1
|
Lanfranchi G, Costanzo S, Selvaggio GGO, Gallotta C, Milani P, Rizzetto F, Musitelli A, Vertemati M, Santaniello T, Campari A, Paraboschi I, Camporesi A, Marinaro M, Calcaterra V, Pierucci UM, Pelizzo G. Virtual Reality Head-Mounted Display (HMD) and Preoperative Patient-Specific Simulation: Impact on Decision-Making in Pediatric Urology: Preliminary Data. Diagnostics (Basel) 2024; 14:1647. [PMID: 39125523 PMCID: PMC11311633 DOI: 10.3390/diagnostics14151647] [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: 06/21/2024] [Revised: 07/19/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
AIM OF THE STUDY To assess how virtual reality (VR) patient-specific simulations can support decision-making processes and improve care in pediatric urology, ultimately improving patient outcomes. PATIENTS AND METHODS Children diagnosed with urological conditions necessitating complex procedures were retrospectively reviewed and enrolled in the study. Patient-specific VR simulations were developed with medical imaging specialists and VR technology experts. Routine CT images were utilized to create a VR environment using advanced software platforms. The accuracy and fidelity of the VR simulations was validated through a multi-step process. This involved comparing the virtual anatomical models to the original medical imaging data and conducting feedback sessions with pediatric urology experts to assess VR simulations' realism and clinical relevance. RESULTS A total of six pediatric patients were reviewed. The median age of the participants was 5.5 years (IQR: 3.5-8.5 years), with an equal distribution of males and females across both groups. A minimally invasive laparoscopic approach was performed for adrenal lesions (n = 3), Wilms' tumor (n = 1), bilateral nephroblastomatosis (n = 1), and abdominal trauma in complex vascular and renal malformation (ptotic and hypoplastic kidney) (n = 1). Key benefits included enhanced visualization of the segmental arteries and the deep vascularization of the kidney and adrenal glands in all cases. The high depth perception and precision in the orientation of the arteries and veins to the parenchyma changed the intraoperative decision-making process in five patients. Preoperative VR patient-specific simulation did not offer accuracy in studying the pelvic and calyceal anatomy. CONCLUSIONS VR patient-specific simulations represent an empowering tool in pediatric urology. By leveraging the immersive capabilities of VR technology, preoperative planning and intraoperative navigation can greatly impact surgical decision-making. As we continue to advance in medical simulation, VR holds promise in educational programs to include even surgical treatment of more complex urogenital malformations.
Collapse
Affiliation(s)
- Giulia Lanfranchi
- Department of Pediatric Surgery, Children’s Hospital “Vittore Buzzi”, 20154 Milan, Italy; (G.L.); (S.C.); (G.G.O.S.); (A.M.); (M.M.); (U.M.P.)
| | - Sara Costanzo
- Department of Pediatric Surgery, Children’s Hospital “Vittore Buzzi”, 20154 Milan, Italy; (G.L.); (S.C.); (G.G.O.S.); (A.M.); (M.M.); (U.M.P.)
| | - Giorgio Giuseppe Orlando Selvaggio
- Department of Pediatric Surgery, Children’s Hospital “Vittore Buzzi”, 20154 Milan, Italy; (G.L.); (S.C.); (G.G.O.S.); (A.M.); (M.M.); (U.M.P.)
| | - Cristina Gallotta
- Department of Biomedical and Clinical Sciences “L Sacco”, University of Milano, 20157 Milan, Italy; (C.G.); (M.V.); (I.P.)
| | - Paolo Milani
- CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milano, 20133 Milan, Italy; (P.M.); (T.S.)
- Department of Physics “Aldo Pontremoli”, University of Milano, 20133 Milan, Italy
| | - Francesco Rizzetto
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milano, 20122 Milan, Italy
| | - Alessia Musitelli
- Department of Pediatric Surgery, Children’s Hospital “Vittore Buzzi”, 20154 Milan, Italy; (G.L.); (S.C.); (G.G.O.S.); (A.M.); (M.M.); (U.M.P.)
| | - Maurizio Vertemati
- Department of Biomedical and Clinical Sciences “L Sacco”, University of Milano, 20157 Milan, Italy; (C.G.); (M.V.); (I.P.)
- CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milano, 20133 Milan, Italy; (P.M.); (T.S.)
| | - Tommaso Santaniello
- CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milano, 20133 Milan, Italy; (P.M.); (T.S.)
- Department of Physics “Aldo Pontremoli”, University of Milano, 20133 Milan, Italy
| | - Alessandro Campari
- Pediatric Radiology and Neuroradiology Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Irene Paraboschi
- Department of Biomedical and Clinical Sciences “L Sacco”, University of Milano, 20157 Milan, Italy; (C.G.); (M.V.); (I.P.)
| | - Anna Camporesi
- Pediatric Anesthesia and Intensive Care Unit, “Vittore Buzzi“ Children’s Hospital, 20154 Milan, Italy;
| | - Michela Marinaro
- Department of Pediatric Surgery, Children’s Hospital “Vittore Buzzi”, 20154 Milan, Italy; (G.L.); (S.C.); (G.G.O.S.); (A.M.); (M.M.); (U.M.P.)
| | - Valeria Calcaterra
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy;
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Ugo Maria Pierucci
- Department of Pediatric Surgery, Children’s Hospital “Vittore Buzzi”, 20154 Milan, Italy; (G.L.); (S.C.); (G.G.O.S.); (A.M.); (M.M.); (U.M.P.)
| | - Gloria Pelizzo
- Department of Pediatric Surgery, Children’s Hospital “Vittore Buzzi”, 20154 Milan, Italy; (G.L.); (S.C.); (G.G.O.S.); (A.M.); (M.M.); (U.M.P.)
- Department of Biomedical and Clinical Sciences “L Sacco”, University of Milano, 20157 Milan, Italy; (C.G.); (M.V.); (I.P.)
| |
Collapse
|
2
|
Bracale U, Iacone B, Tedesco A, Gargiulo A, Di Nuzzo MM, Sannino D, Tramontano S, Corcione F. The use of mixed reality in the preoperative planning of colorectal surgery: Preliminary experience with a narrative review. Cir Esp 2024; 102 Suppl 1:S36-S44. [PMID: 38307256 DOI: 10.1016/j.cireng.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/14/2024] [Indexed: 02/04/2024]
Abstract
New advanced technologies have recently been developed and preliminarily applied to surgery, including virtual reality (VR), augmented reality (AR) and mixed reality (MR). We retrospectively review all colorectal cases in which we used holographic 3D reconstruction from February 2020 to December 2022. This innovative approach was used to identify vascular anomalies, pinpoint tumor locations, evaluate infiltration into neighboring organs and devise surgical plans for both training and educating trainee assistants. We have also provided a state-of-the-art analysis, briefly highlighting what has been stated by the scientific literature to date. VR facilitates training and anatomical assessments, while AR enhances training and laparoscopic performance evaluations. MR, powered by HoloLens, enriches anatomic recognition, navigation, and visualization. Successful implementation was observed in 10 colorectal cancer cases, showcasing the effectiveness of MR in improving preoperative planning and its intraoperative application. This technology holds significant promise for advancing colorectal surgery by elevating safety and reliability standards.
Collapse
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
| |
Collapse
|
3
|
Vanoli S, Grobet-Jeandin E, Windisch O, Valerio M, Benamran D. Evolution of anxiety management in prostate biopsy under local anesthesia: a narrative review. World J Urol 2024; 42:43. [PMID: 38244150 PMCID: PMC10799769 DOI: 10.1007/s00345-023-04723-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/24/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION AND METHODS Prostate biopsy (PB) is an essential step in the diagnosis and active surveillance of prostate cancer (PCa). Transperineal PB (TP-PB) is now the recommended approach and is mostly conducted under local anesthesia. However, this procedure can potentially cause anxiety for patients, given the oncological context and the fear of peri-procedural pain and complications. The objective of this narrative review is to summarize the currently available tools for the management of peri-interventional anxiety during TP-PB, with a particular emphasis on the potential role of virtual reality (VR) in this setting. RESULTS In TP-PB, preoperative anxiety can lead to increased pain perception, longer procedure time, and decreased patient satisfaction. Pharmacological and non-pharmacological approaches have been explored to reduce anxiety, such as premedication, deep sedation, education, relaxation techniques, hypnosis, and music therapy, albeit with mixed results. VR has recently emerged in the technological armamentarium for managing pain and anxiety, and the efficiency of this technology has been evaluated in various medical fields, including pediatrics, gastroenterology, urology, gynecology, and psychiatry. CONCLUSION Despite the paucity of available data, VR appears to be a safe and effective technique in reducing anxiety in many procedures, even in frail patients. No studies have evaluated the role of VR in TP-PB. Future research should thus explore the optimal way to implement VR technology and any potential benefits for TP-PB patients.
