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Bijlstra OD, Broersen A, Oosterveer TTM, Faber RA, Achterberg FB, Hurks R, Burgmans MC, Dijkstra J, Mieog JSD, Vahrmeijer AL, Swijnenburg RJ. Integration of Three-Dimensional Liver Models in a Multimodal Image-Guided Robotic Liver Surgery Cockpit. Life (Basel) 2022; 12:life12050667. [PMID: 35629335 PMCID: PMC9144252 DOI: 10.3390/life12050667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Robotic liver surgery represents the most recent evolution in the field of minimally-invasive liver surgery. For planning and guidance of liver resections, surgeons currently rely on preoperative 2-dimensional (2D) CT and/or MR imaging and intraoperative ultrasonography. Translating 2D images into digital 3-dimensional (3D) models may improve both preoperative planning and surgical guidance. The da Vinci® robotic surgical system is a platform suitable for the integration of multiple imaging modalities into one single view. In this study, we describe multimodal imaging options and introduce the Robotic Liver Surgery Cockpit; Methods: in-house developed software was used and validated for segmentation and registration to create a virtual reality 3D model of the liver based on preoperative imaging. The accuracy of the 3D models in the clinical setting was objectively assessed in 15 patients by measuring tumor diameters and subjectively with a postoperative conducted questionnaire; Results: Implementation and applicability of the 3D model in the surgical cockpit was feasible in all patients and the quality of the 3D reconstructions was high in 14 (93%) of cases. Tumor diameters measured on CT and/or MR imaging were comparable to automated measurements using the segmentation software and 3D models; Conclusions: the 3D model was successfully incorporated in the robotic surgery console as part of a multimodality imaging platform and aided the surgeon in planning and guidance of the resection. Future studies should focus on further automation of 3D rendering and progress into augmented reality.
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Affiliation(s)
- Okker D. Bijlstra
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (R.A.F.); (F.B.A.); (J.S.D.M.); (A.L.V.)
- Department of Surgery, Amsterdam University Medical Center, Cancer Center Amsterdam, University of Amsterdam, 1081 HV Amsterdam, The Netherlands;
- Correspondence:
| | - Alexander Broersen
- Section of Image Processing, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (A.B.); (J.D.)
| | - Timo T. M. Oosterveer
- Section of Interventional Radiology, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (T.T.M.O.); (M.C.B.)
| | - Robin A. Faber
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (R.A.F.); (F.B.A.); (J.S.D.M.); (A.L.V.)
| | - Friso B. Achterberg
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (R.A.F.); (F.B.A.); (J.S.D.M.); (A.L.V.)
| | - Rob Hurks
- Department of Radiology, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands;
| | - Mark C. Burgmans
- Section of Interventional Radiology, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (T.T.M.O.); (M.C.B.)
| | - Jouke Dijkstra
- Section of Image Processing, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (A.B.); (J.D.)
| | - J. Sven D. Mieog
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (R.A.F.); (F.B.A.); (J.S.D.M.); (A.L.V.)
| | - Alexander L. Vahrmeijer
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (R.A.F.); (F.B.A.); (J.S.D.M.); (A.L.V.)
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Amsterdam University Medical Center, Cancer Center Amsterdam, University of Amsterdam, 1081 HV Amsterdam, The Netherlands;
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Przedlacka A, Pellino G, Fletcher J, Bello F, Tekkis PP, Kontovounisios C. Current and future role of three-dimensional modelling technology in rectal cancer surgery: A systematic review. World J Gastrointest Surg 2021; 13:1754-1769. [PMID: 35070078 PMCID: PMC8727188 DOI: 10.4240/wjgs.v13.i12.1754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/09/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models, which more closely resemble the complex environment encountered during surgery. It has been successfully applied to surgical planning and navigation, as well as surgical training and patient education in several surgical specialties, but its uptake lags behind in colorectal surgery. Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis, which is difficult to comprehend and visualise. AIM To review the current and emerging applications of the 3D models, both virtual and physical, in rectal cancer surgery. METHODS Medline/PubMed, Embase and Scopus databases were searched using the keywords "rectal surgery", "colorectal surgery", "three-dimensional", "3D", "modelling", "3D printing", "surgical planning", "surgical navigation", "surgical education", "patient education" to identify the eligible full-text studies published in English between 2001 and 2020. Reference list from each article was manually reviewed to identify additional relevant papers. The conference abstracts, animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded. Data were extracted from the retrieved manuscripts and summarised in a descriptive way. The manuscript was prepared and revised in accordance with PRISMA 2009 checklist. RESULTS Sixteen studies, including 9 feasibility studies, were included in the systematic review. The studies were classified into four categories: feasibility of the use of 3D modelling technology in rectal cancer surgery, preoperative planning and intraoperative navigation, surgical education and surgical device design. Thirteen studies used virtual models, one 3D printed model and 2 both types of models. The construction of virtual and physical models depicting the normal pelvic anatomy and rectal cancer, was shown to be feasible. Within the clinical context, 3D models were used to identify vascular anomalies, for surgical planning and navigation in lateral pelvic wall lymph node dissection and in management of recurrent rectal cancer. Both physical and virtual 3D models were found to be valuable in surgical education, with a preference for 3D printed models. The main limitations of the current technology identified in the studies were related to the restrictions of the segmentation process and the lack of 3D printing materials that could mimic the soft and deformable tissues. CONCLUSION 3D modelling technology has potential to be utilised in multiple aspects of rectal cancer surgery, however, it is still at the experimental stage of application in this setting.
