1
|
Rasheed B, Bjelland Ø, Dalen AF, Schaarschmidt U, Schaathun HG, Pedersen MD, Steinert M, Bye RT. Intraoperative identification of patient-specific elastic modulus of the meniscus during arthroscopy. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 254:108269. [PMID: 38861877 DOI: 10.1016/j.cmpb.2024.108269] [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: 01/23/2024] [Revised: 04/30/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND AND OBJECTIVE Degenerative meniscus tissue has been associated with a lower elastic modulus and can lead to the development of arthrosis. Safe intraoperative measurement of in vivo elastic modulus of the human meniscus could contribute to a better understanding of meniscus health, and for developing surgical simulators where novice surgeons can learn to distinguish healthy from degenerative meniscus tissue. Such measurement can also support intraoperative decision-making by providing a quantitative measure of the meniscus health condition. The objective of this study is to demonstrate a method for intraoperative identification of meniscus elastic modulus during arthroscopic probing using an adaptive observer method. METHODS Ex vivo arthroscopic examinations were performed on five cadaveric knees to estimate the elastic modulus of the anterior, mid-body, and posterior regions of lateral and medial menisci. Real-time intraoperative force-displacement data was obtained and utilized for modulus estimation through an adaptive observer method. For the validation of arthroscopic elastic moduli, an inverse parameter identification approach using optimization, based on biomechanical indentation tests and finite element analyses, was employed. Experimental force-displacement data in various anatomical locations were measured through indentation. An iterative optimization algorithm was employed to optimize elastic moduli and Poisson's ratios by comparing experimental force values at maximum displacement with the corresponding force values from linear elastic region-specific finite element models. Finally, the estimated elastic modulus values obtained from ex vivo arthroscopy were compared against optimized values using a paired t-test. RESULTS The elastic moduli obtained from ex vivo arthroscopy and optimization showcased subject specificity in material properties. Additionally, the results emphasized anatomical and regional specificity within the menisci. The anterior region of the medial menisci exhibited the highest elastic modulus among the anatomical locations studied (9.97±3.20MPa from arthroscopy and 5.05±1.97MPa from finite element-based inverse parameter identification). The paired t-test results indicated no statistically significant difference between the elastic moduli obtained from arthroscopy and inverse parameter identification, suggesting the feasibility of stiffness estimation using arthroscopic examination. CONCLUSIONS This study has demonstrated the feasibility of intraoperative identification of patient-specific elastic modulus for meniscus tissue during arthroscopy.
Collapse
Affiliation(s)
- Bismi Rasheed
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Å lesund, 6025, Norway; Å lesund Biomechanics Lab, Department of Research and Innovation, Møre and Romsdal Hospital Trust, Å lesund, 6017, Norway.
| | - Øystein Bjelland
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Å lesund, 6025, Norway; Å lesund Biomechanics Lab, Department of Research and Innovation, Møre and Romsdal Hospital Trust, Å lesund, 6017, Norway
| | - Andreas F Dalen
- Å lesund Biomechanics Lab, Department of Research and Innovation, Møre and Romsdal Hospital Trust, Å lesund, 6017, Norway; Department of Orthopaedic Surgery, Møre and Romsdal Hospital Trust, Å lesund, 6017, Norway
| | - Ute Schaarschmidt
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Å lesund, 6025, Norway
| | - Hans Georg Schaathun
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Å lesund, 6025, Norway
| | - Morten D Pedersen
- Department of Engineering Cybernetics, Norwegian University of Science and Technology, Trondheim, 7491, Norway
| | - Martin Steinert
- Department of Mechanical and Industrial Engineering, Norwegian University of Science and Technology, Trondheim, 7491, Norway
| | - Robin T Bye
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Å lesund, 6025, Norway
| |
Collapse
|
2
|
Toniolo I, Pirini P, Perretta S, Carniel EL, Berardo A. Endoscopic versus laparoscopic bariatric procedures: A computational biomechanical study through a patient-specific approach. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107889. [PMID: 37944398 DOI: 10.1016/j.cmpb.2023.107889] [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: 07/10/2023] [Revised: 10/25/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Within the framework of computational biomechanics, finite element models of the gastric district could be seen as a potential clinical tool not only to study the effects apported by bariatric surgery, but also to compare different surgical techniques such as the new emerging Endoscopic Sleeve Gastroplasty (ESG) with respect to well-established ones (such as the Laparoscopic Sleeve Gastrectomy, LSG). METHODS This work realized a fully computational comparison between the outcomes obtained from 10 patient-specific stomach models, which were used to simulate ESG, and the complementary results obtained from models representing the post-LSG of the same subjects. Specifically, once the ESG was simulated, a mechanical stimulus was applied by increasing an intragastric pressure up to a maximum of 5 kPa, in order to replicate the process of food intake, as well as for post-LSG models. RESULTS Results revealed non negligible differences between the techniques also within the same subject. In particular, not only LSG could lead to a greater reduction in the stomach volume (about 77 % at baseline, which is strictly linked to weight loss), but also influence the gastric distension (12 % less than pre-operative models). On the contrary, if ESG would be performed, a more similar pre-operative mechanical stimulation of the gastric walls may be seen (difference of about 1 %), thus preserving the mechanosensation, but the detriment of the volume reduction (about 56 % at baseline, and even decreases with increasing pressure). Moreover, since results suggested ESG may be more influenced by the pre-operative gastric cavity than LSG, a predictive model was proposed to support the surgical planning and the estimation of the volume reduction after ESG. CONCLUSIONS ESG and LSG have substantial differences in their protocols and post-surgical effects. This work pointed out that variations between the two procedures may be observed also from a computational point of view, especially when including patient-specific geometries. These insights support gastric modelling as a valuable tool to evaluate, design and critically compare emerging bariatric surgical procedures, not only from empirical aspects and clinical outcomes, but also from a mechanical point of view.
