1
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Bracale U, Iacone B, Tedesco A, Gargiulo A, Di Nuzzo MM, Sannino D, Tramontano S, Corcione F. The use of mixed reality in the preoperative planning of colorectal surgery: Preliminary experience with a narrative review. Cir Esp 2024; 102 Suppl 1:S36-S44. [PMID: 38307256 DOI: 10.1016/j.cireng.2024.01.006] [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: 10/04/2023] [Accepted: 01/14/2024] [Indexed: 02/04/2024]
Abstract
New advanced technologies have recently been developed and preliminarily applied to surgery, including virtual reality (VR), augmented reality (AR) and mixed reality (MR). We retrospectively review all colorectal cases in which we used holographic 3D reconstruction from February 2020 to December 2022. This innovative approach was used to identify vascular anomalies, pinpoint tumor locations, evaluate infiltration into neighboring organs and devise surgical plans for both training and educating trainee assistants. We have also provided a state-of-the-art analysis, briefly highlighting what has been stated by the scientific literature to date. VR facilitates training and anatomical assessments, while AR enhances training and laparoscopic performance evaluations. MR, powered by HoloLens, enriches anatomic recognition, navigation, and visualization. Successful implementation was observed in 10 colorectal cancer cases, showcasing the effectiveness of MR in improving preoperative planning and its intraoperative application. This technology holds significant promise for advancing colorectal surgery by elevating safety and reliability standards.
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Affiliation(s)
- Umberto Bracale
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Biancamaria Iacone
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy.
| | - Anna Tedesco
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Antonio Gargiulo
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | | | - Daniele Sannino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Salvatore Tramontano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
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2
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Chauhan P, Mehra S, Pandya A. Randomised controlled trial: role of virtual interactive 3-dimensional models in anatomical and medical education. J Vis Commun Med 2024:1-7. [PMID: 38767329 DOI: 10.1080/17453054.2024.2352404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
Purpose: Virtual interactive 3-dimensional models (VI3DM) and immersive virtual reality are implemented in medical education and surgical training. VI3DM allow learners to view and interact with a virtual 3D object and help in conceptualising learning objectives that demand high cognitive and visuo-spatial skills. However, the effects of VI3DM in medical education are unknown. We aimed to determine whether VI3DM are helpful in conceptualising complex anatomical structures. Materials and methods: We included 5 specimens, which were assessed by 200 first-year medical students categorised into experimental (n = 100) and control (n = 100) groups using a systemic randomisation method after matching for age and sex. The experimental group was given VI3DM as interventional learning resources while the control group was given 2-dimensional photographs as conventional learning resources for self-directed learning for 30 minutes. Participants completed a questionnaire before and after the learning session to assess their knowledge related to external features, attachments, and relations of anatomical specimens. Results: The scores of the experimental group improved significantly in the post-test compared to those of the control group for all 5 specimens included in the study (p < 0.05, confidence interval = 95%, unpaired student's t-test). Conclusions: VI3DM can help conceptualise external features, attachments, and relations of anatomical structures.
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Affiliation(s)
- Pradip Chauhan
- Department of Anatomy, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | - Simmi Mehra
- Department of Anatomy, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | - Ashish Pandya
- Department of Anatomy, Pandit Deendayal Upadhyay Government Medical College, Rajkot, Gujarat, India
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3
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Yi WS, Rouhi AD, Duffy CC, Ghanem YK, Williams NN, Dumon KR. A Systematic Review of Immersive Virtual Reality for Nontechnical Skills Training in Surgery. JOURNAL OF SURGICAL EDUCATION 2024; 81:25-36. [PMID: 38036388 DOI: 10.1016/j.jsurg.