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Oya T, Kadomatsu Y, Chen-Yoshikawa TF, Nakao M. 2D/3D deformable registration for endoscopic camera images using self-supervised offline learning of intraoperative pneumothorax deformation. Comput Med Imaging Graph 2024; 116:102418. [PMID: 39079410 DOI: 10.1016/j.compmedimag.2024.102418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 09/02/2024]
Abstract
Shape registration of patient-specific organ shapes to endoscopic camera images is expected to be a key to realizing image-guided surgery, and a variety of applications of machine learning methods have been considered. Because the number of training data available from clinical cases is limited, the use of synthetic images generated from a statistical deformation model has been attempted; however, the influence on estimation caused by the difference between synthetic images and real scenes is a problem. In this study, we propose a self-supervised offline learning framework for model-based registration using image features commonly obtained from synthetic images and real camera images. Because of the limited number of endoscopic images available for training, we use a synthetic image generated from the nonlinear deformation model that represents possible intraoperative pneumothorax deformations. In order to solve the difficulty in estimating deformed shapes and viewpoints from the common image features obtained from synthetic and real images, we attempted to improve the registration error by adding the shading and distance information that can be obtained as prior knowledge in the synthetic image. Shape registration with real camera images is performed by learning the task of predicting the differential model parameters between two synthetic images. The developed framework achieved registration accuracy with a mean absolute error of less than 10 mm and a mean distance of less than 5 mm in a thoracoscopic pulmonary cancer resection, confirming improved prediction accuracy compared with conventional methods.
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Affiliation(s)
- Tomoki Oya
- Graduate School of Informatics, Kyoto University, Yoshida-Honmachi, Sakyo, Kyoto, 606-8501, Japan
| | - Yuka Kadomatsu
- Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | | | - Megumi Nakao
- Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan.
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2
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Chen-Yoshikawa TF. Evolution of Three-Dimensional Computed Tomography Imaging in Thoracic Surgery. Cancers (Basel) 2024; 16:2161. [PMID: 38893279 PMCID: PMC11172068 DOI: 10.3390/cancers16112161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
Radiologic reconstruction technology allows the wide use of three-dimensional (3D) computed tomography (CT) images in thoracic surgery. A minimally invasive surgery has become one of the standard therapies in thoracic surgery, and therefore, the need for preoperative and intraoperative simulations has increased. Three-dimensional CT images have been extensively used, and various types of software have been developed to reconstruct 3D-CT images for surgical simulation worldwide. Several software types have been commercialized and widely used by not only radiologists and technicians, but also thoracic surgeons. Three-dimensional CT images are helpful surgical guides; however, in almost all cases, they provide only static images, different from the intraoperative views. Lungs are soft and variable organs that can easily change shape by intraoperative inflation/deflation and surgical procedures. To address this issue, we have developed a novel software called the Resection Process Map (RPM), which creates variable virtual 3D images. Herein, we introduce the RPM and its development by tracking the history of 3D CT imaging in thoracic surgery. The RPM could help develop a real-time and accurate surgical navigation system for thoracic surgery.
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3
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Bassi M, Vaz Sousa R, Zacchini B, Centofanti A, Ferrante F, Poggi C, Carillo C, Pecoraro Y, Amore D, Diso D, Anile M, De Giacomo T, Venuta F, Vannucci J. Lung Cancer Surgery in Octogenarians: Implications and Advantages of Artificial Intelligence in the Preoperative Assessment. Healthcare (Basel) 2024; 12:803. [PMID: 38610225 PMCID: PMC11011722 DOI: 10.3390/healthcare12070803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
The general world population is aging and patients are often diagnosed with early-stage lung cancer at an advanced age. Several studies have shown that age is not itself a contraindication for lung cancer surgery, and therefore, more and more octogenarians with early-stage lung cancer are undergoing surgery with curative intent. However, octogenarians present some peculiarities that make surgical treatment more challenging, so an accurate preoperative selection is mandatory. In recent years, new artificial intelligence techniques have spread worldwide in the diagnosis, treatment, and therapy of lung cancer, with increasing clinical applications. However, there is still no evidence coming out from trials specifically designed to assess the potential of artificial intelligence in the preoperative evaluation of octogenarian patients. The aim of this narrative review is to investigate, through the analysis of the available international literature, the advantages and implications that these tools may have in the preoperative assessment of this particular category of frail patients. In fact, these tools could represent an important support in the decision-making process, especially in octogenarian patients in whom the diagnostic and therapeutic options are often questionable. However, these technologies are still developing, and a strict human-led process is mandatory.