Collapse
Affiliation(s)
- Ilaria Toniolo
- Department of Civil, Environmental and Architectural Engineering, University of Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy
| | - Paola Pirini
- Department of Civil, Environmental and Architectural Engineering, University of Padova, Italy
| | - Silvana Perretta
- IHU Strasbourg, Strasbourg, France; IRCAD France, Strasbourg, France; Department of Digestive and Endocrine Surgery, NHC, Strasbourg, France
| | - Emanuele Luigi Carniel
- Centre for Mechanics of Biological Materials, University of Padova, Italy; Department of Industrial Engineering, University of Padova, Italy.
| | - Alice Berardo
- Department of Civil, Environmental and Architectural Engineering, University of Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy; Department of Biomedical Sciences, University of Padova, Italy.
| |
Collapse
|
3
|
Toniolo I, Berardo A, Foletto M, Fiorillo C, Quero G, Perretta S, Carniel EL. Patient-specific stomach biomechanics before and after laparoscopic sleeve gastrectomy. Surg Endosc 2022; 36:7998-8011. [PMID: 35451669 PMCID: PMC9028903 DOI: 10.1007/s00464-022-09233-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/29/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity has become a global epidemic. Bariatric surgery is considered the most effective therapeutic weapon in terms of weight loss and improvement of quality of life and comorbidities. Laparoscopic sleeve gastrectomy (LSG) is one of the most performed procedures worldwide, although patients carry a nonnegligible risk of developing post-operative GERD and BE. OBJECTIVES The aim of this work is the development of computational patient-specific models to analyze the changes induced by bariatric surgery, i.e., the volumetric gastric reduction, the mechanical response of the stomach during an inflation process, and the related elongation strain (ES) distribution at different intragastric pressures. METHODS Patient-specific pre- and post-surgical models were extracted from Magnetic Resonance Imaging (MRI) scans of patients with morbid obesity submitted to LSG. Twenty-three patients were analyzed, resulting in forty-six 3D-geometries and related computational analyses. RESULTS A significant difference between the mechanical behavior of pre- and post-surgical stomach subjected to the same internal gastric pressure was observed, that can be correlated to a change in the global stomach stiffness and a minor gastric wall tension, resulting in unusual activations of mechanoreceptors following food intake and satiety variation after LSG. CONCLUSIONS Computational patient-specific models may contribute to improve the current knowledge about anatomical and physiological changes induced by LSG, aiming at reducing post-operative complications and improving quality of life in the long run.
Collapse
Affiliation(s)
- Ilaria Toniolo
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Alice Berardo
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy.
- Department of Civil, Environmental and Architectural Engineering, University of Padova, Padova, Italy.
- Department of Biomedical Sciences, University of Padova, Padova, Italy.
| | - Mirto Foletto
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
- Bariatric Surgery Unit, Azienda Ospedaliera, University of Padova, Padova, Italy
| | - Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart of Rome, Rome, Italy
| | - Silvana Perretta
- IHU Strasbourg, Strasbourg, France
- IRCAD France, Strasbourg, France
- Department of Digestive and Endocrine Surgery, NHC, Strasbourg, France
| | - Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| |
Collapse
|
4
|
Suazo M, Herrero J, Fortuny G, Puigjaner D, López JM. Biomechanical response of human rib cage to cardiopulmonary resuscitation maneuvers: Effects of the compression location. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3585. [PMID: 35188706 PMCID: PMC9285513 DOI: 10.1002/cnm.3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/01/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
The biomechanical response of a human rib cage to cardiopulmonary resuscitation maneuvers was investigated by means of finite element simulations. We analyzed the effect of the location where the force was applied on the achieved compression depths and stress levels experienced by the breastbone and ribs. For compression locations on the breastbone, a caudal shift of the application area toward the breastbone tip resulted in a 17% reduction of the force required to achieve a target 5 cm compression depth. We found that the use of compression regions located on the costal cartilages would involve higher risk of rib fractures.
