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Zheng YA, Lee YC, Huang JY, Hsieh HY, Chen YS, Chiang XH, Han PH, Lin MW, Hsu HH, Hung YP, Chen JS. Enhancing three-dimensional anatomical understanding in complex thoracic surgery: a comparative study of OpVerse and Synapse 3D. Eur J Cardiothorac Surg 2025; 67:ezaf069. [PMID: 40163682 DOI: 10.1093/ejcts/ezaf069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 02/18/2025] [Accepted: 03/28/2025] [Indexed: 04/02/2025] Open
Abstract
OBJECTIVES Virtual reality (VR) technology is increasingly employed in medical settings to provide innovative solutions for complex surgeries. In this study, we introduced and compared OpVerse, a multifunctional new VR platform developed for surgical simulations, with established software Synapse 3D to assess its efficacy in facilitating complex thoracic surgeries. METHODS Patient-specific VR digital twin thoracic models were created based on computed tomography scans of 9 patients with large thoracic neoplasms and 4 requiring tracheobronchial reconstruction. Twelve doctors as system testers were enlisted to evaluate the usability and user acceptance of OpVerse and Synapse 3D using the System Usability Scale (SUS) and the Technology Acceptance Model; they provided qualitative feedback through interviews. RESULTS OpVerse achieved higher scores than Synapse 3D in SUS (73.3 ± 14.6 vs 53.8 ± 11.6, P = 0.0006), as well as perceived usefulness (4.5 ± 0.4 vs 4.1 ± 0.5, P = 0.0134), perceived ease of use (4.2 ± 0.4 vs 3.8 ± 0.6, P = 0.0364) and attitude towards using and behavioural intention to use (4.6 ± 0.4 vs 3.6 ± 0.7, P = 0.0002) in Technology Acceptance Model, compared to Synapse 3D, indicating enhanced efficiency and user engagement with the new system. Participants favoured OpVerse for its immersive qualities, intuitive interface (particularly rotation and enhanced visual transparency effects) and ability to enhance comprehension of complex 3D anatomical structures. CONCLUSIONS OpVerse, our streaming VR simulation platform, enables the manipulation and visualization of patient-specific digital twin thoracic models through features such as rotation, enhanced visual transparency effects and measurement. Preliminary results suggest that OpVerse may offer advantages in terms of immersion, ease of use and understanding of 3D anatomical structures compared to Synapse 3D.
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Affiliation(s)
- Yu-An Zheng
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Lee
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jing-Yuan Huang
- Graduate Institute of Networking and Multimedia, National Taiwan University, Taipei, Taiwan
| | - Hsien-Yuan Hsieh
- Graduate Institute of Networking and Multimedia, National Taiwan University, Taipei, Taiwan
| | - Yang-Sheng Chen
- Graduate Institute of Networking and Multimedia, National Taiwan University, Taipei, Taiwan
| | - Xu-Heng Chiang
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping-Hsuan Han
- Department of Interaction Design, National Taipei University of Technology, Taipei, Taiwan
| | - Mong-Wei Lin
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yi-Ping Hung
- Graduate Institute of Networking and Multimedia, National Taiwan University, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Ganigara M, Osea K, Nguyen AB, Hibino N, Earing MG, Pophal SG. 3D Visualization Technology for Cardiac Transplant Planning in a Patient With Failing Fontan Circulation. JACC Case Rep 2025; 30:103132. [PMID: 40054948 PMCID: PMC11911868 DOI: 10.1016/j.jaccas.2024.103132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 11/11/2024] [Accepted: 11/18/2024] [Indexed: 03/20/2025]
Abstract
Patients with complex single ventricle anatomy and failing Fontan physiology present unique anatomic challenges to heart transplantation. Cardiac computed tomography scans can be analyzed in a virtual reality environment to aid in understanding of the complex anatomy, perform virtual heart transplant, and help create virtual reality-assisted baffles. This paper presents a case that demonstrates the evolving role of advanced imaging and 3-dimensional virtual modeling in planning complex surgeries.