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Affiliation(s)
- Massimiliano Bassi
- Division of Thoracic Surgery, Department of General Surgery and Surgical Specialties “Paride Stefanini”, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
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Zhang X, Yang D, Li L, Wang J, Liang S, Li P, Han Z, Wang X, Zhang K. Application of three-dimensional technology in video-assisted thoracoscopic surgery sublobectomy. Front Oncol 2024; 14:1280075. [PMID: 38525423 PMCID: PMC10957557 DOI: 10.3389/fonc.2024.1280075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/15/2024] [Indexed: 03/26/2024] Open
Abstract
Background Due to the widespread use of imaging techniques, the detection rate of early-stage lung cancer has increased. Video-assisted thoracoscopic surgery (VATS) sublobectomy has emerged as a prominent alternative to lobectomy, offering advantages like reduced resection range, better preservation of lung function, and enhanced postoperative quality of life. However, sublobectomy is more intricate than lobectomy, necessitating a higher level of surgical proficiency and anatomical understanding. Methods Three electronic databases were searched to capture relevant studies from January 2016 to March 2023, which related to the application of three-dimensional(3D) technology in VATS sublobectomy. Results Currently, clinical departments such as orthopedics, hepatobiliary surgery, and urology have started using 3D technology. This technology is expected to be widely used in thoracic surgery in future. Now 3D technology assists in preoperative planning, intraoperative navigation and doctor-patient communication. Conclusion 3D technologies, instrumental in locating pulmonary nodules and identifying variations in target lung segmental vessels and bronchi, play pivotal roles in VATS sublobectomy, especially in preoperative planning, intraoperative navigation, and doctor-patient communication. The limitations of 3D technology in clinical application are analyzed, and the future direction of existing 3D technology development is prospected.
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Affiliation(s)
- Xinyu Zhang
- Clinical Medical College of Hebei University, Affiliated Hospital of Hebei University, Baoding, China
- Thoracic Surgery Department, Affiliated Hospital of Hebei University Cardiothoracic Surgical Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Di Yang
- Clinical Medical College of Hebei University, Affiliated Hospital of Hebei University, Baoding, China
- Thoracic Surgery Department, Affiliated Hospital of Hebei University Cardiothoracic Surgical Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Linqian Li
- Surgical Department, Affiliated Hospital of Hebei University, Baoding, China
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, China
- Institute of Life Science and Green Development, Hebei University, Baoding, China
- 3D Image and 3D Printing Center, Affiliated Hospital of Hebei University, Baoding, China
| | - Jianing Wang
- Institute of Life Science and Green Development, Hebei University, Baoding, China
- Imaging Department of Hebei University Affiliated Hospital, Baoding, China
| | - Si Liang
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, China
- Institute of Life Science and Green Development, Hebei University, Baoding, China
| | - Peng Li
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, China
- Institute of Life Science and Green Development, Hebei University, Baoding, China
| | - Zhe Han
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, China
- Institute of Life Science and Green Development, Hebei University, Baoding, China
| | - Xiaodong Wang
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, China
- Institute of Life Science and Green Development, Hebei University, Baoding, China
| | - Ke Zhang
- Thoracic Surgery Department, Affiliated Hospital of Hebei University Cardiothoracic Surgical Department, Affiliated Hospital of Hebei University, Baoding, China
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, China
- Institute of Life Science and Green Development, Hebei University, Baoding, China
- 3D Image and 3D Printing Center, Affiliated Hospital of Hebei University, Baoding, China
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Ujiie H, Chiba R, Yamaguchi A, Nomura S, Shiiya H, Fujiwara-Kuroda A, Kaga K, Eitel C, Clapp TR, Kato T. Developing a Virtual Reality Simulation System for Preoperative Planning of Robotic-Assisted Thoracic Surgery. J Clin Med 2024; 13:611. [PMID: 38276117 PMCID: PMC10817249 DOI: 10.3390/jcm13020611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
Background. Robotic-assisted thoracic surgery (RATS) is now standard for lung cancer treatment, offering advantages over traditional methods. However, RATS's minimally invasive approach poses challenges like limited visibility and tactile feedback, affecting surgeons' navigation through com-plex anatomy. To enhance preoperative familiarization with patient-specific anatomy, we devel-oped a virtual reality (VR) surgical navigation system. Using head-mounted displays (HMDs), this system provides a comprehensive, interactive view of the patient's anatomy pre-surgery, aiming to improve preoperative simulation and intraoperative navigation. Methods. We integrated 3D data from preoperative CT scans into Perspectus VR Education software, displayed via HMDs for in-teractive 3D reconstruction of pulmonary structures. This detailed visualization aids in tailored preoperative resection simulations. During RATS, surgeons access these 3D images through Tile-ProTM multi-display for real-time guidance. Results. The VR system enabled precise visualization of pulmonary structures and lesion relations, enhancing surgical safety and accuracy. The HMDs offered true 3D interaction with patient data, facilitating surgical planning. Conclusions. VR sim-ulation with HMDs, akin to a robotic 3D viewer, offers a novel approach to developing robotic surgical skills. Integrated with routine imaging, it improves preoperative planning, safety, and accuracy of anatomical resections. This technology particularly aids in lesion identification in RATS, optimizing surgical outcomes.
