Virtual surgical planning is a useful tool in the surgical management of mandibular condylar fractures

Optimizing Surgical Efficiency in Complex Spine Surgery Using Virtual Reality as a Communication Technology to Promote a Shared Mental Model: A Case Series and Review

BACKGROUND AND OBJECTIVES

Virtual reality (VR) is an emerging technology that can be used to promote a shared mental model among a surgical team. We present a case series demonstrating the use of 3-dimensional (3D) VR models to visually communicate procedural steps to a surgical team to promote a common operating objective. We also review the literature on existing uses of VR for preoperative communication and planning in spine surgery.

METHODS

Narrations of 3 to 4-minute walkthroughs were created in a VR visualization platform, converted, and distributed to team members through text and email the night before surgical intervention. A VR huddle was held immediately before the intervention to refine surgical goals. After the intervention, the participating team members' perceptions on the value of the tool were assessed using a survey that used a 5-point Likert scale. MEDLINE, Google Scholar, and Dimensions AI databases were queried from July 2010 to October 2022 to examine existing literature on preoperative VR use to plan spine surgery.

RESULTS

Three illustrative cases are presented with accompanying video. Postoperative survey results demonstrate a positive experience among surgical team members after reviewing preoperative plans created with patient-specific 3D VR models. Respondents felt that preoperative VR video review was "moderately useful" or more useful in improving their understanding of the operational sequence (71%, 5/7), in enhancing their ability to understand their role (86%, 6/7), and in improving the safety or efficiency of the case (86%, 6/7).

CONCLUSION

We present a proof of concept of a novel preoperative communication tool used to create a shared mental model of a common operating objective for surgical team members using narrated 3D VR models. Initial survey results demonstrate positive feedback among respondents. There is a paucity of literature investigating VR technology as a means for preoperative surgical communication in spine surgery.

ETHICS

Institutional review board approval (IRB-300009785) was obtained before this study.

Risk Factors for Hardware Removal Following Bimaxillary Surgery: A National Database Analysis

Orthognathic surgery typically relies on the rigid fixation of fracture fragments using metal hardware. Though hardware is usually intended to be implanted permanently, the removal of hardware (ROH) is sometimes indicated for a variety of reasons. The authors sought to identify risk factors for ROH following orthognathic surgery. The authors conducted a retrospective analysis of the Merative MarketScan Research Databases, 2007-2021 using Current Procedural Terminology (CPT) and International Classification of Disease (ICD-9 and ICD-10) codes to identify patients who underwent an index Le Fort 1 osteotomy and bilateral sagittal split osteotomy operation on the same day. Statistical analysis involved χ2, Shapiro-Wilk, Wilcoxon-Mann-Whitney, Poisson regression, and multivariable logistic regression tests. 4698 patients met the inclusion criteria. The mean age at surgery was 25 years, and 57% were female. ROH occurred in 5.9% of patients. The mean time to hardware removal was 190.5±172.4 days. In a multivariate logistic regression, increased odds of ROH were associated with older patient age [OR: 1.02 (1.01-1.03), P=0.046], sleep apnea [OR: 1.62 (1.13-2.32), P=0.018], and craniofacial syndrome and/or cleft diagnoses [OR: 1.88 (1.14-2.55), P<0.001]. In the same model, postoperative oral antibiotic prophylaxis was not associated with ROH (P=0.494). The incidence of all-cause complications [IRR: 1.03 (1.01-1.05), P<0.001] rose over the study period, while the incidence of ROH did not change significantly (P=0.281). Patients at elevated risk should be counseled on the increased possibility of a second operation for ROH before having orthognathic surgery to ensure expectations and health care utilization decisions align with the evidence.

Optimizing Surgical Performance Using Preoperative Virtual Reality Planning: A Systematic Review

BACKGROUND

Surgery is often a complex process that requires detailed 3-dimensional anatomical knowledge and rigorous interplay between team members to attain ideal operational efficiency or "flow." Virtual Reality (VR) represents a technology by which to rehearse complex plans and communicate precise steps to a surgical team prior to entering the operating room. The objective of this study was to evaluate the use of VR for preoperative surgical team planning and interdisciplinary communication across all surgical specialties.

METHODS

A systematic review of the literature was performed examining existing research on VR use for preoperative surgical team planning and interdisciplinary communication across all surgical fields in order to optimize surgical efficiency. MEDLINE, SCOPUS, CINAHL databases were searched from inception to July 31, 2022 using standardized search clauses. A qualitative data synthesis was performed with particular attention to preoperative planning, surgical efficiency optimization, and interdisciplinary collaboration/communication techniques determined a priori. Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. All included studies were appraised for their quality using the Medical Education Research Study Quality Instrument (MERSQI) tool.

RESULTS

One thousand and ninety-three non-duplicated articles with abstract and full text availability were identified. Thirteen articles that examined preoperative VR-based planning techniques for optimization of surgical efficiency and/or interdisciplinary communication fulfilled inclusion and exclusion criteria. These studies had a low-to-medium methodological quality with a MERSQI mean score of 10.04 out of 18 (standard deviation 3.61).

CONCLUSIONS

This review demonstrates that time spent rehearsing and visualizing patient-specific anatomical relationships in VR may improve operative efficiency and communication across multiple surgical specialties.

AGE ASSESSMENT OF THE DYNAMICS OF MORPHOLOGICAL REARRANGEMENT OF BONE TISSUE OF THE ARTICULAR PROCESSES OF THE HUMAN LOWER JAW DEPENDING ON THE LOSS OF THE MASTICATORY TEETH

OBJECTIVE

Aim: To analyze morphometric changes in the structure of bone tissue of the mandibular articular processes and establish their densitometric dependence on the masticatory teeth loss in people of I-II periods of adulthood.

PATIENTS AND METHODS

Materials and methods: We analyzed 136 digital CT recordings of human temporomandibular joints. The research subjects were divided into three groups based on the degree of dentition defect acquisition: the first - a limited defect, the second - a final defect, and the third - a preserved dentition (control); by age into two periods of adulthood of postnatal human ontogenesis. Digital statistical analysis of the bone density is presented as M±σ (mean and standard deviation). We compared the experimental groups with the control group using nonparametric statistical analysis.

RESULTS

Results: Changes in the vertical dimension of occlusion due to limited masticatory teeth loss acquire variable morphometric features, causing an interrelated process of bone atrophy of the cellular part and the trabecular layer of the mandibular processes. The density of bone tissue of the cortical layer of the articular-fossa quadrant (A-Fh/q) of the articular head of the mandibular process increases on the right with limited defects and decreases with final defects. Indicators of bone densitometry of A-Fh/q on the left is characterized by a decrease with limited defects for individuals of the I-st period of adulthood and an increase in the final defects in the II-nd on the left and right.

CONCLUSION

Conclusions: Multifactorial pathomorphological compensatory processes ensure bone density, but with a change in values on the right and a decrease on the left. Morphometric values of trabecular layers, the most vulnerable areas of the neck and base of the mandibular articular processes, indicate the reconstruc¬tion of their bone tissue with limited defects; in the first period of the adulthood, they decrease with a significant predominance on the left.