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Affiliation(s)
- Madhusudan Ganigara
- Division of Cardiology, Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA.
| | - Kathleen Osea
- Division of Cardiology, Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
| | - Ann B Nguyen
- Division of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Narutoshi Hibino
- Division of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Michael G Earing
- Division of Cardiology, Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA; Division of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Stephen G Pophal
- Division of Cardiology, Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
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Wu MH, Chen CJ, Lee HF. Effectiveness of Mobile-Based Learning for Nasogastric Tube Intubation Among Medical Students: A Randomized Controlled Trial. Healthcare (Basel) 2025; 13:546. [PMID: 40077108 PMCID: PMC11898943 DOI: 10.3390/healthcare13050546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Revised: 02/22/2025] [Accepted: 02/27/2025] [Indexed: 03/14/2025] Open
Abstract
Background: Nasogastric tube (NGT) intubation is a critical skill, but it comes with the blind nature of the procedure and its high failure rates. Resources restrict access to traditional training methods, such as simulations based on manikins. We developed a mobile-based application, the Mobile-based Hands-on Learning System for Nasogastric Tube Intubation (MoHoNGT), to enhance undergraduate medical students' training in this essential procedure. Methods: This open-label, randomized controlled trial was conducted in a medical center between August and October 2020, with medical students expected to enter their clerkships. The MoHoNGT and control group were exposed to the traditional training course and a self-learning period. The MoHoNGT group received additional access to MoHoNGT. Training effectiveness was evaluated by measuring knowledge, self-confidence, and performance on an objective structured clinical examination (OSCE). Statistical analyses included descriptive statistics, chi-square tests, and t-tests. Results: Seventy-three medical students were recruited. Thirty-two were allocated to the MoHoNGT group. No between-group differences were observed regarding demographic data. Post-intervention results indicated that the MoHoNGT group revealed more pronounced improvements in both NGT intubation knowledge (38.75 vs. 21.46, p < 0.001) and the confidence scale (8.50 vs. 5.17, p = 0.04). Post-study scores for NGT intubation knowledge were also higher in the MoHoNGT group (69.06 vs. 49.02, p < 0.001). Additionally, participants in the MoHoNGT group demonstrated superior performance on the OSCE (98.81 vs. 91.18, p = 0.003). Conclusions: Employing MoHoNGT with traditional training methods significantly enhanced the knowledge, self-confidence, and skills in NGT intubation among undergraduate medical students. This approach addresses various limitations of conventional techniques, suggesting that mobile-based learning could be a potential strategy for medical education.
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Affiliation(s)
- Ming-Hsuan Wu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Chen-Ju Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Huan-Fang Lee
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan 704401, Taiwan
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Mahtab EAF, Max SA, Braun J, Regeer MV, Kaufman B, Dunning J, Bibleraaj B, Andreas M, Rodríguez Lecoq R, Klinceva M, Rosalia R, Lorusso R, Bruining N, Egorova AD. Developing a Systematic Approach for the Implementation of Medical Extended Reality Learning Modules in Cardiothoracic Health Care: Recommendations From an International Expert Group. JACC. ADVANCES 2025; 4:101633. [PMID: 40147055 PMCID: PMC11973246 DOI: 10.1016/j.jacadv.2025.101633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 01/12/2025] [Accepted: 01/19/2025] [Indexed: 03/29/2025]
Abstract
Extended reality (XR) modalities in health care are quickly evolving. There is a lack of systematically described developmental process and the "how to" execute a business-case guidance. This article formulates a systematic approach on the technical developmental steps and generation of business-case to guide the iterative development of an XR tool. An international expert group was established and several available frameworks related to entrepreneurship and business-case development were used to generate recommendations. Our ongoing experience with the development life cycle of an XR tool for cardiopulmonary resuscitation training is provided as a real-life case illustration. Market demand, value proposition, stakeholder analyses, and profitability scenarios are captured with a business model canvas. Developmental process is divided into 4 aspects: Desirability, Feasibility, Viability, and Scalability. Technical- and Investment Readiness Level models are used in defining the technical feasibility and the business viability and scalability, respectively. Best practice recommendations including examples are provided. Health care professionals, health care financers, and health care policymakers are urged to consider the provided systematic approach and recommendations prior to starting a venture with XR.