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Immersive virtual reality (IVR) can be utilized to provide low cost and easily accessible simulation on all aspects of surgical education. In addition to technical skills training in surgery, IVR simulation has been utilized for nontechnical skills training in domains such as clinical decision-making and pre-operative planning. This systematic review examines the current literature on the effectiveness of IVR for nontechnical skill acquisition in surgical education. DESIGN A literature search was performed using MEDLINE, EMBASE, and Web of Science for primary studies published between January 1, 1995 and February 9, 2022. Four reviewers screened titles, abstracts, full texts, extracted data, and analyzed included studies to answer 5 key questions: How is IVR being utilized in nontechnical skills surgical education? What is the methodological quality of studies? What technologies are being utilized? What metrics are reported? What are the findings of these studies? RESULTS The literature search yielded 2340 citations, with 12 articles included for qualitative synthesis. Of included articles, 33% focused on clinical decision-making and 67% on anatomy/pre-operative planning. Motion sickness was a recorded metric in 25% of studies, with an aggregate incidence of 13% (11/87). An application score was reported in 33% and time to completion in 16.7%. A commercially developed application was utilized in 25%, while 75% employed a noncommercial application. The Oculus Rift was used in 41.7% of studies, HTC Vive in 25%, Samsung Gear in 16.7% of studies, Google Daydream in 8%, and 1 study did not report. The mean Medical Education Research Quality Instrument (MERSQI) score was 10.3 ± 2.3 (out of 18). In all studies researching clinical decision-making, participants preferred IVR to conventional teaching methods and in a nonrandomized control study it was found to be more effective. Averaged across all studies, mean scores were 4.33 for enjoyment, 4.16 for utility, 4.11 for usability, and 3.73 for immersion on a 5-point Likert scale. CONCLUSIONS The IVR nontechnical skills applications for surgical education are designed for clinical decision-making or anatomy/pre-operative planning. These applications are primarily noncommercially produced and rely upon a diverse array of HMDs for content delivery, suggesting that development is primarily coming from within academia and still without clarity on optimal utilization of the technology. Excitingly, users find these applications to be immersive, enjoyable, usable, and of utility in learning. Although a few studies suggest that IVR is additive or superior to conventional teaching or imaging methods, the data is mixed and derived from studies with weak design. Motion sickness with IVR remains a complication of IVR use needing further study to determine the cause and means of mitigation.
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Affiliation(s)
- William S Yi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgical Education, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Clinical Simulation Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Armaun D Rouhi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caoimhe C Duffy
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yazid K Ghanem
- Department of Surgery, Cooper University Hospital, Camden, New Jersey
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgical Education, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Clinical Simulation Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgical Education, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Clinical Simulation Center, University of Pennsylvania, Philadelphia, Pennsylvania.
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4
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Nanashima A, Kai K, Hamada T, Munakata S, İmamura N, Hiyoshi M, Hamada K, Shimizu I, Tsuchimochi Y, Tsuneyoshi I. Questionnaire survey of virtual reality experiences of digestive surgery at a rural academic institute: A pilot study for pre-surgical education. Turk J Surg 2023; 39:328-335. [PMID: 38694519 PMCID: PMC11057923 DOI: 10.47717/turkjsurg.2023.6202] [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: 08/01/2023] [Accepted: 12/16/2023] [Indexed: 05/04/2024]
Abstract
We developed a prototype VR platform, VECTORS L&M (VLM), aiming to enhance the understanding of digestive surgery for students, interns, and young surgeons by limiting costs. Its efficacy was assessed via questionnaires before implementation in surgical education. The VLM provides nine-minute VR views of surgeries, from both 180- and 360-degree angles. It was created with L.A.B. Co., Ltd. and incorporates surgery videos from biliary malignancy patients. Following VLM development, a survey was conducted among surgeons who had experienced it. Twenty-eight participants (32% of observers) responded to the survey. A majority (81%) reported positive experiences with the VR content and showed interest in VR video production, though some reported sickness. Most respondents were experienced surgeons, and nearly all believed VR was important for medical education with a mean score of 4.14 on a scale of up to 5. VR was preferred over 3D printed models due to its application versatility. Participants expressed the desire for future VR improvements, such as increased mobility, cloud connectivity, cost reduction, and better resolution. The VLM platform, coupled with this innovative teaching approach, offers experiential learning in intraabdominal surgery, effectively enriching the knowledge of students and surgeons ahead of surgical education and training.