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Affiliation(s)
- Anna Przedlacka
- Department of Surgery and Cancer, Imperial College London, London SW10 9NH, United Kingdom
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples 80138, Campania, Italy
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona 08029, Spain
- Colorectal Surgery, Royal Marsden NHS Foundation Trust, London SW3 6JJ, United Kingdom
| | - Jordan Fletcher
- Department of Surgery and Cancer, St Mark’s Hospital Academic Institute, Imperial College London, London HA1 3UJ, United Kingdom
| | - Fernando Bello
- Centre for Engagement and Simulation Science, Imperial College London, London SW10 9NH, United Kingdom
| | - Paris P Tekkis
- Department of Surgery and Cancer, Imperial College London, London SW10 9NH, United Kingdom
- Colorectal Surgery, Royal Marsden NHS Foundation Trust, London SW3 6JJ, United Kingdom
- Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, United Kingdom
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Imperial College London, London SW10 9NH, United Kingdom
- Colorectal Surgery, Royal Marsden NHS Foundation Trust, London SW3 6JJ, United Kingdom
- Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, United Kingdom
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Zheng S, Wu F, Winzenberg T, Cicuttini F, Wluka AE, Antony B, Aitken D, Blizzard L, Ding C. The cross-sectional and longitudinal associations of dietary patterns with knee symptoms and MRI detected structure in patients with knee osteoarthritis. Osteoarthritis Cartilage 2021; 29:527-535. [PMID: 33588084 DOI: 10.1016/j.joca.2020.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine the cross-sectional and longitudinal associations of dietary patterns with knee symptoms and structures in patients with knee osteoarthritis (OA). METHODS Participants with symptomatic knee OA were recruited from a randomised, placebo-controlled trial conducted in Tasmania (N = 259) and Victoria (N = 133). Diet was assessed by the Anti-Cancer Council of Victoria food frequency questionnaire. Factor analysis was used to identify dietary patterns. Knee symptoms were assessed using Western Ontario and McMaster Universities Arthritis Index (WOMAC) and structures using MRI. Multivariable linear regressions were used to examine associations. RESULTS Three dietary patterns ("high-fat", "healthy" and "mixed") were identified in whole sample. Participants with higher "healthy pattern" score had lower total WOMAC, pain, function and stiffness scores at baseline but the associations were not significant over 24 months. Three ("western", "vegetable and meat" and "mediterranean") and two ("processed" and "vegetable") patterns were identified in Tasmania and Victoria, respectively. Cross-sectionally, only "mediterranean pattern" and "vegetable pattern" scores were significantly and negatively associated with total WOMAC or function scores. Longitudinally, participants with higher "western pattern" had worsening function (β: 0.35, 95%CI: 0.03, 0.67) and total WOMAC (β: 0.40, 95%CI: 0.07, 0.72) scores; furthermore, "vegetable pattern" was associated with decreased WOMAC stiffness score (β: -0.47, 95%CI: -0.93, -0.02). In contrast, dietary patterns were largely not associated with structural changes. CONCLUSION Some healthy dietary patterns were associated with reduced joint symptoms but dietary patterns were not associated with joint structure in this sample with knee OA. Further studies are required to confirm these findings.
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Affiliation(s)
- S Zheng
- Department of Rheumatology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - F Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - T Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - A E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - B Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - D Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - L Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Department of Rheumatology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China.
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Kosieradzki M, Lisik W, Gierwiało R, Sitnik R. Applicability of Augmented Reality in an Organ Transplantation. Ann Transplant 2020; 25:e923597. [PMID: 32732862 PMCID: PMC7418780 DOI: 10.12659/aot.923597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/20/2022] Open
Abstract
Augmented reality (AR) delivers virtual information or some of its elements to the real world. This technology, which has been used primarily for entertainment and military applications, has vigorously entered medicine, especially in radiology and surgery, yet has never been used in organ transplantation. AR could be useful in training transplant surgeons, promoting organ donations, graft retrieval and allocation, and microscopic diagnosis of rejection, treatment of complications, and post-transplantation neoplasms. The availability of AR display tools such as Smartphone screens and head-mounted goggles, accessibility of software for automated image segmentation and 3-dimensional reconstruction, and algorithms allowing registration, make augmented reality an attractive tool for surgery including transplantation. The shortage of hospital IT specialists and insufficient investments from medical equipment manufacturers into the development of AR technology remain the most significant obstacles in its broader application.
