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Werner P, Winter M, Mahr S, Stelzmueller ME, Zimpfer D, Ehrlich M. Cerebral Protection Strategies in Aortic Arch Surgery-Past Developments, Current Evidence, and Future Innovation. Bioengineering (Basel) 2024; 11:775. [PMID: 39199732 PMCID: PMC11351742 DOI: 10.3390/bioengineering11080775] [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: 05/22/2024] [Revised: 07/18/2024] [Accepted: 07/26/2024] [Indexed: 09/01/2024] Open
Abstract
Surgery of the aortic arch remains a complex procedure, with neurological events such as stroke remaining its most dreaded complications. Changes in surgical technique and the continuous innovation in neuroprotective strategies have led to a significant decrease in cerebral and spinal events. Different modes of cerebral perfusion, varying grades of hypothermia, and a number of pharmacological strategies all aim to reduce hypoxic and ischemic cerebral injury, yet there is no evidence indicating the clear superiority of one method over another. While surgical results continue to improve, novel hybrid and interventional techniques are just entering the stage and the question of optimal neuroprotection remains up to date. Within this perspective statement, we want to shed light on the current evidence and controversies of cerebral protection in aortic arch surgery, as well as what is on the horizon in this fast-evolving field. We further present our institutional approach as a large tertiary aortic reference center.
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Affiliation(s)
- Paul Werner
- Correspondence: (P.W.); (M.W.); Tel.: +431-40400-69890 (P.W.)
| | - Martin Winter
- Correspondence: (P.W.); (M.W.); Tel.: +431-40400-69890 (P.W.)
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2
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Allan P, Knight M, Evans R, Narayanan A. Artificial intelligence is poised to usher in a paradigm shift in surgery: application of ChatGPT in Aotearoa New Zealand and Australia. ANZ J Surg 2024; 94:780-781. [PMID: 38616527 DOI: 10.1111/ans.19000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Philip Allan
- Vascular, Endovascular & Transplantation Service, Wellington Regional Hospital, Wellington, New Zealand
- Vascular & Endovascular Surgery, Waikato Hospital, Waikato, New Zealand
| | - Michael Knight
- Vascular, Endovascular & Transplantation Service, Wellington Regional Hospital, Wellington, New Zealand
| | - Richard Evans
- Vascular, Endovascular & Transplantation Service, Wellington Regional Hospital, Wellington, New Zealand
| | - Anantha Narayanan
- Vascular, Endovascular & Transplantation Service, Wellington Regional Hospital, Wellington, New Zealand
- Vascular & Endovascular Surgery, Waikato Hospital, Waikato, New Zealand
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Galyfos G, Pikula M, Skalski A, Vagena S, Filis K, Sigala F. Using a novel three-dimensional holographic technology to perform open vascular surgery procedures. J Vasc Surg Cases Innov Tech 2024; 10:101440. [PMID: 38464890 PMCID: PMC10924202 DOI: 10.1016/j.jvscit.2024.101440] [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: 12/12/2023] [Accepted: 01/11/2024] [Indexed: 03/12/2024] Open
Abstract
Augmented reality technology has been introduced during recent years into everyday clinical practice. Several surgical specialties have begun using such technology for preoperative planning as well as intraoperatively. Regarding vascular surgery, a limited number of reports have described the benefits, mainly for endovascular procedures. We aim to present a novel three-dimensional holographic system we used to perform an open vascular procedure.