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Affiliation(s)
- Atsushi Nanashima
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Kengo Kai
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Takeomi Hamada
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Shun Munakata
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Naoya İmamura
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Masahide Hiyoshi
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Kiyoaki Hamada
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Ikko Shimizu
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Yuki Tsuchimochi
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Isao Tsuneyoshi
- Department of Anesthesiology, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
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5
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Destro F, Salerno R, Calcaterra V, Ardizzone S, Meroni M, Roveri M, Pierucci UM, Zaja A, Rizzetto F, Campari A, Vertemati M, Milani P, Pelizzo G. Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040760. [PMID: 37190009 DOI: 10.3390/children10040760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023]
Abstract
Introduction: Endoscopic procedures are performed more frequently in children due to technological advances that can be safely performed in an adequate setting with a support of a multidisciplinary team. Pediatric indications for ERCP (endoscopic retrograde cholangiopancreatography) and EUS (endoscopic ultrasound) occur mainly due to congenital malformations. In a pediatric case series, we report the application of EUS combined with duodenoscopy, eventually associated with ERCP and minimally invasive surgery, highlighting the importance of defining a tailored dedicated management pathway for each patient. Patients and methods: A series of 12 patients, managed at our Center in the last three years, were evaluated, and their management was discussed. Results: EUS was performed in eight patients and permitted the differential diagnosis of duplication cysts and the visualization of the biliary tree and pancreatic anatomy. ERCP was attempted in five patients: in one case, it permitted the preservation of pancreatic tissue, postponing surgery and in three patients, it was technically unfeasible. MIS (minimally invasive surgery) was performed in seven patients, two with laparoscopic common bile duct exploration (LCBDE). Precise anatomical definition and the possibility of surgical simulation and team sharing were evaluated under VR HMD (Virtual Reality Head Mounted Display) in four cases. Conclusions: Exploration of the common bile duct in children differs from that of the adult population and combines echo-endoscopy and ERCP. The integrated use of minimally invasive surgery in the pediatric area is necessary for the whole management perspective in complex malformations and small patients. The introduction in the clinical practice of a preoperative study with Virtual Reality allows a better survey of the malformation and a tailored treatment.
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Affiliation(s)
- Francesca Destro
- Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Raffaele Salerno
- Gastrointestinal and Digestive Endoscopy Unit, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Sandro Ardizzone
- Gastrointestinal and Digestive Endoscopy Unit, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Milena Meroni
- Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Margherita Roveri
- Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Ugo Maria Pierucci
- Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Alberta Zaja
- CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milano, 20133 Milan, Italy
| | - Francesco Rizzetto
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, via Festa del Perdono 7, 20122 Milan, Italy
| | - Alessandro Campari
- Department of Pediatric Radiology, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Maurizio Vertemati
- CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milano, 20133 Milan, Italy
| | - Paolo Milani
- CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milano, 20133 Milan, Italy
| | - Gloria Pelizzo
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy
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6
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Laparoscopic Microwave Ablation: Which Technologies Improve the Results. Cancers (Basel) 2023; 15:cancers15061814. [PMID: 36980701 PMCID: PMC10046461 DOI: 10.3390/cancers15061814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Liver resection is the best treatment for hepatocellular carcinoma (HCC) when resectable. Unfortunately, many patients with HCC cannot undergo liver resection. Percutaneous thermoablation represents a valid alternative for inoperable neoplasms and for small HCCs, but it is not always possible to accomplish it. In cases where the percutaneous approach is not feasible (not a visible lesion or in hazardous locations), laparoscopic thermoablation may be indicated. HCC diagnosis is commonly obtained from imaging modalities, such as CT and MRI, However, the interpretation of radiological images, which have a two-dimensional appearance, during the surgical procedure and in particular during laparoscopy, can be very difficult in many cases for the surgeon who has to treat the tumor in a three-dimensional environment. In recent years, more technologies have helped surgeons to improve the results after ablative treatments. The three-dimensional reconstruction of the radiological images has allowed the surgeon to assess the exact position of the tumor both before the surgery (virtual reality) and during the surgery with immersive techniques (augmented reality). Furthermore, indocyanine green (ICG) fluorescence imaging seems to be a valid tool to enhance the precision of laparoscopic thermoablation. Finally, the association with laparoscopic ultrasound with contrast media could improve the localization and characteristics of tumor lesions. This article describes the use of hepatic three-dimensional modeling, ICG fluorescence imaging and laparoscopic ultrasound examination, convenient for improving the preoperative surgical preparation for personalized laparoscopic approach.