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Affiliation(s)
- Maciej Kosieradzki
- Department of General and Transplantation Surgery, The Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Lisik
- Department of General and Transplantation Surgery, The Medical University of Warsaw, Warsaw, Poland
| | - Radosław Gierwiało
- Virtual Reality Techniques Division, Institute of Micromechanics and Photonics, Faculty of Mechatronics, Warsaw University of Technology, Warsaw, Poland
| | - Robert Sitnik
- Virtual Reality Techniques Division, Institute of Micromechanics and Photonics, Faculty of Mechatronics, Warsaw University of Technology, Warsaw, Poland
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Qian L, Wu JY, DiMaio SP, Navab N, Kazanzides P. A Review of Augmented Reality in Robotic-Assisted Surgery. ACTA ACUST UNITED AC 2020. [DOI: 10.1109/tmrb.2019.2957061] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kim HJ, Choi GS, Park JS, Park SY, Cho SH, Seo AN, Yoon GS. S122: impact of fluorescence and 3D images to completeness of lateral pelvic node dissection. Surg Endosc 2019; 34:469-476. [PMID: 31139999 DOI: 10.1007/s00464-019-06830-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 05/14/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lateral pelvic lymph node dissection (LPND) is a technically demanding procedure. Consequently, there is a possibility of incomplete dissection of lateral pelvic lymph nodes (LPNs). We aimed to identify metastatic LPNs intraoperatively in real-time under dual guidance of fluorescence imaging and 3D lymphovascular reconstruction, and then to remove them completely. METHODS Rectal cancer patients who were scheduled to undergo LPND after preoperative chemoradiotherapy (CRT) were prospectively enrolled. We traced changes in suspected metastatic LPNs during preoperative CRT and defined them as index LPNs on post-CRT imaging studies. For fluorescence imaging, indocyanine green (ICG) at a dose of 2.5 mg was injected transanally around the tumor before the operation. For 3D reconstruction images, each patient underwent preoperative axial CT scan with contrast (0.6 mm slice thickness). These images were then manipulated with OsiriX. Index LPNs and essential structures in the pelvic sidewall, such as the obturator nerve, were reconstructed with abdominal arteries from 3D volume rendering. All surgical procedures were performed via laparoscopic or robotic approach. RESULTS From March to July 2017, ten rectal cancer patients underwent total mesorectal excision with LPND after preoperative CRT under dual image guidance. Bilateral LPND was performed in five patients. All index LPNs among ICG-bearing lymph nodes were clearly identified intraoperatively by matching with their corresponding 3D images. Pathologic LPN metastasis was confirmed in four patients (40.0%) and in five of the 15 dissected pelvic sidewalls (33.0%). All metastatic LPNs were identified among index LPNs. Four (80.0%) of the five metastatic LPNs were located in the internal iliac area. CONCLUSION Index LPNs among ICG-bearing lymph nodes in pelvic sidewall were clearly identified and completely removed by matching with their corresponding 3D reconstruction images. Further studies and long-term oncologic outcomes are required to determine the real impact of dual image guidance in LPND.
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Affiliation(s)
- Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, 807 Hogukro, Buk-gu, Daegu, 41404, South Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, 807 Hogukro, Buk-gu, Daegu, 41404, South Korea.
| | - Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, 807 Hogukro, Buk-gu, Daegu, 41404, South Korea
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, 807 Hogukro, Buk-gu, Daegu, 41404, South Korea
| | - Seung Hyun Cho
- Department of Radiology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - An Na Seo
- Department of Pathology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ghuil Suk Yoon
- Department of Pathology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
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Chen BR, Buchanan IA, Kellis S, Kramer D, Ohiorhenuan I, Blumenfeld Z, Grisafe Ii DJ, Barbaro MF, Gogia AS, Lu JY, Chen BB, Lee B. Utilizing Light-field Imaging Technology in Neurosurgery. Cureus 2018; 10:e2459. [PMID: 29888163 PMCID: PMC5991932 DOI: 10.7759/cureus.2459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Traditional still cameras can only focus on a single plane for each image while rendering everything outside of that plane out of focus. However, new light-field imaging technology makes it possible to adjust the focus plane after an image has already been captured. This technology allows the viewer to interactively explore an image with objects and anatomy at varying depths and clearly focus on any feature of interest by selecting that location during post-capture viewing. These images with adjustable focus can serve as valuable educational tools for neurosurgical residents. We explore the utility of light-field cameras and review their strengths and limitations compared to other conventional types of imaging. The strength of light-field images is the adjustable focus, as opposed to the fixed-focus of traditional photography and video. A light-field image also is interactive by nature, as it requires the viewer to select the plane of focus and helps with visualizing the three-dimensional anatomy of an image. Limitations include the relatively low resolution of light-field images compared to traditional photography and video. Although light-field imaging is still in its infancy, there are several potential uses for the technology to complement traditional still photography and videography in neurosurgical education.