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Affiliation(s)
- Hideki Ujiie
- Department of Thoracic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan; (R.C.); (S.N.); (H.S.); (A.F.-K.); (K.K.); (T.K.)
| | - Ryohei Chiba
- Department of Thoracic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan; (R.C.); (S.N.); (H.S.); (A.F.-K.); (K.K.); (T.K.)
| | - Aogu Yamaguchi
- Division of Radiology, Department of Medical Technology, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan;
| | - Shunsuke Nomura
- Department of Thoracic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan; (R.C.); (S.N.); (H.S.); (A.F.-K.); (K.K.); (T.K.)
| | - Haruhiko Shiiya
- Department of Thoracic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan; (R.C.); (S.N.); (H.S.); (A.F.-K.); (K.K.); (T.K.)
| | - Aki Fujiwara-Kuroda
- Department of Thoracic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan; (R.C.); (S.N.); (H.S.); (A.F.-K.); (K.K.); (T.K.)
| | - Kichizo Kaga
- Department of Thoracic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan; (R.C.); (S.N.); (H.S.); (A.F.-K.); (K.K.); (T.K.)
| | - Chad Eitel
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA; (C.E.); (T.R.C.)
| | - Tod R. Clapp
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA; (C.E.); (T.R.C.)
| | - Tatsuya Kato
- Department of Thoracic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan; (R.C.); (S.N.); (H.S.); (A.F.-K.); (K.K.); (T.K.)
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Shen J, Cao J, He J, Yu H, Chen M. Clinical utility of resected pancreatic volume ratio calculation for predicting postoperative new-onset diabetes mellitus after distal pancreatectomy-a propensity-matched analysis. Heliyon 2023; 9:e15998. [PMID: 37206003 PMCID: PMC10189175 DOI: 10.1016/j.heliyon.2023.e15998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/06/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
Background Limited literature is available on new-onset diabetes mellitus (NODM) after distal pancreatectomy. This study aimed to investigate the correlation between surgery-related factors and the incidence of NODM after distal pancreatectomy. Methods Patients were divided into the NODM-positive or NODM-negative group according to the diagnosis of NODM. After propensity score matching, the correlation between operation-related factors and the incidence of NODM was analyzed. The diagnostic threshold for predicting NODM was determined using the receiver operating characteristic (ROC) curve and the Youden index. Results No significant correlation was observed between the NODM incidence after distal pancreatectomy and operative blood loss, spleen preservation, surgical method (open or laparoscopy), postoperative ALB and HB (first day after surgery), and postoperative pathology. However, a significant correlation was found between the NODM incidence and the postoperative pancreatic volume or the resected pancreatic volume ratio. Resected pancreatic volume ratio was identified as a predictive risk factor for NODM. Youden index of the ROC curve was 0.548, with a cut off value of 32.05% for resected pancreatic volume ratio. The sensitivity and specificity of the cut off values were 0.952 and 0.595, respectively. Conclusions This study demonstrated that the volume ratio of pancreatic resection is a risk factor for the incidence of NODM after distal pancreatectomy. This can be used to predict the incidence of NODM and may have further clinical applications.
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Affiliation(s)
- Jiliang Shen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, China
| | - Jie He
- Department of Radiology, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, China
| | - Hong Yu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, China
- Corresponding author.
| | - Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, China
- Corresponding author.
