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Petrella F, Rizzo SMR, Rampinelli C, Casiraghi M, Bagnardi V, Frassoni S, Pozzi S, Pappalardo O, Pravettoni G, Spaggiari L. Assessment of pulmonary vascular anatomy: comparing augmented reality by holograms versus standard CT images/reconstructions using surgical findings as reference standard. Eur Radiol Exp 2024; 8:57. [PMID: 38724831 PMCID: PMC11082107 DOI: 10.1186/s41747-024-00458-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/07/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND We compared computed tomography (CT) images and holograms (HG) to assess the number of arteries of the lung lobes undergoing lobectomy and assessed easiness in interpretation by radiologists and thoracic surgeons with both techniques. METHODS Patients scheduled for lobectomy for lung cancer were prospectively included and underwent CT for staging. A patient-specific three-dimensional model was generated and visualized in an augmented reality setting. One radiologist and one thoracic surgeon evaluated CT images and holograms to count lobar arteries, having as reference standard the number of arteries recorded at surgery. The easiness of vessel identification was graded according to a Likert scale. Wilcoxon signed-rank test and κ statistics were used. RESULTS Fifty-two patients were prospectively included. The two doctors detected the same number of arteries in 44/52 images (85%) and in 51/52 holograms (98%). The mean difference between the number of artery branches detected by surgery and CT images was 0.31 ± 0.98, whereas it was 0.09 ± 0.37 between surgery and HGs (p = 0.433). In particular, the mean difference in the number of arteries detected in the upper lobes was 0.67 ± 1.08 between surgery and CT images and 0.17 ± 0.46 between surgery and holograms (p = 0.029). Both radiologist and surgeon showed a higher agreement for holograms (κ = 0.99) than for CT (κ = 0.81) and found holograms easier to evaluate than CTs (p < 0.001). CONCLUSIONS Augmented reality by holograms is an effective tool for preoperative vascular anatomy assessment of lungs, especially when evaluating the upper lobes, more prone to anatomical variations. TRIAL REGISTRATION ClinicalTrials.gov, NCT04227444 RELEVANCE STATEMENT: Preoperative evaluation of the lung lobe arteries through augmented reality may help the thoracic surgeons to carefully plan a lobectomy, thus contributing to optimize patients' outcomes. KEY POINTS • Preoperative assessment of the lung arteries may help surgical planning. • Lung artery detection by augmented reality was more accurate than that by CT images, particularly for the upper lobes. • The assessment of the lung arterial vessels was easier by using holograms than CT images.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Department of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Via G. B. Pergolesi, 33, 20900, Monza, Italy
| | - Stefania Maria Rita Rizzo
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC) Via Tesserete 46, 6900, Lugano, Switzerland.
- Facoltà di Scienze biomediche, Università della Svizzera italiana (USI), Via Buffi 13, 6900, Lugano, Switzerland.
| | - Cristiano Rampinelli
- Division of Radiology, IRCCS European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126, Milan, Italy
| | - Silvia Pozzi
- Artiness srl, Viale Cassala 57, 20143, Milan, Italy
| | | | - Gabriella Pravettoni
- Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
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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:S2173-5077(24)00037-1. [PMID: 38307256 DOI: 10.1016/j.cireng.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Porpiglia F, Checcucci E, Amparore D, Peretti D, Piramide F, De Cillis S, Piana A, Niculescu G, Verri P, Manfredi M, Poggio M, Stura I, Migliaretti G, Cossu M, Fiori C. Percutaneous Kidney Puncture with Three-dimensional Mixed-reality Hologram Guidance: From Preoperative Planning to Intraoperative Navigation. Eur Urol 2021; 81:588-597. [PMID: 34799199 DOI: 10.1016/j.eururo.2021.10.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 09/05/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite technical and technological innovations, percutaneous puncture still represents the most challenging step when performing percutaneous nephrolithotomy. This maneuver is characterized by the steepest learning curve and a risk of injuring surrounding organs and kidney damage. OBJECTIVE To evaluate the feasibility of three-dimensional mixed reality (3D MR) holograms in establishing the access point and guiding the needle during percutaneous kidney puncture. DESIGN, SETTING, AND PARTICIPANTS This prospective study included ten patients who underwent 3D MR endoscopic combined intrarenal surgery (ECIRS) for kidney stones from July 2019 to January 2020. A retrospective series of patients who underwent a standard procedure were selected for matched pair analysis. SURGICAL PROCEDURE For patients who underwent 3D MR ECIRS, holograms were overlapped on the real anatomy to guide the surgeon during percutaneous puncture. In the standard group, the procedures were only guided by ultrasound and fluoroscopy. MEASUREMENTS Differences in preoperative and postoperative patient characteristics between the groups were tested using a χ2 test and a Kruskal-Wallis test for categorical and continuous variables, respectively. Results are reported as the median and interquartile range for continuous variables and as the frequency and percentage for categorical variables. RESULTS AND LIMITATIONS Ten patients underwent 3D MR ECIRS. In all cases, the inferior calyx was punctured correctly, as planned using the overlapping hologram. The median puncture and radiation exposure times were 27 min and 120 