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Affiliation(s)
- Brian R Chen
- Department of Neurosurgery, University of Southern California, Los Angeles, USA
| | - Ian A Buchanan
- Department of Neurosurgery, University of Southern California, Los Angeles, USA
| | - Spencer Kellis
- Department of Neurosurgery, University of Southern California, Los Angeles, USA
| | - Daniel Kramer
- Department of Neurosurgery, University of Southern California, Los Angeles, USA
| | - Ifije Ohiorhenuan
- Department of Neurosurgery, University of Southern California, Los Angeles, USA
| | - Zack Blumenfeld
- Department of Neurosurgery, University of Southern California, Los Angeles, USA
| | | | - Michael F Barbaro
- Department of Neurosurgery, University of Southern California, Los Angeles, USA
| | - Angad S Gogia
- Department of Neurosurgery, University of Southern California, Los Angeles, USA
| | - James Y Lu
- Department of Neurosurgery, University of Southern California, Los Angeles, USA
| | - Beverly B Chen
- Department of Neurosurgery, University of Southern California, Los Angeles, USA
| | - Brian Lee
- Department of Neurosurgery, University of Southern California, Los Angeles, USA
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Wang X, Jin X, Blizzard L, Antony B, Han W, Zhu Z, Cicuttini F, Wluka AE, Winzenberg T, Jones G, Ding C. Associations Between Knee Effusion-synovitis and Joint Structural Changes in Patients with Knee Osteoarthritis. J Rheumatol 2017; 44:1644-1651. [DOI: 10.3899/jrheum.161596] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 02/06/2023]
Abstract
Objective.To describe the associations between effusion-synovitis and joint structural abnormalities in patients with knee osteoarthritis (OA) over 24 months.Methods.A posthoc analysis using data from a randomized controlled trial in 413 patients with symptomatic OA (aged 63 ± 7 yrs, 208 women). Knee effusion-synovitis volume and score, cartilage defects, cartilage volume, and bone marrow lesions (BML) were assessed using magnetic resonance imaging. Joint space narrowing (JSN) and osteophytes were assessed using radiograph. Least significant change criterion was used to define change in effusion-synovitis volume. Knee symptoms were assessed by Western Ontario and McMaster University OA Index. Multivariable linear/logistic regression and multilevel generalized mixed-effects models were used in longitudinal analyses.Results.Total effusion-synovitis volume increased modestly from baseline (8.0 ± 8.5 ml) to followup (9.0 ± 10.5 ml). Baseline BML, cartilage defect, JSN, and osteophyte scores were positively associated with change in effusion-synovitis volume (p < 0.05). Baseline cartilage defects and JSN were also associated with change in effusion-synovitis score (p < 0.05). However, neither baseline effusion-synovitis score nor volume consistently predicted change in the above structures except cartilage volume. In the mixed-effects models, knee effusion-synovitis was positively associated with BML (volume: β = 1.19 ml/grade; score: OR = 1.75/grade) and cartilage defects (volume: β = 1.87 ml/grade; score: OR = 2.22/grade), while negatively associated with cartilage volume loss. Change in effusion-synovitis volume was positively correlated with changes in knee pain and stiffness scores (p < 0.05).Conclusion.Knee cartilage and subchondral bone abnormalities predicted change in effusion-synovitis, but effusion-synovitis did not predict knee structural changes. These findings suggest that synovial inflammation is likely the result of joint structural abnormalities in established OA. ClinicalTrials.gov identifier: NCT01176344. Australian New Zealand Clinical Trials Registry: ACTRN12610000495022.
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Zheng S, Jin X, Cicuttini F, Wang X, Zhu Z, Wluka A, Han W, Winzenberg T, Antony B, Aitken D, Blizzard L, Jones G, Ding C. Maintaining Vitamin D Sufficiency Is Associated with Improved Structural and Symptomatic Outcomes in Knee Osteoarthritis. Am J Med 2017; 130:1211-1218. [PMID: 28549923 DOI: 10.1016/j.amjmed.2017.04.038] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/22/2017] [Accepted: 04/17/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim of this study was to describe whether maintaining sufficient serum vitamin D levels in people with knee osteoarthritis and baseline vitamin D insufficiency has an association with change in knee structures and symptoms over 2 years. METHODS Participants (n = 413, mean age 63.2 years) with symptomatic knee osteoarthritis and vitamin D insufficiency were enrolled in a clinical trial. In all, 340 participants (82.3%) completed the study, with 25-hydroxyvitamin D [25(OH)D] measurements at baseline and months 3 and 24. Participants were classified as consistently insufficient [serum 25(OH)D ≤50 nmol/L at months 3 and 24, n = 45], fluctuating [25(OH)D >50 nmol/L at either point, n = 68), and consistently sufficient [25(OH)D >50 nmol/L at months 3 and 24, n = 226] groups. Knee cartilage volume, cartilage defects, bone marrow lesions, and effusion-synovitis volume were assessed using MRI at baseline and month 24. Knee symptoms were assessed at baseline and months 3, 6, 12, and 24 using the Western Ontario and McMaster Universities Arthritis Index. RESULTS The consistently sufficient group had significantly less loss of tibial cartilage volume (β 2.1%; 95% confidence interval [CI], 0.3%, 3.9%), less increase in effusion-synovitis volume (β -2.5 mL; 95 CI%, -4.7, -0.2 mL), and less loss of Western Ontario and McMaster Universities Arthritis Index physical function (β -94.2; 95% CI, -183.8, -4.5) compared with the consistently insufficient group in multivariable analyses. In contrast, there were no significant differences in these outcomes between the fluctuating and consistently insufficient groups. Changes in cartilage defects, bone marrow lesions, and knee pain were similar between groups. CONCLUSION This post hoc analysis suggests beneficial effects of maintaining vitamin D sufficiency on cartilage loss, effusion-synovitis, and physical function in people with knee osteoarthritis.