Collapse
Affiliation(s)
- Sylvain Vanoli
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Elisabeth Grobet-Jeandin
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Olivier Windisch
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Massimo Valerio
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Daniel Benamran
- Urology Department, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| |
Collapse
|
4
|
Sultan LR, Haertter A, Al-Hasani M, Demiris G, Cary TW, Tung-Chen Y, Sehgal CM. Can Artificial Intelligence Aid Diagnosis by Teleguided Point-of-Care Ultrasound? A Pilot Study for Evaluating a Novel Computer Algorithm for COVID-19 Diagnosis Using Lung Ultrasound. AI 2023; 4:875-887. [PMID: 37929255 PMCID: PMC10623579 DOI: 10.3390/ai4040044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
With the 2019 coronavirus disease (COVID-19) pandemic, there is an increasing demand for remote monitoring technologies to reduce patient and provider exposure. One field that has an increasing potential is teleguided ultrasound, where telemedicine and point-of-care ultrasound (POCUS) merge to create this new scope. Teleguided POCUS can minimize staff exposure while preserving patient safety and oversight during bedside procedures. In this paper, we propose the use of teleguided POCUS supported by AI technologies for the remote monitoring of COVID-19 patients by non-experienced personnel including self-monitoring by the patients themselves. Our hypothesis is that AI technologies can facilitate the remote monitoring of COVID-19 patients through the utilization of POCUS devices, even when operated by individuals without formal medical training. In pursuit of this goal, we performed a pilot analysis to evaluate the performance of users with different clinical backgrounds using a computer-based system for COVID-19 detection using lung ultrasound. The purpose of the analysis was to emphasize the potential of the proposed AI technology for improving diagnostic performance, especially for users with less experience.
Collapse
Affiliation(s)
- Laith R. Sultan
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Allison Haertter
- Radiation Oncology Department, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Maryam Al-Hasani
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
| | - George Demiris
- Informatics Division of the Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theodore W. Cary
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
| | - Yale Tung-Chen
- Emergency Medicine Department, La Madrida Hospital, 28006 Madrid, Spain
| | - Chandra M. Sehgal
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
| |
Collapse
|
5
|
Haack M, Reisen K, Ghazy A, Stroh K, Frey L, Sparwasser P, Duwe G, Mager R, Haferkamp A, Borgmann H. Understanding tumor localization in multiparametric MRI of the prostate-effectiveness of 3D printed models. Front Surg 2023; 10:1264164. [PMID: 37799119 PMCID: PMC10547869 DOI: 10.3389/fsurg.2023.1264164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Understanding tumor localization in multiparametric MRI (mpMRI) of the prostate is challenging for urologists but of great importance in mpMRI-fused prostate biopsy or radical prostatectomy. The aim was to evaluate the effectiveness of 3D printed models of the prostate to help urologists to locate tumors. Methods and Participants 20 urologists from University Medical Center Mainz (Germany) were asked to plot the location of a cancer suspicious lesion (PI-RADS ≥ 4) on a total of 30 mpMRI on a prostate sector diagram. The following 3 groups (as matched triplets) were divided into: mpMRI only, mpMRI with radiological report and mpMRI with 3D printed model (scaled 1:1). Statistical analysis was performed using one-way and two-way ANOVA (with bonferroni post-test). Results Overall, localization of the suspicious lesion was superior with the radiological report (median of max. 10 [IQR]: MRI 2 [IQR 1;5], MRI + report: 8 [6.3;9], MRI + 3D model 3 [1.3;5.8]; p < 0.001). Residents with <1 year of experience had a significantly higher detection rate using a 3D printed model [5 (5;5.8)] compared to mpMRI alone [1.5 (1;3.5)] (p < 0.05). Regarding the estimation of index lesion extension, the 3D model showed a significant benefit (mean percentage difference [95% CI]: MRI alone 234% [17.1;451.5], MRI + report 114% [78.5;149.6], MRI + 3D model 17% [-7.4;41.3] (p < 0.01). Conclusion Urologists still need the written radiological report for a sufficient understanding of tumor localization. The effectiveness of the 3D printed model regarding tumor localization is particularly evident in young residents (<1 year) and leads to a better overall assessment of the tumor extension.