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7
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Tokuno J, Fried GM. Digital Education in General Thoracic Surgery: A Narrative Review. Ann Thorac Surg 2023; 115:787-794. [PMID: 35561802 DOI: 10.1016/j.athoracsur.2022.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/23/2022] [Accepted: 04/13/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Since advanced technologies were introduced into surgical education, a variety of new programs have been developed. However, a comprehensive review of digital education in general thoracic surgery has not been performed. This narrative review was conducted was to identify the current applications of digital education in general thoracic surgery. METHODS A literature search was performed using keywords related to general thoracic surgery and digital education, including e-learning and virtual simulation, up to September 2021. Studies published in English investigating the effect of digital education in general thoracic surgery were included. RESULTS Thirteen studies met the criteria. The settings were in undergraduate (n = 6) and postgraduate education (residency) (n = 5) and mixed audience with other disciplines (n = 2). Theoretical knowledge (n = 5), technical skills (n = 4), and both knowledge and technical skills (n = 4) were the stated educational objectives for the studies. The didactic materials were transferred to hardware, software, or online platforms and delivered with multimedia materials. Technical skills training for bronchoscopy and chest tube insertion (n = 5) were offered using virtual reality and computer-based simulations. Subjective evaluation was done in 10 studies. Although after the digital education training there was observed improvement in knowledge or skills in 8 studies, studies were not designed to test for superiority compared with controls through randomized controlled studies. CONCLUSIONS This review summarizes the current applications of digital education in general thoracic surgery and helps establish the needs for future studies in this field.
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Affiliation(s)
- Junko Tokuno
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Science, Montreal, Quebec, Canada
| | - Gerald M Fried
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Science, Montreal, Quebec, Canada; Department of Surgery, McGill University, Montreal, Quebec, Canada.
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Nakao M, Nakamura M, Matsuda T. Image-to-Graph Convolutional Network for 2D/3D Deformable Model Registration of Low-Contrast Organs. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:3747-3761. [PMID: 35901001 DOI: 10.1109/tmi.2022.3194517] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Organ shape reconstruction based on a single-projection image during treatment has wide clinical scope, e.g., in image-guided radiotherapy and surgical guidance. We propose an image-to-graph convolutional network that achieves deformable registration of a three-dimensional (3D) organ mesh for a low-contrast two-dimensional (2D) projection image. This framework enables simultaneous training of two types of transformation: from the 2D projection image to a displacement map, and from the sampled per-vertex feature to a 3D displacement that satisfies the geometrical constraint of the mesh structure. Assuming application to radiation therapy, the 2D/3D deformable registration performance is verified for multiple abdominal organs that have not been targeted to date, i.e., the liver, stomach, duodenum, and kidney, and for pancreatic cancer. The experimental results show shape prediction considering relationships among multiple organs can be used to predict respiratory motion and deformation from digitally reconstructed radiographs with clinically acceptable accuracy.
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Chen-Yoshikawa TF. Is it true that less is more in thoracic surgery? J Thorac Dis 2022; 14:3674-3676. [PMID: 36389325 PMCID: PMC9641330 DOI: 10.21037/jtd-22-951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/04/2022] [Indexed: 12/01/2023]
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10
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Krass S, Lassen-Schmidt B, Schenk A. Computer-assisted image-based risk analysis and planning in lung surgery - a review. Front Surg 2022; 9:920457. [PMID: 36211288 PMCID: PMC9535081 DOI: 10.3389/fsurg.2022.920457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
In this paper, we give an overview on current trends in computer-assisted image-based methods for risk analysis and planning in lung surgery and present our own developments with a focus on computed tomography (CT) based algorithms and applications. The methods combine heuristic, knowledge based image processing algorithms for segmentation, quantification and visualization based on CT images of the lung. Impact for lung surgery is discussed regarding risk assessment, quantitative assessment of resection strategies, and surgical guiding. In perspective, we discuss the role of deep-learning based AI methods for further improvements.