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Affiliation(s)
- Shuang Zheng
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Xingzhong Jin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Xia Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Zhaohua Zhu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Anita Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Weiyu Han
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Translational Research Centre, Academy of Orthopaedics, Guangdong Province, Southern Medical University, Guangzhou, China
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Faculty of Health, University of Tasmania, Hobart, Australia
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Translational Research Centre, Academy of Orthopaedics, Guangdong Province, Southern Medical University, Guangzhou, China.
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Vávra P, Roman J, Zonča P, Ihnát P, Němec M, Kumar J, Habib N, El-Gendi A. Recent Development of Augmented Reality in Surgery: A Review. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:4574172. [PMID: 29065604 PMCID: PMC5585624 DOI: 10.1155/2017/4574172] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. However, the awareness of possibilities of augmented reality is generally low. This review evaluates whether augmented reality can presently improve the results of surgical procedures. METHODS We performed a review of available literature dating from 2010 to November 2016 by searching PubMed and Scopus using the terms "augmented reality" and "surgery." Results. The initial search yielded 808 studies. After removing duplicates and including only journal articles, a total of 417 studies were identified. By reading of abstracts, 91 relevant studies were chosen to be included. 11 references were gathered by cross-referencing. A total of 102 studies were included in this review. CONCLUSIONS The present literature suggest an increasing interest of surgeons regarding employing augmented reality into surgery leading to improved safety and efficacy of surgical procedures. Many studies showed that the performance of newly devised augmented reality systems is comparable to traditional techniques. However, several problems need to be addressed before augmented reality is implemented into the routine practice.
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Affiliation(s)
- P. Vávra
- Department of Surgery, University Hospital Ostrava, 17. Listopadu 1790, 708 52 Ostrava, Czech Republic
| | - J. Roman
- Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - P. Zonča
- Department of Surgery, University Hospital Ostrava, 17. Listopadu 1790, 708 52 Ostrava, Czech Republic
| | - P. Ihnát
- Department of Surgery, University Hospital Ostrava, 17. Listopadu 1790, 708 52 Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - M. Němec
- Faculty of Electrical Engineering and Computer Science, Technical University of Ostrava, 17. Listopadu 15/2172, 708 33 Ostrava, Czech Republic
| | - J. Kumar
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - N. Habib
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - A. El-Gendi
- Department of Surgery, Faculty of Medicine, Alexandria University, Chamblion Street, El Azareeta, Alexandria Governorate, Egypt
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11
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Wang X, Cicuttini F, Jin X, Wluka AE, Han W, Zhu Z, Blizzard L, Antony B, Winzenberg T, Jones G, Ding C. Knee effusion-synovitis volume measurement and effects of vitamin D supplementation in patients with knee osteoarthritis. Osteoarthritis Cartilage 2017; 25:1304-1312. [PMID: 28274889 DOI: 10.1016/j.joca.2017.02.804] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop a measure of knee joint effusion-synovitis volume and to examine the effect of vitamin D supplementation on effusion-synovitis in people with knee osteoarthritis (OA) and low vitamin D levels over 24 months. METHOD Symptomatic knee OA patients with low 25-(OH)D levels (12.5-60 nmol/l) were recruited for a multi-centre, randomised, placebo-controlled and double-blind trial. Participants (age 63 ± 7 years, 208 females) were allocated to either 50,000 IU monthly vitamin D3 (n = 209) or placebo (n = 204) for 24 months. Knee effusion-synovitis volume in suprapatellar and other regions was measured on magnetic resonance imaging (MRI) using OsiriX software. The intra-class correlation coefficients (ICCs) were used to test inter- and intra-rater reliabilities. The least significant change criterion was used to define the increase/decrease in effusion-synovitis volume. RESULT The reproducibilities of effusion-synovitis volume measurement were high with ICCs ranging from 0.93 to 0.99. Over 24 months, effusion-synovitis volume remained stable in the vitamin D group but increased in placebos with a significant between-group difference (-1.94 ml, 95% confidence interval (CI): -3.54, -0.33). This effect was evident in those with baseline effusion-synovitis and with suprapatellar effusion-synovitis. The proportion with an increase in effusion-synovitis volume was lower in the vitamin D group than placebo (risk ratio (RR): 0.87, 95% CI: 0.77, 0.97). CONCLUSION This highly reproducible effusion-synovitis volume measurement could be a promising outcome measure in OA trials. Vitamin D supplementation could retard the progression of effusion-synovitis which can potentially benefit people with an inflammatory OA phenotype.
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Affiliation(s)
- X Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - X Jin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - A E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - W Han
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Translational Research Centre, Academy of Orthopedics, Guangdong Province, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Z Zhu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - L Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - B Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - T Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Translational Research Centre, Academy of Orthopedics, Guangdong Province, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China.
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Abstract
The last two decades witnessed the inception and exponential implementation of key technological advancements in laparoscopic urology. While some of these technologies thrived and became part of daily practice, others are still hindered by major challenges. This review was conducted through a comprehensive literature search in order to highlight some of the most promising technologies in laparoscopic visualization, augmented reality, and insufflation. Additionally, this review will provide an update regarding the current status of single-site and natural orifice surgery in urology.