Collapse
Affiliation(s)
- Maximilian Haack
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Katja Reisen
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Ahmed Ghazy
- Department of Cardiovascular Surgery, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Kristina Stroh
- Department of Diagnostic and Interventional Radiology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Lisa Frey
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Peter Sparwasser
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Gregor Duwe
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Hendrik Borgmann
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
- Department of Urology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| |
Collapse
|
6
|
Sparwasser P, Haack M, Frey L, Boehm K, Boedecker C, Huber T, Stroh K, Brandt MP, Mager R, Höfner T, Tsaur I, Haferkamp A, Borgmann H. Assessment of a novel smartglass-based point-of-care fusion approach for mixed reality-assisted targeted prostate biopsy: A pilot proof-of-concept study. Front Surg 2022; 9:892170. [PMID: 35937598 PMCID: PMC9354482 DOI: 10.3389/fsurg.2022.892170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose While several biopsy techniques and platforms for magnetic resonance imaging (MRI)-guided targeted biopsy of the prostate have been established, none of them has proven definite superiority. Augmented and virtual reality (mixed reality) smartglasses have emerged as an innovative technology to support image-guidance and optimize accuracy during medical interventions. We aimed to investigate the benefits of smartglasses for MRI-guided mixed reality-assisted cognitive targeted biopsy of the prostate. Methods For prospectively collected patients with suspect prostate PIRADS lesions, multiparametric MRI was uploaded to a smartglass (Microsoft® Hololens I), and smartglass-assisted targeted biopsy (SMART TB) of the prostate was executed by generation of a cognitive fusion technology at the point-of-care. Detection rates of prostate cancer (PCA) were compared between SMART TB and 12-core systematic biopsy. Assessment of SMART-TB was executed by the two performing surgeons based on 10 domains on a 10-point scale ranging from bad (1) to excellent (10). Results SMART TB and systematic biopsy of the prostate were performed for 10 patients with a total of 17 suspect PIRADS lesions (PIRADS 3, n = 6; PIRADS 4, n = 6; PIRADS 5, n = 5). PCA detection rate per core was significant (p < 0.05) higher for SMART TB (47%) than for systematic biopsy (19%). Likelihood for PCA according to each core of a PIRADS lesion (17%, PIRADS 3; 58%, PIRADS 4; 67%, PIRADS 5) demonstrated convenient accuracy. Feasibility scores for SMART TB were high for practicality (10), multitasking (10), execution speed (9), comfort (8), improvement of surgery (8) and image quality (8), medium for physical stress (6) and device handling (6) and low for device weight (5) and battery autonomy (4). Conclusion SMART TB has the potential to increase accuracy for PCA detection and might enhance cognitive MRI-guided targeted prostate biopsy in the future.
Collapse
Affiliation(s)
- P. Sparwasser
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
- Correspondence: Peter Sparwasser
| | - M. Haack
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - L. Frey
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - K. Boehm
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - C. Boedecker
- Department of General, Visceral and Transplant Surgery, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - T. Huber
- Department of General, Visceral and Transplant Surgery, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - K. Stroh
- Department of Radiology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - M. P. Brandt
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - R. Mager
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - T. Höfner
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - I. Tsaur
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - A. Haferkamp
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - H. Borgmann
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
- Department of Urology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| |
Collapse
|