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Affiliation(s)
- George Galyfos
- Vascular Unit, First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Marcel Pikula
- Vascular Unit, First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Andrzej Skalski
- Vascular Unit, First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Sylvia Vagena
- Vascular Unit, First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Konstantinos Filis
- Vascular Unit, First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Frangiska Sigala
- Vascular Unit, First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
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Hatzl J, Henning D, Böckler D, Hartmann N, Meisenbacher K, Uhl C. Comparing Different Registration and Visualization Methods for Navigated Common Femoral Arterial Access-A Phantom Model Study Using Mixed Reality. J Imaging 2024; 10:76. [PMID: 38667974 PMCID: PMC11051344 DOI: 10.3390/jimaging10040076] [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: 02/11/2024] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
Mixed reality (MxR) enables the projection of virtual three-dimensional objects into the user's field of view via a head-mounted display (HMD). This phantom model study investigated three different workflows for navigated common femoral arterial (CFA) access and compared it to a conventional sonography-guided technique as a control. A total of 160 punctures were performed by 10 operators (5 experts and 5 non-experts). A successful CFA puncture was defined as puncture at the mid-level of the femoral head with the needle tip at the central lumen line in a 0° coronary insertion angle and a 45° sagittal insertion angle. Positional errors were quantified using cone-beam computed tomography following each attempt. Mixed effect modeling revealed that the distance from the needle entry site to the mid-level of the femoral head is significantly shorter for navigated techniques than for the control group. This highlights that three-dimensional visualization could increase the safety of CFA access. However, the navigated workflows are infrastructurally complex with limited usability and are associated with relevant cost. While navigated techniques appear as a potentially beneficial adjunct for safe CFA access, future developments should aim to reduce workflow complexity, avoid optical tracking systems, and offer more pragmatic methods of registration and instrument tracking.
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Affiliation(s)
- Johannes Hatzl
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Daniel Henning
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Niklas Hartmann
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Christian Uhl
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Department of Vascular Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany
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Lee KH, Li M, Varble N, Negussie AH, Kassin MT, Arrichiello A, Carrafiello G, Hazen LA, Wakim PG, Li X, Xu S, Wood BJ. Smartphone Augmented Reality Outperforms Conventional CT Guidance for Composite Ablation Margins in Phantom Models. J Vasc Interv Radiol 2024; 35:452-461.e3. [PMID: 37852601 DOI: 10.1016/j.jvir.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 09/23/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE To develop and evaluate a smartphone augmented reality (AR) system for a large 50-mm liver tumor ablation with treatment planning for composite overlapping ablation zones. MATERIALS AND METHODS A smartphone AR application was developed to display tumor, probe, projected probe paths, ablated zones, and real-time percentage of the ablated target tumor volume. Fiducial markers were attached to phantoms and an ablation probe hub for tracking. The system was evaluated with tissue-mimicking thermochromic phantoms and gel phantoms. Four interventional radiologists performed 2 trials each of 3 probe insertions per trial using AR guidance versus computed tomography (CT) guidance approaches in 2 gel phantoms. Insertion points and optimal probe paths were predetermined. On Gel Phantom 2, serial ablated zones were saved and continuously displayed after each probe placement/adjustment, enabling feedback and iterative planning. The percentages of tumor ablated for AR guidance versus CT guidance, and with versus without display of recorded ablated zones, were compared among interventional radiologists with pairwise t-tests. RESULTS The means of percentages of tumor ablated for CT freehand and AR guidance were 36% ± 7 and 47% ± 4 (P = .004), respectively. The mean composite percentages of tumor ablated for AR guidance were 43% ± 1 (without) and 50% ± 2 (with display of ablation zone) (P = .033). There was no strong correlation between AR-guided percentage of ablation and years of experience (r < 0.5), whereas there was a strong correlation between CT-guided percentage of ablation and years of experience (r > 0.9). CONCLUSIONS A smartphone AR guidance system for dynamic iterative large liver tumor ablation was accurate, performed better than conventional CT guidance, especially for less experienced interventional radiologists, and enhanced more standardized performance across experience levels for ablation of a 50-mm tumor.
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Affiliation(s)
- Katerina H Lee
- McGovern Medical School at UTHealth, Houston, Texas; Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Ming Li
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Nicole Varble
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland; Philips Research North America, Cambridge, Massachusetts
| | - Ayele H Negussie
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Michael T Kassin
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Antonio Arrichiello
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Gianpaolo Carrafiello
- Department of Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lindsey A Hazen
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Paul G Wakim
- Biostatistics and Clinical Epidemiology Service, National Institutes of Health, Bethesda, Maryland
| | - Xiaobai Li
- Biostatistics and Clinical Epidemiology Service, National Institutes of Health, Bethesda, Maryland
| | - Sheng Xu
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland.