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Affiliation(s)
- Edris A F Mahtab
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, the Netherlands; Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - Samuel A Max
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, the Netherlands; Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Madelien V Regeer
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Brian Kaufman
- Departments of Medicine, Anesthesiology & Neurosurgery, New York University Langone Health, New York, New York, USA
| | - Joel Dunning
- Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Bhuvaneswari Bibleraaj
- Directorate of Nursing, Midwifery and Social Work Research, University of Salford, Salford, United Kingdom; Department of Cardiothoracic Surgery, Manchester Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | | | | | | | - Rodney Rosalia
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; Healthcare Consulting, Skopje, Republic of North Macedonia
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Nico Bruining
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anastasia D Egorova
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands; Centre for Congenital Heart Disease Amsterdam Leiden (CAHAL), Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
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Nakada T, Koyachi M, Sugahara K, Nishiyama A, Kawakami M, Nakajima S, Tachizawa K, Odaka K, Matsunaga S, Sugimoto M, Katakura A. A Case of Application of Computer-Aided Design and Manufacturing Technology and Extended Reality Surgical Assistance to Marginal Mandibulectomy. J Clin Med 2024; 14:8. [PMID: 39797090 PMCID: PMC11721740 DOI: 10.3390/jcm14010008] [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: 11/18/2024] [Revised: 12/19/2024] [Accepted: 12/22/2024] [Indexed: 01/13/2025] Open
Abstract
Background/Objectives: Mandibular gingival squamous cell carcinoma (SCC) is the second most common oral cancer after tongue cancer. As these carcinomas often invade the mandible early, accurately defining the resection extent is important. This report highlights the use of preoperative virtual surgery data, computer-aided design and manufacturing (CAD/CAM) technology, surgical guidance, and extended reality (XR) support in achieving highly accurate marginal mandibulectomy without recurrence or metastasis. Methods: CT imaging data obtained a month before surgery were imported into Materialize Mimics and Materialize Magics (Materialize, Leuven, Belgium, Ver22.0) CAD/CAM software and used to design an osteotomy guide. An STL file was generated, and the guide was fabricated using a 3D printer (Objet 260 Connex; Stratasys Ltd., Eden Prairie, MN, USA) prior to the operation. An XR application, installed on a HoloLens (Microsoft, WA, USA) head-mounted display, projected a hologram onto the surgical field. Results: The rapid intraoperative diagnostic tests were negative, and histopathology confirmed SCC without vascular or perineural invasion. No complications, including occlusal or feeding problems and sensory abnormalities, were observed. Postoperative imaging 3 years later showed no recurrence. Conclusions: Combining CAD/CAM and XR techniques for mandibulectomy may improve surgical accuracy and safety in oral and maxillofacial surgeries, whereas in-house 3D printing aids in managing tumor progression.
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Affiliation(s)
- Takahiro Nakada
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan; (T.N.); (M.K.); (A.N.); (M.K.); (S.N.); (K.T.); (M.S.); (A.K.)
| | - Masahide Koyachi
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan; (T.N.); (M.K.); (A.N.); (M.K.); (S.N.); (K.T.); (M.S.); (A.K.)
| | - Keisuke Sugahara
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan; (T.N.); (M.K.); (A.N.); (M.K.); (S.N.); (K.T.); (M.S.); (A.K.)
| | - Akihiro Nishiyama
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan; (T.N.); (M.K.); (A.N.); (M.K.); (S.N.); (K.T.); (M.S.); (A.K.)
| | - Mana Kawakami
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan; (T.N.); (M.K.); (A.N.); (M.K.); (S.N.); (K.T.); (M.S.); (A.K.)
| | - Shintaro Nakajima
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan; (T.N.); (M.K.); (A.N.); (M.K.); (S.N.); (K.T.); (M.S.); (A.K.)
| | - Kotaro Tachizawa
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan; (T.N.); (M.K.); (A.N.); (M.K.); (S.N.); (K.T.); (M.S.); (A.K.)
| | - Kento Odaka
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan;
| | - Satoru Matsunaga
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan;
| | - Maki Sugimoto
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan; (T.N.); (M.K.); (A.N.); (M.K.); (S.N.); (K.T.); (M.S.); (A.K.)