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Affiliation(s)
- Stefan Krass
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
- Correspondence: Stefan Krass
| | | | - Andrea Schenk
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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11
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Bae SY, Lee H, Na KJ, Na B, Park S, Park IK, Kang CH, Kim YT. Computed tomography volumetric analysis for predicting postoperative lung function for segmentectomy. Interact Cardiovasc Thorac Surg 2022; 35:6649700. [PMID: 35876799 PMCID: PMC9338704 DOI: 10.1093/icvts/ivac195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/22/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Seon Yong Bae
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
| | - Haeju Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea
| | - Bubse Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea
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Wu Z, Huang Z, Qin Y, Jiao W. Progress in three-dimensional computed tomography reconstruction in anatomic pulmonary segmentectomy. Thorac Cancer 2022; 13:1881-1887. [PMID: 35585765 PMCID: PMC9250838 DOI: 10.1111/1759-7714.14443] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
The number of minimally invasive surgeries, such as video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery, has increased enormously in recent years. More and more relevant studies report that anatomic pulmonary segmentectomy has the same effect as traditional lobectomy in the surgical treatment of early stage non-small cell lung cancer (diameter less than 2.0 cm). Segmentectomy requires sufficient knowledge of the location of the pulmonary nodules, as well as the anatomy of the target segments, blood vessels, and bronchi. With the rapid development of imaging technology and three-dimensional technology, three-dimensional reconstruction has been widely used in the medical field. It can effectively assess the vascular branching patterns, discover the anatomic variations of the blood vessels and bronchi, determine the location of the lesion, and clarify the division of the segments. Therefore, it is helpful for preoperative positioning, surgical planning, preoperative simulation and intraoperative navigation, and provides a reference for formulating an individualized surgical plan. It therefore plays a positive role in anatomic pulmonary segmentectomy. This study reviews the progress made in three-dimensional computed tomography reconstruction in anatomic pulmonary segmentectomy.
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Affiliation(s)
- Zhe Wu
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhangfeng Huang
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi Qin
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjie Jiao
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
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13
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Tokuno J, Chen-Yoshikawa TF, Nakao M, Iwakura M, Motoki T, Matsuda T, Date H. Creation of a video library for education and virtual simulation of anatomical lung resection. Interact Cardiovasc Thorac Surg 2022; 34:808-813. [PMID: 35018431 PMCID: PMC9153380 DOI: 10.1093/icvts/ivab379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/20/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Junko Tokuno
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toyofumi Fengshi Chen-Yoshikawa
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Thoracic Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Megumi Nakao
- Graduate School of Informatics, Kyoto University, Kyoto, Japan
| | - Masashi Iwakura
- Institution for Information Management and Communication, Kyoto University, Kyoto, Japan
| | - Tamaki Motoki
- Institution for Information Management and Communication, Kyoto University, Kyoto, Japan
| | - Tetsuya Matsuda
- Graduate School of Informatics, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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14
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Tokuno J, Chen-Yoshikawa TF, Nakajima D, Aoyama A, Motoyama H, Sato M, Date H. Improved visualization of virtual-assisted lung mapping by indocyanine green. JTCVS Tech 2022; 10:542-549. [PMID: 34977805 PMCID: PMC8690872 DOI: 10.1016/j.xjtc.2021.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 07/30/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives Virtual-assisted lung mapping (VAL-MAP) is a bronchoscopic marking method of dye application on the surface of the lungs before resecting nonpalpable nodules. However, in some cases, it can be difficult to identify the markings of VAL-MAP on computed tomography and intraoperative thoracoscopy. We developed and assessed the feasibility of indocyanine green VAL-MAP (ICG-VAL-MAP). Methods A historical control trial was conducted to investigate the effectiveness of ICG-VAL-MAP for marking visualization compared with that of VAL-MAP. In ICG-VAL-MAP, instead of indigo carmine, ICG and computed tomography contrast agents were used for dye marking, and near-infrared fluorescence endoscopy was employed to visualize the ICG markings. The other processes in VAL-MAP were carried out. The marking visibility was assessed in 3 grades of easy, faint, or not identifiable. We compared the visibility of the markings on computed tomography images and during thoracoscopic operations between VAL-MAP (567 markings in 147 cases) and ICG-VAL-MAP (142 markings in 63 cases). Results On the preoperative computed tomography images, ICG-VAL-MAP provided significantly better marking visualization than VAL-MAP (easy/faint/not identifiable = 142/0/0 vs 427/100/30; P < .0001). ICG-VAL-MAP provided significantly better intraoperative markings than VAL-MAP (easy/faint/not identifiable = 141/0/1, respectively, vs 475/50/42, respectively; P < .0001). Regarding complications, pneumothorax occurred in 8 (5.4%) cases of VAL-MAP and zero cases (0%) of ICG-VAL-MAP (P = .12); fever was observed in 7 (5.0%) cases of VAL-MAP and 2 (3.2%) cases of ICG-VAL-MAP (P = .72). Conclusions ICG-VAL-MAP provided significantly better visibility of markings than VAL-MAP. It might be useful in the resection of nonpalpable small lung lesions.