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Settembrini P, Sultan S, Settembrini A. Editorial: New discoveries in bioengineering applied to vascular surgery. Front Surg 2023; 10:1293094. [PMID: 37901306 PMCID: PMC10613043 DOI: 10.3389/fsurg.2023.1293094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- P. Settembrini
- Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università Degli Studi di Milano, Milan, Italy
| | - S. Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland
- Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland, Galway Affiliated Teaching Hospitals, Galway, Ireland
- CÚRAM-CORRIB-Vascular Group, National University of Ireland, Galway, Ireland
| | - A. Settembrini
- Department of Cardio Thoracic and Vascular Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Yaneva A, Shopova D, Bakova D, Mihaylova A, Kasnakova P, Hristozova M, Semerdjieva M. The Progress in Bioprinting and Its Potential Impact on Health-Related Quality of Life. Bioengineering (Basel) 2023; 10:910. [PMID: 37627795 PMCID: PMC10451845 DOI: 10.3390/bioengineering10080910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
The intensive development of technologies related to human health in recent years has caused a real revolution. The transition from conventional medicine to personalized medicine, largely driven by bioprinting, is expected to have a significant positive impact on a patient's quality of life. This article aims to conduct a systematic review of bioprinting's potential impact on health-related quality of life. A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was undertaken using the PubMed, Scopus, Google Scholar, and ScienceDirect databases between 2019 and 2023. We have identified some of the most significant potential benefits of bioprinting to improve the patient's quality of life: personalized part production; saving millions of lives; reducing rejection risks after transplantation; accelerating the process of skin tissue regeneration; homocellular tissue model generation; precise fabrication process with accurate specifications; and eliminating the need for organs donor, and thus reducing patient waiting time. In addition, these advances in bioprinting have the potential to greatly benefit cancer treatment and other research, offering medical solutions tailored to each individual patient that could increase the patient's chance of survival and significantly improve their overall well-being. Although some of these advancements are still in the research stage, the encouraging results from scientific studies suggest that they are on the verge of being integrated into personalized patient treatment. The progress in bioprinting has the power to revolutionize medicine and healthcare, promising to have a profound impact on improving the quality of life and potentially transforming the field of medicine and healthcare.
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Affiliation(s)
- Antoniya Yaneva
- Department of Medical Informatics, Biostatistics and eLearning, Faculty of Public Health, Medical University, 4000 Plovdiv, Bulgaria;
| | - Dobromira Shopova
- Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University, 4000 Plovdiv, Bulgaria
| | - Desislava Bakova
- Department of Healthcare Management, Faculty of Public Health, Medical University, 4000 Plovdiv, Bulgaria; (D.B.); (A.M.); (P.K.); (M.H.); (M.S.)
| | - Anna Mihaylova
- Department of Healthcare Management, Faculty of Public Health, Medical University, 4000 Plovdiv, Bulgaria; (D.B.); (A.M.); (P.K.); (M.H.); (M.S.)
| | - Petya Kasnakova
- Department of Healthcare Management, Faculty of Public Health, Medical University, 4000 Plovdiv, Bulgaria; (D.B.); (A.M.); (P.K.); (M.H.); (M.S.)
| | - Maria Hristozova
- Department of Healthcare Management, Faculty of Public Health, Medical University, 4000 Plovdiv, Bulgaria; (D.B.); (A.M.); (P.K.); (M.H.); (M.S.)
| | - Maria Semerdjieva
- Department of Healthcare Management, Faculty of Public Health, Medical University, 4000 Plovdiv, Bulgaria; (D.B.); (A.M.); (P.K.); (M.H.); (M.S.)
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Setacci C, Settembrini AM, Benevento D. The web of clinical data, bioengineering, augmented reality and robotic in vascular surgery. Front Surg 2022; 9:971776. [PMID: 36311918 PMCID: PMC9614067 DOI: 10.3389/fsurg.2022.971776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Carlo Setacci
- Vascular Surgery Unit, University of Siena, Siena, Italy
| | - Alberto Maria Settembrini
- Unit of Vascular Surgery, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Correspondence: Alberto Settembrini
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