- Innovation Lab, Teikyo University Okinaga Research Institute, 2-16-1 Hirakawacho, Chiyoda-ku, Tokyo 102-0093, Japan
| | - Akira Katakura
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan; (T.N.); (M.K.); (A.N.); (M.K.); (S.N.); (K.T.); (M.S.); (A.K.)
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Kolcz J, Rudek-Budzynska A, Grandys K. Unifocalization of Major Aortopulmonary Collateral Arteries (MAPCAs) and Native Pulmonary Arteries in Infancy-Application of 3D Printing and Virtual Reality. J Cardiovasc Dev Dis 2024; 11:403. [PMID: 39728293 DOI: 10.3390/jcdd11120403] [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: 11/08/2024] [Revised: 11/30/2024] [Accepted: 12/10/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND Major aortopulmonary collateral arteries (MAPCAs) are rare remnants of pulmonary circulation embryological development usually associated with complex congenital anomalies of the right ventricular outflow tract and pulmonary arteries. Effective management requires surgical unifocalization of MAPCAs and native pulmonary arteries (NPAs). Traditional imaging may lack the spatial clarity needed for precise surgical planning. AIM This study evaluated the feasibility of integrating three-dimensional (3D) printing and virtual reality (VR) into preoperative planning to improve surgical precision, team communication, and parental understanding. In a prospective cohort study, nine infants undergoing MAPCA unifocalization were included. Four patients underwent conventional imaging-based planning (control), while five were additionally assessed using VR and 3D-printed models (intervention). The outcomes measured included operative times, team confidence, collaboration, and parental satisfaction. Statistical analysis was performed using standard tests. RESULTS The intervention group had shorter operative and cardiopulmonary bypass times compared to the control group. Intraoperative complications were absent in the VR/3D group but occurred in the control group. Medical staff in the VR/3D group reported significantly improved understanding of anatomy, surgical preparedness, and team collaboration (p < 0.05). Parents also expressed higher satisfaction, with better comprehension of their child's anatomy and surgical plan. CONCLUSIONS VR and 3D printing enhanced preoperative planning, surgical precision, and communication, proving valuable for complex congenital heart surgery. These technologies offer promising potential to improve clinical outcomes and patient-family experiences, meriting further investigation in larger studies.
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Affiliation(s)
- Jacek Kolcz
- Jagiellonian University, Collegium Medicum, Department of Pediatric Cardiac Surgery, 31-007 Krakow, Poland
| | - Anna Rudek-Budzynska
- Jagiellonian University, Collegium Medicum, Department of Pediatric Cardiac Surgery, 31-007 Krakow, Poland
| | - Krzysztof Grandys
- Department of Anesthesiology, University Children's Hospital, 30-663 Krakow, Poland
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Doornbos MCJ, Peek JJ, Maat APWM, Ruurda JP, De Backer P, Cornelissen BMW, Mahtab EAF, Sadeghi AH, Kluin J. Augmented Reality Implementation in Minimally Invasive Surgery for Future Application in Pulmonary Surgery: A Systematic Review. Surg Innov 2024; 31:646-658. [PMID: 39370802 PMCID: PMC11475712 DOI: 10.1177/15533506241290412] [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] [Indexed: 10/08/2024]
Abstract
OBJECTIVE This systematic review investigates of Augmented Reality (AR) systems used in minimally invasive surgery of deformable organs, focusing on initial registration, dynamic tracking, and visualization. The objective is to acquire a comprehensive understanding of the current knowledge, applications, and challenges associated with current AR-techniques, aiming to leverage these insights for developing a dedicated AR pulmonary Video or Robotic Assisted Thoracic Surgery (VATS/RATS) workflow. METHODS A systematic search was conducted within Embase, Medline (Ovid) and Web of Science on April 16, 2024, following the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA). The search focused on intraoperative AR applications and intraoperative navigational purposes for deformable organs. Quality assessment was performed and studies were categorized according to initial registration and dynamic tracking methods. RESULTS 33 articles were included, of which one involved pulmonary surgery. Studies used both manual and (semi-) automatic registration methods, established through anatomical landmark-based, fiducial-based, or surface-based techniques. Diverse outcome measures were considered, including surgical outcomes and registration accuracy. The majority of studies that reached an registration accuracy below 5 mm applied surface-based registration. CONCLUSIONS AR can potentially aid surgeons with real-time navigation and decision making during anatomically complex minimally invasive procedures. Future research for pulmonary applications should focus on exploring surface-based registration methods, considering their non-invasive, marker-less nature, and promising accuracy. Additionally, vascular-labeling-based methods are worth exploring, given the importance and relative stability of broncho-vascular anatomy in pulmonary VATS/RATS. Assessing clinical feasibility of these approaches is crucial, particularly concerning registration accuracy and potential impact on surgical outcomes.