Collapse
Affiliation(s)
- Mario Suazo
- Departament d’ Enginyeria Informàtica i MatemàtiquesUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
- Departamento de Matemática AplicadaEscuela de Matemática y Ciencias de la Computación, UNAH–VSTegucigalpaHonduras
| | - Joan Herrero
- Departament d’ Enginyeria QuímicaUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
| | - Gerard Fortuny
- Departament d’ Enginyeria Informàtica i MatemàtiquesUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
| | - Dolors Puigjaner
- Departament d’ Enginyeria Informàtica i MatemàtiquesUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
| | - Josep M. López
- Departament d’ Enginyeria Informàtica i MatemàtiquesUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
| |
Collapse
|
5
|
Sabet FA, Koric S, Idkaidek A, Jasiuk I. High-Performance Computing Comparison of Implicit and Explicit Nonlinear Finite Element Simulations of Trabecular Bone. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 200:105870. [PMID: 33280935 DOI: 10.1016/j.cmpb.2020.105870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Finite element models built from micro-computed tomography scans have become a powerful tool to investigate the mechanical properties of trabecular bone. There are two types of solving algorithms in the finite element method: implicit and explicit. Both of these methods have been utilized to study the trabecular bone. However, an investigation comparing the results obtained using the implicit and explicit solvers is lacking. Thus, in this paper, we contrast implicit and explicit procedures by analyzing trabecular bone samples as a case study. METHODS Micro-computed tomography-based finite element analysis of trabecular bone under a direct quasi-static compression was done using implicit and explicit methods. The differences in the predictions of mechanical properties and computational time of the two methods were studied using high-performance computing. RESULTS Our findings indicate that the results using implicit and explicit solvers are well comparable, given that similar problem set up is carefully utilized. Also, the parallel scalability of the two methods was similar, while the explicit solver performed about five times faster than the implicit method. Along with faster performance, the explicit method utilized significantly less memory for the analysis, which shows another benefit of using an explicit solver for this case study. CONCLUSIONS The comparison of the implicit and explicit methods for the simulation of trabecular bone samples should be highly valuable to the bone modeling community and researchers studying complex cellular and architectured materials.
Collapse
Affiliation(s)
- Fereshteh A Sabet
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Seid Koric
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; National Center for Supercomputing Applications, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Ashraf Idkaidek
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Iwona Jasiuk
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| |
Collapse
|
6
|
A finite element analysis for evaluating mandibular advancement devices. J Biomech 2021; 119:110298. [PMID: 33639337 DOI: 10.1016/j.jbiomech.2021.110298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/12/2021] [Accepted: 01/23/2021] [Indexed: 02/07/2023]
Abstract
Obstructive sleep apnoea (OSA) is a disorder characterised by complete or partial occlusion of the upper airway during sleep. Muscles relax during sleeping and collapse into the airway, closing the throat and prohibiting air flowing into the lungs. Different solutions have been adopted to manage the pathology to improve the life quality of affected patients. Mandibular advancement devices (MADs) are proven to be a compliant and successful therapy in the forward repositioning of the mandible to increase the upper airway volume. However, this method has some long-term adverse events that may affect the teeth and periodontal ligaments. This paper presents a finite element model to evaluate the MADs effects (displacement and stress) on teeth and periodontal ligaments, by varying the design, the point of application of the force and the material. The modelled bodies have been reconstructed through a Reverse Engineering approach and computer-aided design tools starting from tomographic images of anatomic bodies and from laser scans of a physical MAD. The results suggest that a central connection mechanism could affect mostly the anterior teeth. In contrast, a lateral connection mechanism provides a more uniform distribution of the load on teeth.
Collapse
|
7
|
Computational Biomechanics: In-Silico Tools for the Investigation of Surgical Procedures and Devices. Bioengineering (Basel) 2020; 7:bioengineering7020048. [PMID: 32486216 PMCID: PMC7357080 DOI: 10.3390/bioengineering7020048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 12/29/2022] Open
Abstract
Biomechanical investigations of surgical procedures and devices are usually developed by means of human or animal models. The exploitation of computational methods and tools can reduce, refine, and replace (3R) the animal experimentations for scientific purposes and for pre-clinical research. The computational model of a biological structure characterizes both its geometrical conformation and the mechanical behavior of its building tissues. Model development requires coupled experimental and computational activities. Medical images and anthropometric information provide the geometrical definition of the computational model. Histological investigations and mechanical tests on tissue samples allow for characterizing biological tissues' mechanical response by means of constitutive models. The assessment of computational model reliability requires comparing model results and data from further experimentations. Computational methods allow for the in-silico analysis of surgical procedures and devices' functionality considering many different influencing variables, the experimental investigation of which should be extremely expensive and time consuming. Furthermore, computational methods provide information that experimental methods barely supply, as the strain and the stress fields that regulate important mechano-biological phenomena. In this work, general notes about the development of biomechanical tools are proposed, together with specific applications to different fields, as dental implantology and bariatric surgery.
Collapse
|