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Azagury DE, Dua MM, Barrese JC, Henderson JM, Buchs NC, Ris F, Cloyd JM, Martinie JB, Razzaque S, Nicolau S, Soler L, Marescaux J, Visser BC. Image-guided surgery. Curr Probl Surg 2015; 52:476-520. [PMID: 26683419 DOI: 10.1067/j.cpsurg.2015.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/01/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Dan E Azagury
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Monica M Dua
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - James C Barrese
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Jaimie M Henderson
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Nicolas C Buchs
- Department of Surgery, University Hospital of Geneva, Clinic for Visceral and Transplantation Surgery, Geneva, Switzerland
| | - Frederic Ris
- Department of Surgery, University Hospital of Geneva, Clinic for Visceral and Transplantation Surgery, Geneva, Switzerland
| | - Jordan M Cloyd
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - John B Martinie
- Department of Surgery, Carolinas Healthcare System, Charlotte, NC
| | - Sharif Razzaque
- Department of Surgery, Carolinas Healthcare System, Charlotte, NC
| | - Stéphane Nicolau
- IRCAD (Research Institute Against Digestive Cancer), Strasbourg, France
| | - Luc Soler
- IRCAD (Research Institute Against Digestive Cancer), Strasbourg, France
| | - Jacques Marescaux
- IRCAD (Research Institute Against Digestive Cancer), Strasbourg, France
| | - Brendan C Visser
- Department of Surgery, Stanford University School of Medicine, Stanford, CA.
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15
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Lopez A, Zlatev DV, Mach KE, Bui D, Liu JJ, Rouse RV, Harris T, Leppert JT, Liao JC. Intraoperative Optical Biopsy during Robotic Assisted Radical Prostatectomy Using Confocal Endomicroscopy. J Urol 2015; 195:1110-1117. [PMID: 26626214 DOI: 10.1016/j.juro.2015.10.182] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 01/16/2023]
Abstract
PURPOSE Intraoperative optical biopsy technologies may aid in the identification of important anatomical landmarks and improve surgical outcomes of robotic assisted radical prostatectomy. We evaluate the feasibility of confocal laser endomicroscopy during robotic assisted radical prostatectomy. MATERIALS AND METHODS A total of 21 patients with biopsy proven prostate cancer scheduled for robotic assisted radical prostatectomy were recruited. After intravenous administration of fluorescein 15 patients underwent in vivo intraoperative confocal laser endomicroscopy of prostatic and periprostatic structures using a 2.6 or 0.85 mm imaging probe. Standard robotic instruments were used to grasp and maneuver the confocal laser endomicroscopy probes for image acquisition. Confocal laser endomicroscopy imaging was performed ex vivo on fresh prostate specimens from 20 patients. Confocal video sequences acquired in vivo and ex vivo were reviewed and analyzed, with additional image processing using a mosaicing algorithm. Processed confocal images were compared with standard hematoxylin and eosin analysis of imaged regions. RESULTS Confocal laser endomicroscopy was successfully integrated with robotic surgery, including co-registration of confocal video sequences with white light and probe handling with standard robotic instrumentation. Intraoperative confocal laser endomicroscopy imaging of the neurovascular bundle before and after nerve sparing dissection revealed characteristic features including dynamic vascular flow and intact axon fibers. Ex vivo confocal imaging of the prostatic parenchyma demonstrated normal prostate glands, stroma and prostatic carcinoma. CONCLUSIONS We report the initial feasibility of optical biopsy of prostatic and periprostatic tissue during robotic assisted radical prostatectomy. Image guidance and tissue interrogation using confocal laser endomicroscopy offer a new intraoperative imaging method that has the potential to improve the functional and oncologic outcomes of prostate cancer surgery.
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Affiliation(s)
- Aristeo Lopez
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Dimitar V Zlatev
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Kathleen E Mach
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Daniel Bui
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Jen-Jane Liu
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Robert V Rouse
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304.,Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
| | - Theodore Harris
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Joseph C Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
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16
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Ris F, Yeung T, Hompes R, Mortensen NJ. Enhanced Reality and Intraoperative Imaging in Colorectal Surgery. Clin Colon Rectal Surg 2015; 28:158-64. [PMID: 26491408 DOI: 10.1055/s-0035-1555007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Colorectal surgery is one of the most common procedures performed around the world with more than 600,000 operations each year in the United States, and more than a million worldwide. In the past two decades, there has been a clear trend toward minimal access and surgeons have embraced this evolution. Widespread adoption of advanced minimally invasive procedures is often limited by procedural complexity and the need for specific technical skills. Furthermore, the loss of 3D vision, limited overview of the surgical field, and diminished tactile sensation make major colorectal procedures more challenging and have an impact on the surgeons' learning curves. New technologies are emerging that can compensate for some of the sensory losses associated with laparoscopy. High-definition picture acquisition, 3D camera systems, and the use of biomarkers will allow improved identification of the target structures and help differentiate them from surrounding tissues. In this article, we describe some of the new technologies available and, in particular, focus on the possible implications of biomarkers and fluorescent laparoscopic imaging.