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Affiliation(s)
- Junko Tokuno
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toyofumi F. Chen-Yoshikawa
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Thoracic Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hideki Motoyama
- Department of Thoracic Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Address for reprints: Hiroshi Date, MD, PhD, Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
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15
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Nakao M, Kobayashi K, Tokuno J, Chen-Yoshikawa T, Date H, Matsuda T. Deformation analysis of surface and bronchial structures in intraoperative pneumothorax using deformable mesh registration. Med Image Anal 2021; 73:102181. [PMID: 34303889 DOI: 10.1016/j.media.2021.102181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
The positions of nodules can change because of intraoperative lung deflation, and the modeling of pneumothorax-associated deformation remains a challenging issue for intraoperative tumor localization. In this study, we introduce spatial and geometric analysis methods for inflated/deflated lungs and discuss heterogeneity in pneumothorax-associated lung deformation. Contrast-enhanced CT images simulating intraoperative conditions were acquired from live Beagle dogs. The images contain the overall shape of the lungs, including all lobes and internal bronchial structures, and were analyzed to provide a statistical deformation model that could be used as prior knowledge to predict pneumothorax. To address the difficulties of mapping pneumothorax CT images with topological changes and CT intensity shifts, we designed deformable mesh registration techniques for mixed data structures including the lobe surfaces and the bronchial centerlines. Three global-to-local registration steps were performed under the constraint that the deformation was spatially continuous and smooth, while matching visible bronchial tree structures as much as possible. The developed framework achieved stable registration with a Hausdorff distance of less than 1 mm and a target registration error of less than 5 mm, and visualized deformation fields that demonstrate per-lobe contractions and rotations with high variability between subjects. The deformation analysis results show that the strain of lung parenchyma was 35% higher than that of bronchi, and that deformation in the deflated lung is heterogeneous.
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Affiliation(s)
- Megumi Nakao
- Graduate School of Informatics, Kyoto University, Yoshida-Honmachi, Sakyo, Kyoto, 606-8501, Japan.
| | - Kotaro Kobayashi
- Graduate School of Informatics, Kyoto University, Yoshida-Honmachi, Sakyo, Kyoto, 606-8501, Japan
| | - Junko Tokuno
- Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | | | - Hiroshi Date
- Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Tetsuya Matsuda
- Graduate School of Informatics, Kyoto University, Yoshida-Honmachi, Sakyo, Kyoto, 606-8501, Japan
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16
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Chen-Yoshikawa TF, Fukui T, Nakamura S, Ito T, Kadomatsu Y, Tsubouchi H, Ueno H, Sugiyama T, Goto M, Mori S, Ozeki N, Hakiri S, Kawaguchi K. Current trends in thoracic surgery. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:161-174. [PMID: 32581397 PMCID: PMC7276403 DOI: 10.18999/nagjms.82.2.161] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Thoracic surgery has evolved drastically in recent years. Although thoracic surgeons mainly deal with tumorous lesion in the lungs, mediastinum, and pleura, they also perform lung transplantation surgery in patients with end-stage lung disease. Herein, we introduce various major current topics in thoracic surgery. Minimally invasive surgical procedures include robot-assisted thoracic surgery and uniportal video-assisted thoracic surgery. Novel techniques for sublobar resection include virtual-assisted lung mapping, image-guided video-assisted thoracic surgery, and segmentectomy using indocyanine green. Three-dimensional (3D) computed tomography (CT) simulation consists of surgeon-friendly 3D-CT image analysis systems and new-generation, dynamic 3D-CT imaging systems. Updates in cadaveric lung transplantation include use of marginal donors, including donation after circulatory death, and ex vivo lung perfusion for such donors. Topics in living donor lobar lung transplantation include size matching, donor issues, and new surgical techniques. During routine clinical practice, thoracic surgeons encounter various pivotal topics related to thoracic surgery, which are described in this report.