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7
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Lan L, Mao RQ, Qiu RY, Kay J, de Sa D. Immersive Virtual Reality for Patient-Specific Preoperative Planning: A Systematic Review. Surg Innov 2023; 30:109-122. [PMID: 36448920 PMCID: PMC9925905 DOI: 10.1177/15533506221143235] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background. Immersive virtual reality (iVR) facilitates surgical decision-making by enabling surgeons to interact with complex anatomic structures in realistic 3-dimensional environments. With emerging interest in its applications, its effects on patients and providers should be clarified. This systematic review examines the current literature on iVR for patient-specific preoperative planning. Materials and Methods. A literature search was performed on five databases for publications from January 1, 2000 through March 21, 2021. Primary studies on the use of iVR simulators by surgeons at any level of training for patient-specific preoperative planning were eligible. Two reviewers independently screened titles, abstracts, and full texts, extracted data, and assessed quality using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results were qualitatively synthesized, and descriptive statistics were calculated. Results. The systematic search yielded 2,555 studies in total, with 24 full-texts subsequently included for qualitative synthesis, representing 264 medical personnel and 460 patients. Neurosurgery was the most frequently represented discipline (10/24; 42%). Preoperative iVR did not significantly improve patient-specific outcomes of operative time, blood loss, complications, and length of stay, but may decrease fluoroscopy time. In contrast, iVR improved surgeon-specific outcomes of surgical strategy, anatomy visualization, and confidence. Validity, reliability, and feasibility of patient-specific iVR models were assessed. The mean QATSDD score of included studies was 32.9%. Conclusions. Immersive VR improves surgeon experiences of preoperative planning, with minimal evidence for impact on short-term patient outcomes. Future work should focus on high-quality studies investigating long-term patient outcomes, and utility of preoperative iVR for trainees.
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Affiliation(s)
- Lucy Lan
- Michael G. DeGroote School of
Medicine, McMaster University, Hamilton, ON, Canada,Lucy Lan, Michael G. DeGroote School of
Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8N 3Z5,
Canada.
| | - Randi Q. Mao
- Michael G. DeGroote School of
Medicine, McMaster University, Hamilton, ON, Canada
| | - Reva Y. Qiu
- Michael G. DeGroote School of
Medicine, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, ON, Canada
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8
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Pelizzo G, Costanzo S, Roveri M, Lanfranchi G, Vertemati M, Milani P, Zuccotti G, Cassin S, Panfili S, Rizzetto F, Campari A, Camporesi A, Calcaterra V. Developing Virtual Reality Head Mounted Display (HMD) Set-Up for Thoracoscopic Surgery of Complex Congenital Lung MalFormations in Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:50. [PMID: 35053675 PMCID: PMC8774663 DOI: 10.3390/children9010050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 11/19/2022]
Abstract
Video assisted thoracoscopic surgery (VATS) has been adopted in pediatric age for the treatment of congenital lung malformations (CLM). The success of VATS in pediatrics largely depends on the surgeon's skill ability to understand the airways, vascular system and lung parenchyma anatomy in CLM. In the last years, virtual reality (VR) and 3-dimensional (3D) printing of organ models and VR head mounted display (HMD) technologies have been introduced for completion of preoperative planning in adult patients. To date no reports about the use of VR HMD technologies in a pediatric setting are available. The aim of this report is to introduce a VR HMD model in VATS procedure to improve the quality of care in children with CLM. VR HMD set-up for planning thoracoscopic surgery was performed in a series of pediatric patients with diagnosis of CLM. The preoperative VR HMD evaluation allowed a navigation into the malformation with the aim to explore, interact, and make the surgeon more confident and skilled to answer to the traps. A development of surgical simulations models and teaching program dedicated to education and training in pediatric VATS is suitable among the pediatric surgery community. Further studies should demonstrate all the benefits of such technology in pediatric patients submitted to VATS procedure.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (S.C.); (M.R.); (G.L.)
- Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, 20157 Milan, Italy; (M.V.); (G.Z.); (S.C.); (S.P.)
| | - Sara Costanzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (S.C.); (M.R.); (G.L.)
| | - Margherita Roveri
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (S.C.); (M.R.); (G.L.)
| | - Giulia Lanfranchi
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (S.C.); (M.R.); (G.L.)
| | - Maurizio Vertemati
- Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, 20157 Milan, Italy; (M.V.); (G.Z.); (S.C.); (S.P.)
- CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milano, 20133 Milan, Italy;
| | - Paolo Milani
- CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milano, 20133 Milan, Italy;
- Department of Physics “Aldo Pontremoli”, University of Milano, 20157 Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, 20157 Milan, Italy; (M.V.); (G.Z.); (S.C.); (S.P.)