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Affiliation(s)
- Frederic Ris
- Service of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Trevor Yeung
- Department of Colorectal Surgery, Oxford University Hospitals, Oxford, United Kingdom
| | - Roel Hompes
- Department of Colorectal Surgery, Oxford University Hospitals, Oxford, United Kingdom
| | - Neil J Mortensen
- Department of Colorectal Surgery, Oxford University Hospitals, Oxford, United Kingdom
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17
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Buchs NC, Hompes R. Stereotactic navigation and augmented reality for transanal total mesorectal excision? Colorectal Dis 2015; 17:825-7. [PMID: 26139308 DOI: 10.1111/codi.13058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 02/08/2023]
Affiliation(s)
- N C Buchs
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK. .,Division of Visceral Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland.
| | - R Hompes
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
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18
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Murakami T, Tajika Y, Ueno H, Awata S, Hirasawa S, Sugimoto M, Kominato Y, Tsushima Y, Endo K, Yorifuji H. An integrated teaching method of gross anatomy and computed tomography radiology. ANATOMICAL SCIENCES EDUCATION 2014; 7:438-449. [PMID: 24443310 DOI: 10.1002/ase.1430] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/04/2013] [Accepted: 11/13/2013] [Indexed: 06/03/2023]
Abstract
It is essential for medical students to learn and comprehend human anatomy in three dimensions (3D). With this in mind, a new system was designed in order to integrate anatomical dissections with diagnostic computed tomography (CT) radiology. Cadavers were scanned by CT scanners, and students then consulted the postmortem CT images during cadaver dissection to gain a better understanding of 3D human anatomy and diagnostic radiology. Students used handheld digital imaging and communications in medicine viewers at the bench-side (OsiriX on iPod touch or iPad), which enabled "pixel-to-tissue" direct comparisons of CT images and cadavers. Students had lectures and workshops on diagnostic radiology, and they completed study assignments where they discussed findings in the anatomy laboratory compared with CT radiology findings. This teaching method for gross and radiological anatomy was used beginning in 2009, and it yielded strongly positive student perspectives and significant improvements in radiology skills in later clinical courses.
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Affiliation(s)
- Tohru Murakami
- Department of Anatomy, Gunma University Graduate School of Medicine, Maebashi, Japan
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Image Guidance for All—TilePro Display of 3-Dimensionally Reconstructed Images in Robotic Partial Nephrectomy. Urology 2014; 84:237-42. [DOI: 10.1016/j.urology.2014.02.051] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/02/2014] [Accepted: 02/08/2014] [Indexed: 11/23/2022]
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20
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Iannessi A, Marcy PY, Clatz O, Fillard P, Ayache N. Touchless intra-operative display for interventional radiologist. Diagn Interv Imaging 2014; 95:333-7. [DOI: 10.1016/j.diii.2013.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Andrade AO, Pereira AA, Walter S, Almeida R, Loureiro R, Compagna D, Kyberd PJ. Bridging the gap between robotic technology and health care. Biomed Signal Process Control 2014. [DOI: 10.1016/j.bspc.2013.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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22
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Teoh AYB, Chiu PWY. Collaboration between laparoscopic surgery and endoscopic resection: an evidence-based review. Dig Endosc 2014; 26 Suppl 1:12-9. [PMID: 24188505 DOI: 10.1111/den.12193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/18/2013] [Indexed: 02/08/2023]
Abstract
Developments in endoscopy and laparoscopy have made monumental changes to the way gastrointestinal diseases are being managed. Many diseases that were traditionally managed by open surgical resection could now be treated by endoscopy alone. However, there are still instances where endoscopic treatment alone is inadequate for disease control and laparoscopic surgery is required. In addition, the collaboration between laparoscopic surgery and endoscopic submucosal dissection or other endoscopic resectional techniques represents a new frontier for further research. The present manuscript aims to discuss the complementary role of laparoscopic surgery to endoscopic resection in the traditional context and also its future development.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- CUHK Jockey Club Minimally Invasive Surgical Skills Center and Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Buchs NC, Oldani G, Orci LA, Majno PE, Mentha G, Morel P, Toso C. Current status of robotic liver resection: a systematic review. Expert Rev Anticancer Ther 2013; 14:237-46. [PMID: 24313681 DOI: 10.1586/14737140.2014.863155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Robotic surgery is an emerging technique for the management of patients with liver disease, and only a limited number of reports are available. A systematic search of electronic databases (PubMed, Embase and Cochrane), including only case series with more than five patients, identified nine series (with one from our institution), which totaled to 232 patients. Overall, the peri-operative outcomes of the reported patients are similar to those utilizing the laparoscopic and open approaches. Robotic surgery appears to be a valid option for selected hepatic resections in experienced hands. It could represent a bridge toward minimally invasive approaches for confirmed liver surgeons. By contrast, the long-term oncological outcomes remain uncertain and need further studies.
