous Procedures in Spine Surgery. LECTURE NOTES IN COMPUTER SCIENCE 2016. [DOI: 10.1007/978-3-319-40651-0_4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Nesgaard JM, Stimec BV, Bakka AO, Edwin B, Ignjatovic D. Navigating the mesentery: a comparative pre- and per-operative visualization of the vascular anatomy. Colorectal Dis 2015; 17:810-8. [PMID: 25988347 DOI: 10.1111/codi.13003] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/26/2015] [Indexed: 02/08/2023]
Abstract
AIM Awareness of anatomy is critical for performing safe surgery within the root of the mesentery. Our aim was to investigate the anatomical relationship between the superior mesenteric artery (SMA) and vein (SMV) and their branches within a predefined D3 area of the right colon and to compare preoperatively established three-dimensional (3D) mesenteric vessel anatomy from CT with that found at surgery. METHOD Prospective data were collected on 139 patients included in the 'Safe Radical D3 Right Hemicolectomy for Cancer Through Preoperative Biphasic Multi-detector Computed Tomography (MDCT) Angiography' trial. CT data sets were 3D reconstructed before surgery and compared with photographs taken during the operation. RESULTS The ileocolic artery was present and correctly identified in all patients and crossed the SMV anteriorly in 58 (41.7%). Seventeen patients had a right colic artery at surgery and there were three false-negative and one false-positive CT findings, yielding a diagnostic accuracy of 97.1%, sensitivity of 85.7% and specificity of 95.2%. Positive and negative predictive values were 94.7% and 97.5%, respectively. The middle colic artery was absent in one (0.7%) patient and multiple (nine double and one triple) in 10 (7.2%) patients. A mean of 3.8 ± 1.2 jejunal arteries and 2.0 ± 0.8 jejunal veins arose from the SMA and SMV. Jejunal veins crossed the SMA in the D3 area anteriorly in 30.9% of patients. In 26 (18.7%) patients, additional veins drained into the SMV, including pancreaticoduodenal in 16, right colic in six and both in two. The inferior mesenteric vein entered the SMV in 58 (41.7%) patients and crossed the D3 area in three (2.2%). CONCLUSION CT-reconstructed anatomy has high specificity, sensitivity, accuracy and reliability.
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Affiliation(s)
- J M Nesgaard
- Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tonsberg, Norway
| | - B V Stimec
- Faculty of Medicine, Department of Cellular Physiology and Metabolism, Anatomy Sector, University of Geneva, Geneva, Switzerland
| | - A O Bakka
- Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lorenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - B Edwin
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Interventional Centre, Gastrointestinal and Pediatric Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - D Ignjatovic
- Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tonsberg, Norway.,Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lorenskog, Norway
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Badiali G, Ferrari V, Cutolo F, Freschi C, Caramella D, Bianchi A, Marchetti C. Augmented reality as an aid in maxillofacial surgery: Validation of a wearable system allowing maxillary repositioning. J Craniomaxillofac Surg 2014; 42:1970-6. [DOI: 10.1016/j.jcms.2014.09.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 07/05/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022] Open
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Maeda Y, Shinohara T, Nagatsu A, Futakawa N, Hamada T. Laparoscopic resection aided by preoperative 3-D CT angiography for rectosigmoid colon cancer associated with a horseshoe kidney: A case report. Asian J Endosc Surg 2014; 7:317-9. [PMID: 25354377 DOI: 10.1111/ases.12123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/27/2014] [Accepted: 06/08/2014] [Indexed: 11/29/2022]
Abstract
We herein report a case of laparoscopic high anterior resection with D3 lymph node dissection for rectosigmoid colon cancer with a horseshoe kidney. A 65-year-old Japanese man referred to our hospital for rectosigmoid colon cancer was found to have a horseshoe kidney on a CT scan. On 3-D CT angiography, an aberrant renal artery was visualized feeding the renal isthmus that arises from the aorta just below the root of the inferior mesenteric artery (IMA). Laparoscopic anterior rectal resection with D3 lymph node dissection was performed. During the operation, the IMA, left ureter, left gonadal vessels and hypogastric nerve plexus could be seen passing over the horseshoe kidney isthmus. With the aid of preoperative 3-D CT angiography, the root of the IMA was identified on the temporal side of the isthmus and divided safely just above the hypogastric nerve. As a horseshoe kidney is often accompanied by aberrant renal arteries and/or abnormal running of the ureter, 3-D CT angiography is useful for determining the location of these structures and avoiding intraoperative injury.
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Affiliation(s)
- Yoshiaki Maeda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
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Patient-specific ultrasound liver phantom: materials and fabrication method. Int J Comput Assist Radiol Surg 2014; 10:1065-75. [DOI: 10.1007/s11548-014-1120-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
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Three-dimensional reconstruction of the peripancreatic vascular system based on computed tomographic angiography images and its clinical application in the surgical management of pancreatic tumors. Pancreas 2014; 43:389-95. [PMID: 24622068 DOI: 10.1097/mpa.0000000000000035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed to investigate the clinical significance of 3-dimensional (3D) reconstruction of peripancreatic vessels for patients with suspected pancreatic cancer (PC). METHODS A total of 89 patients with PC were included; 60 patients randomly underwent computed tomographic angiography. Based on the findings of 3D reconstruction of peripancreatic vessels, the appropriate method for individualized tumor resection was determined. These patients were compared with 29 conventionally treated patients with PC. RESULTS The rate of visualization was 100% for great vessels around the pancreas. The detection rates for anterior superior pancreaticoduodenal artery, posterior superior pancreaticoduodenal artery, anterior inferior pancreaticoduodenal artery, posterior inferior pancreaticoduodenal artery, dorsal pancreatic artery, superior marginal arterial branch of the pancreatic head, anterior superior pancreaticoduodenal vein, posterior superior pancreaticoduodenal vein, anterior inferior pancreaticoduodenal vein, and posterior inferior pancreaticoduodenal vein were 86.6%, 85.0%, 76.6%, 71.6%, 91.6%, 53.3%, 61.6%, 55.0%, 43.3%, and 51.6%, respectively. Forty-three patients who had undergone 3D reconstruction underwent surgery. Of the 29 conventionally treated patients, 19 underwent surgery. The operative time, blood loss, length of hospital stay, and complication incidence of the 43 patients were superior to that of the 19 patients. CONCLUSIONS A peripancreatic vascular reconstruction can reveal the vascular anatomy, variations of peripancreatic vascular, and tumor-induced vascular changes; the application of the simulation surgery platform could reduce surgical trauma and decrease operative time.
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Condino S, Calabrò E, Alberti A, Parrini S, Cioni R, Berchiolli R, Gesi M, Ferrari V, Ferrari M. Simultaneous Tracking of Catheters and Guidewires: Comparison to Standard Fluoroscopic Guidance for Arterial Cannulation. Eur J Vasc Endovasc Surg 2014; 47:53-60. [DOI: 10.1016/j.ejvs.2013.10.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/01/2013] [Indexed: 11/15/2022]
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