- Pediatric Department, Children’s Hospital “Vittore Buzzi”, 20154 Milan, Italy;
| | - Simone Cassin
- Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, 20157 Milan, Italy; (M.V.); (G.Z.); (S.C.); (S.P.)
| | - Sebastiano Panfili
- Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, 20157 Milan, Italy; (M.V.); (G.Z.); (S.C.); (S.P.)
| | - Francesco Rizzetto
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy;
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milano, 20157 Milan, Italy
| | - Alessandro Campari
- Pediatric Radiology and Neuroradiology Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Anna Camporesi
- Division of Pediatric Anesthesia and Intensive Care Unit, Department of Pediatrics, Children’s Hospital Vittore Buzzi, 20154 Milan, Italy;
| | - Valeria Calcaterra
- Pediatric Department, Children’s Hospital “Vittore Buzzi”, 20154 Milan, Italy;
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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9
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Paraboschi I, Gnech M, De Marco EA, Minoli DG, Bebi C, Zanetti SP, Manzoni G, Montanari E, Berrettini A. Pediatric Urolithiasis: Current Surgical Strategies and Future Perspectives. Front Pediatr 2022; 10:886425. [PMID: 35757114 PMCID: PMC9218273 DOI: 10.3389/fped.2022.886425] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/16/2022] [Indexed: 12/23/2022] Open
Abstract
New technological innovations and cutting-edge techniques have led to important changes in the surgical management of pediatric urolithiasis. Miniaturized technologies and minimally invasive approaches have been increasingly used in children with urinary stones to minimize surgical complications and improve patient outcomes. Moreover, the new computer technologies of the digital era have been opening new horizons for the preoperative planning and surgical treatment of children with urinary calculi. Three-dimensional modeling reconstructions, virtual, augmented, and mixed reality are rapidly approaching the surgical practice, equipping surgeons with powerful instruments to enhance the real-time intraoperative visualization of normal and pathological structures. The broad range of possibilities offered by these technological innovations in the adult population finds increasing applications in pediatrics, offering a more detailed visualization of small anatomical structures. This review illustrates the most promising techniques and devices to enhance the surgical treatment of pediatric urolithiasis in children, aiming to favor an early adoption and to stimulate more research on this topic.
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Affiliation(s)
- Irene Paraboschi
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Gnech
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Erika Adalgisa De Marco
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Guido Minoli
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Bebi
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Gianantonio Manzoni
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Alfredo Berrettini
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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10
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Gulick V, Graves D, Ames S, Krishnamani PP. Effect of a Virtual Reality-Enhanced Exercise and Education Intervention on Patient Engagement and Learning in Cardiac Rehabilitation: Randomized Controlled Trial. J Med Internet Res 2021; 23:e23882. [PMID: 33856355 PMCID: PMC8085751 DOI: 10.2196/23882] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/10/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is clinically proven to reduce morbidity and mortality; however, many eligible patients do not enroll in treatment. Furthermore, many enrolled patients do not complete their full course of treatment. This is greatly influenced by socioeconomic factors but is also because of patients' lack of understanding of the importance of their care and a lack of motivation to maintain attendance. OBJECTIVE This study aims to explore the potential benefits of virtual reality (VR) walking trails within CR treatment, specifically with regard to patient knowledge retention, satisfaction with treatment, and the overall attendance of treatment sessions. METHODS New CR patients were enrolled and randomized on a rolling basis to either the control group or intervention group. Intervention patients completed their time on the treadmill with VR walking trails, which included audio-recorded education, whereas control patients completed the standard of care therapy. Both groups were assisted by nursing staff for all treatment sessions. Primary outcomes were determined by assessing 6-minute walk test improvement. In addition, secondary outcomes of patients' cardiac knowledge and satisfaction were assessed via a computer-based questionnaire; patient adherence to the recommended number of sessions was also monitored. Cardiac knowledge assessment included a prerehabilitation education quiz, and the same quiz was repeated at patients' final visit and again at the 2-month follow-up. The satisfaction questionnaire was completed at the final visit. RESULTS Between January 2018 and May 2019, 72 patients were enrolled-41 in the intervention group and 31 in the control group. On the basis of the results of the prerehabilitation and postrehabilitation 6-minute walk test, no significant differences were observed between the intervention and control groups (P=.64). No statistical differences were observed between groups in terms of education (P=.86) or satisfaction (P=.32) at any time point. The control group had statistically more favorable rates of attendance, as determined by the risk group comparison (P=.02) and the comparison of the rates for completing the minimum number of sessions (P=.046), but no correlation was observed between the study group and reasons for ending treatment. CONCLUSIONS Although no improvements were seen in the VR intervention group over the control group, it is worth noting that limitations in the study design may have influenced these outcomes, not the medium itself. Furthermore, the qualitative information suggests that patients may have indeed enjoyed their experience with VR, even though quantitative satisfaction data did not capture this. Further considerations for how and when VR should be applied to CR are suggested in this paper. TRIAL REGISTRATION ClinicalTrials.gov NCT03945201; https://clinicaltrials.gov/ct2/show/NCT03945201.