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Affiliation(s)
- Nicolas C Buchs
- Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Switzerland
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24
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Hughes-Hallett A, Mayer EK, Marcus HJ, Cundy TP, Pratt PJ, Darzi AW, Vale JA. Augmented reality partial nephrectomy: examining the current status and future perspectives. Urology 2013; 83:266-73. [PMID: 24149104 DOI: 10.1016/j.urology.2013.08.049] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 06/28/2013] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
Abstract
A minimal access approach to partial nephrectomy has historically been under-utilized, but is now becoming more popular with the growth of robot-assisted laparoscopy. One of the criticisms of minimal access partial nephrectomy is the loss of haptic feedback. Augmented reality operating environments are forecast to play a major enabling role in the future of minimal access partial nephrectomy by integrating enhanced visual information to supplement this loss of haptic sensation. In this article, we systematically examine the current status of augmented reality in partial nephrectomy by identifying existing research challenges and exploring future agendas for this technology to achieve wider clinical translation.
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Affiliation(s)
| | - Erik K Mayer
- Department of Surgery and Cancer, Imperial College London, United Kingdom.
| | - Hani J Marcus
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, United Kingdom
| | - Thomas P Cundy
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, United Kingdom
| | - Philip J Pratt
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, United Kingdom
| | - Ara W Darzi
- Department of Surgery and Cancer, Imperial College London, United Kingdom; The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, United Kingdom
| | - Justin A Vale
- Department of Surgery and Cancer, Imperial College London, United Kingdom
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Buchs NC, Pugin F, Volonté F, Morel P. Reliability of robotic system during general surgical procedures in a university hospital. Am J Surg 2013; 207:84-8. [PMID: 24090485 DOI: 10.1016/j.amjsurg.2013.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/10/2013] [Accepted: 06/14/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Data concerning the reliability of robotic systems are scarce, especially for general surgery. The aim of this study was to assess the incidence and consequences of robotic malfunction in a teaching institution. METHODS From January 2006 to September 2012, 526 consecutive robotic general surgical procedures were performed. All failures were prospectively recorded in a computerized database and reviewed retrospectively. RESULTS Robotic malfunctions occurred in 18 cases (3.4%). These dysfunctions concerned the robotic instruments in 9 cases, the robotic arms in 4 cases, the surgical console in 3 cases, and the optical system in 2 cases. Two malfunctions were considered critical, and 1 led to a laparoscopic conversion (conversion rate due to malfunction, .2%). Overall, there were more dysfunctions at the beginning of the study period (2006 to 2010) than more recently (2011 to 2012) (4.2% vs 2.6%, P = .35). CONCLUSIONS The robotic system malfunction rate was low. Most malfunctions could be resolved during surgery, allowing the procedures to be completed safely. With increased experience, the system malfunction rate seems to be reduced.
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Affiliation(s)
- Nicolas C Buchs
- Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Rue Gabriel-Perret-Gentil, 4, 1211 Geneva 14, Switzerland.
| | - François Pugin
- Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Rue Gabriel-Perret-Gentil, 4, 1211 Geneva 14, Switzerland
| | - Francesco Volonté
- Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Rue Gabriel-Perret-Gentil, 4, 1211 Geneva 14, Switzerland
| | - Philippe Morel
- Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Rue Gabriel-Perret-Gentil, 4, 1211 Geneva 14, Switzerland
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26
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Buchs NC, Volonte F, Pugin F, Toso C, Fusaglia M, Gavaghan K, Majno PE, Peterhans M, Weber S, Morel P. Augmented environments for the targeting of hepatic lesions during image-guided robotic liver surgery. J Surg Res 2013; 184:825-31. [PMID: 23684617 DOI: 10.1016/j.jss.2013.04.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/08/2013] [Accepted: 04/17/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Stereotactic navigation technology can enhance guidance during surgery and enable the precise reproduction of planned surgical strategies. Currently, specific systems (such as the CAS-One system) are available for instrument guidance in open liver surgery. This study aims to evaluate the implementation of such a system for the targeting of hepatic tumors during robotic liver surgery. MATERIAL AND METHODS Optical tracking references were attached to one of the robotic instruments and to the robotic endoscopic camera. After instrument and video calibration and patient-to-image registration, a virtual model of the tracked instrument and the available three-dimensional images of the liver were displayed directly within the robotic console, superimposed onto the endoscopic video image. An additional superimposed targeting viewer allowed for the visualization of the target tumor, relative to the tip of the instrument, for an assessment of the distance between the tumor and the tool for the realization of safe resection margins. RESULTS Two cirrhotic patients underwent robotic navigated atypical hepatic resections for hepatocellular carcinoma. The augmented endoscopic view allowed for the definition of an accurate resection margin around the tumor. The overlay of reconstructed three-dimensional models was also used during parenchymal transection for the identification of vascular and biliary structures. Operative times were 240 min in the first case and 300 min in the second. There were no intraoperative complications. CONCLUSIONS The da Vinci Surgical System provided an excellent platform for image-guided liver surgery with a stable optic and instrumentation. Robotic image guidance might improve the surgeon's orientation during the operation and increase accuracy in tumor resection. Further developments of this technological combination are needed to deal with organ deformation during surgery.
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Affiliation(s)
- Nicolas C Buchs
- Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland.
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van den Berg NS, Valdés-Olmos RA, van der Poel HG, van Leeuwen FW. Sentinel Lymph Node Biopsy for Prostate Cancer: A Hybrid Approach. J Nucl Med 2013; 54:493-6. [DOI: 10.2967/jnumed.112.113746] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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