s, respectively. No intraoperative or major postoperative complications occurred. Matched pair analysis with the standard ECIRS group revealed a significantly shorter radiation exposure time for the 3D MR group (p < 0.001) even though the puncture time was longer in comparison to the standard group (p < 0.001). Finally, use of 3D MR led to a higher success rate for renal puncture at the first attempt (100% vs 50%; p = 0.032). The main limitations of the study are the small sample size and manual overlapping of the rigid hologram models. CONCLUSIONS Our experience demonstrates that 3D MR guidance for renal puncture is feasible and safe. The procedure proved to be effective, with the inferior calyx correctly punctured in all cases, and was associated with a low intraoperative radiation exposure time because of the MR guidance. PATIENT SUMMARY Three-dimensional virtual models visualized as holograms and intraoperatively overlapped on the patient's real anatomy seem to be a valid new tool for guiding puncture of the kidney through the skin for minimally invasive treatment.
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Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy; Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy; Uro-technology and Social Media Working Group of the Young Academic Urologists of the European Association of Urology, Arnhem, The Netherlands.
| | - Daniele Amparore
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Dario Peretti
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Federico Piramide
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Sabrina De Cillis
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Alberto Piana
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Gabriel Niculescu
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Paolo Verri
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Massimiliano Poggio
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Ilaria Stura
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Giuseppe Migliaretti
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Marco Cossu
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
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Rubio RR, Bonaventura RD, Kournoutas I, Barakat D, Vigo V, El-Sayed I, Abla AA. Stereoscopy in Surgical Neuroanatomy: Past, Present, and Future. Oper Neurosurg (Hagerstown) 2021; 18:105-117. [PMID: 31214715 DOI: 10.1093/ons/opz123] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/13/2018] [Indexed: 11/13/2022] Open
Abstract
Since the dawn of antiquity, scientists, philosophers, and artists have pondered the nature of optical stereopsis-the perception of depth that arises from binocular vision. The early 19th century saw the advent of stereoscopes, devices that could replicate stereopsis by producing a 3D illusion from the super-imposition of 2D photographs. This phenomenon opened up a plethora of possibilities through its usefulness as an educational tool-particularly in medicine. Before long, photographers, anatomists, and physicians were collaborating to create some of the first stereoscopic atlases available for the teaching of medical students and residents. In fields like neurosurgery-where a comprehensive visuospatial understanding of neuro-anatomical correlates is crucial-research into stereoscopic modalities are of fundamental importance. Already, medical institutions all over the world are capitalizing on new and immersive technologies-such as 3D intraoperative recording, and 3D endoscopes-to refine their pedagogical efforts as well as improve their clinical capacities. The present paper surveys the history of stereoscopy from antiquity to the modern era-with a focus on its role in neurosurgery and medical education. Through the tracking of this evolution, we can discuss potential benefits, future directions, and highlight areas in which further research is needed. By anticipating these factors, we may strive to take full advantage of an emergent field of technology, for our ultimate goal of improving patient care.
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Affiliation(s)
- Roberto Rodriguez Rubio
- Department of Neurological Surgery, University of California, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California.,Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, California
| | - Rina Di Bonaventura
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Ioannis Kournoutas
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Dania Barakat
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Vera Vigo
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Ivan El-Sayed
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California.,Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, California
| | - Adib A Abla
- Department of Neurological Surgery, University of California, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
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Abstract
With the increasing volume of information for students to learn in a health sciences and medicine degree, tertiary educators need teaching resources that can maintain up-to-date information and educate effectively across a range of diseases and illnesses. Holograms may be the disruptive technology that can assist in this goal.
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Affiliation(s)
- Christian Moro
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland 4229 Australia
| | - Charlotte Phelps
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland 4229 Australia
| | - Dominique Jones
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland 4229 Australia
| | - Zane Stromberga
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland 4229 Australia
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