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Affiliation(s)
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshinari Ito
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuka Kadomatsu
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Tsubouchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Harushi Ueno
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoshi Sugiyama
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Goto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Mori
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuhei Hakiri
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Kawaguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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17
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Ujiie H, Yamaguchi A, Gregor A, Chan H, Kato T, Hida Y, Kaga K, Wakasa S, Eitel C, Clapp TR, Yasufuku K. Developing a virtual reality simulation system for preoperative planning of thoracoscopic thoracic surgery. J Thorac Dis 2021; 13:778-783. [PMID: 33717550 PMCID: PMC7947494 DOI: 10.21037/jtd-20-2197] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Video-assisted thoracoscopic surgery (VATS) has become a standard approach for the treatment of lung cancer. However, its minimally invasive nature limits the field of view and reduces tactile feedback. These limitations make it vital that surgeons thoroughly familiarize themselves with the patient’s anatomy preoperatively. We have developed a virtual reality (VR) surgical navigation system using head-mounted displays (HMD). The aim of this study was to investigate the potential utility of this VR simulation system in both preoperative planning and intraoperative assistance, including support during thoracoscopic sublobar resection. Methods Three-dimensional (3D) polygon data derived from preoperative computed tomography data was loaded into BananaVision software developed at Colorado State University and displayed on an HMD. An interactive 3D reconstruction image was created, in which all the pulmonary structures could be individually imaged. Preoperative resection simulations were performed with patient-individualized reconstructed 3D images. Results The 3D anatomic structure of pulmonary vessels and a clear vision into the space between the lesion and adjacent tissues were successfully appreciated during preoperative simulation. Surgeons could easily evaluate the real patient’s anatomy in preoperative simulations to improve the accuracy and safety of actual surgery. The VR software and HMD allowed surgeons to visualize and interact with real patient data in true 3D providing a unique perspective. Conclusions This initial experience suggests that a VR simulation with HMD facilitated preoperative simulation. Routine imaging modalities combined with VR systems could substantially improve preoperative planning and contribute to the safety and accuracy of anatomic resection.
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Affiliation(s)
- Hideki Ujiie
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University, Hokkaido, Japan.,Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aogu Yamaguchi
- Division of Radiology, Department of Medical Technology, Hokkaido University, Hokkaido, Japan
| | - Alexander Gregor
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Harley Chan
- TECHNA Institute/Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Tatsuya Kato
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University, Hokkaido, Japan
| | - Yasuhiro Hida
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University, Hokkaido, Japan
| | - Kichizo Kaga
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University, Hokkaido, Japan
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University, Hokkaido, Japan
| | - Chad Eitel
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Tod R Clapp
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,TECHNA Institute/Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
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18
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Nakazawa S, Hanawa R, Nagashima T, Shimizu K, Yajima T, Shirabe K. Segmentectomy Guided by 3-Dimensional Images Reconstructed From Nonenhanced Computed Tomographic Data. Ann Thorac Surg 2020; 111:e301-e304. [PMID: 33144109 DOI: 10.1016/j.athoracsur.2020.07.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/25/2020] [Indexed: 11/16/2022]
Abstract
Three-dimensional (3D) imaging is an essential tool for performing an accurate segmentectomy. However, data acquired from contrast-enhanced computed tomography (CT) are considered necessary when reconstructing 3D pulmonary vascular images. Therefore, 3D images are currently unavailable for patients who cannot undergo contrast-enhanced CT scans due to patient-related issues such as anaphylaxis to the contrast agent, among others. We present here our experience with atypical segmentectomies guided by 3D images reconstructed from nonenhanced CT data.
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Affiliation(s)
- Seshiru Nakazawa
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Ryutaro Hanawa
- Department of Thoracic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Toshiteru Nagashima
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshiki Yajima
- Department of Innovative Cancer Immunotherapy, Gunma University, Graduate School of Medicine, Maebashi, Japan.
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Japan
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Commentary: The surprise is gone! Far beyond surgical instinct-the power of information. JTCVS Tech 2020; 4:321-322. [PMID: 34318061 PMCID: PMC8304892 DOI: 10.1016/j.xjtc.2020.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 11/20/2022] Open
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20
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D'Amico TA. Commentary: Seeking the grail? Choose wisely. J Thorac Cardiovasc Surg 2019; 159:1141. [PMID: 31607493 DOI: 10.1016/j.jtcvs.2019.07.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas A D'Amico
- Section of General Thoracic Surgery, Duke University Medical Center, Durham, NC.
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21
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Commentary: A small step for technology, a potential giant leap for thoracic surgery. J Thorac Cardiovasc Surg 2019; 159:1139-1140. [PMID: 31604642 DOI: 10.1016/j.jtcvs.2019.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/22/2022]
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