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Affiliation(s)
- Victoria Gulick
- Information Services & Technologies, Jefferson Health, Philadelphia, PA, United States
| | - Daniel Graves
- Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, United States
| | - Shannon Ames
- Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, United States
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Aseni P, Vezzulli F, Rizzetto F, Cassin S, Rantas S, Cereda A, Chiara O, Vanzulli A, Vertemati M. Grade IV Liver Injury Following Mechanical Cardiopulmonary Resuscitation with Postoperative Three-dimensional Evaluation. J Emerg Trauma Shock 2020; 13:306-308. [PMID: 33897149 PMCID: PMC8047959 DOI: 10.4103/jets.jets_28_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/03/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
A 48-year-old female presented to the emergency department with chest pain and collapsed at the front desk. She was reanimated with mechanical chest compression, and after coronary angiography, a left anterior descending/diagonal bifurcation mini-crush stenting was performed. Few hours after the procedure, the patient showed severe hypotension. Abdominal ultrasound and computed tomography (CT) scan evidenced a massive subcapsular liver hematoma (Grade IV, American association for the surgery of trauma (AAST) liver injury scale) of the right lobe with extrahepatic blushing. Transhepatic embolization was attempted but without benefit, so the patient underwent emergency laparotomy for damage control surgery with perihepatic packing. After hemodynamic stabilization, right hepatectomy was performed with a favorable outcome and full recovery. The patient CT scan was retrospectively processed to obtain a virtual model visualizable through a head-mounted display. The virtual reconstruction could improve the comprehension of the injury and the liver surgical anatomy for educational purpose, and it could represent a new tool for preoperative planning.
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Affiliation(s)
- Paolo Aseni
- Department of Emergency, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Federico Vezzulli
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Francesco Rizzetto
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.,Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Simone Cassin
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Sofia Rantas
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Alberto Cereda
- Department of Cardiovascular, ASST della Valtellina e dell'Alto Lario, Sondrio, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Angelo Vanzulli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Maurizio Vertemati
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.,CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milan, Milan, Italy
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Accuracy and Reproducibility of Linear and Angular Measurements in Virtual Reality: a Validation Study. J Digit Imaging 2019; 33:111-120. [PMID: 31396777 DOI: 10.1007/s10278-019-00259-3] [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: 10/26/2022] Open
Abstract
The purpose of this experimental study is to validate linear and angular measurements acquired in a virtual reality (VR) environment via a comparison with the physical measurements. The hypotheses tested are as follows: VR linear and angular measurements (1) are equivalent to the corresponding physical measurements and (2) achieve a high degree of reproducibility. Both virtual and physical measurements were performed by two raters in four different sessions. A total of 40 linear and 15 angular measurements were acquired from three physical objects (an L-block, a hand model, and a dry skull) via the use of fiducial markers on selected locations. After both intra- and inter-rater reliability were evaluated using inter-class coefficient (ICC), equivalence between virtual and physical measurements was analyzed via paired t test and Bland-Altman plots. The accuracy of the virtual measurements was further estimated using two one-sided tests (TOST) procedure. The reproducibility of virtual measurements was evaluated via ICC as well as the repeatability coefficient. Virtual reality measurements were equivalent to physical measurements as evidenced by a paired t test with p values of 0.413 for linear and 0.533 for angular measurements and Bland-Altman plots in all three objects. The accuracy of virtual measurements was estimated to be 0.5 mm for linear and 0.7° for angular measurements, respectively. Reproducibility in VR measurements was high as evidenced by ICC of 1.00 for linear and 0.99 for angular measurements, respectively. Both linear and angular measurements in the VR environment are equivalent to the physical measurements with high accuracy and reproducibility.
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