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Affiliation(s)
- Marie-Claire J. Doornbos
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
- Educational Program Technical Medicine, Leiden University Medical Center, Delft University of Technology & Erasmus University Medical Center Rotterdam, Leiden, The Netherlands
| | - Jette J. Peek
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | | | - Jelle P. Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Edris A. F. Mahtab
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Amir H. Sadeghi
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, The Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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Gao L, Zhang H, Xu Y, Dong Y, Sheng L, Fan Y, Qin C, Gu W. Mixed reality-assisted versus landmark-guided spinal puncture in elderly patients: protocol for a stratified randomized controlled trial. Trials 2024; 25:780. [PMID: 39558217 PMCID: PMC11575154 DOI: 10.1186/s13063-024-08628-2] [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: 08/12/2024] [Accepted: 11/11/2024] [Indexed: 11/20/2024] Open
Abstract
BACKGROUND Performing spinal anesthesia in elderly patients with spine degeneration is challenging for novice practitioners. This stratified randomized controlled trial aims to compare the effectiveness of mixed reality-assisted spinal puncture (MRasp) with that of landmark-guided spinal puncture (LGsp) performed by novice practitioners in elderly patients. METHODS This prospective, single-center, stratified, blocked, parallel randomized controlled trial will include 168 patients (aged ≥ 65 years) scheduled for elective surgery involving spinal anesthesia. All spinal punctures will be performed by anesthesiology interns and residents trained at Huadong Hospital. Patients will be randomly assigned to the MRasp group (n = 84) or the LGsp group (n = 84). Based on each intern/resident's experience in spinal puncture, participants will be stratified into three clusters: the primary group, intermediate group, and advanced group. The primary outcome will be the comparison of the rate of successful first-attempt needle insertion between the MRasp group and the LGsp group. Secondary outcomes will include the number of needle insertion attempts, the number of redirection attempts, the number of passes, the rate of successful first needle pass, the spinal puncture time, the total procedure time, and the incidence of perioperative complications. A stratified subgroup analysis will also be conducted for interns/residents at different experience levels. DISCUSSION The findings from this trial establish the effectiveness of MRasp by novice practitioners in elderly patients. This trial may provide experimental evidence for exploring an effective visualization technology to assist in spinal puncture. TRIAL REGISTRATION Chinese Clinical Trials Registry ChiCTR2300075291. Registered on August 31, 2023. https://www.chictr.org.cn/bin/project/edit?pid=189622 .
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Affiliation(s)
- Lei Gao
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Haichao Zhang
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Yidi Xu
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Yanjun Dong
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Lu Sheng
- Department of Urology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Yongqian Fan
- Department of Orthopedics, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Chunhui Qin
- Department of Pain Management, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
| | - Weidong Gu
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China.
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Edalati S, Slobin J, Harsinay A, Vasan V, Taha MA, Del Signore A, Govindaraj S, Iloreta AM. Augmented and Virtual Reality Applications in Rhinology: A Scoping Review. Laryngoscope 2024; 134:4433-4440. [PMID: 38924127 DOI: 10.1002/lary.31602] [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: 04/01/2024] [Revised: 05/22/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES Virtual reality (VR) and augmented reality (AR) are innovative technologies that have a wide range of potential applications in the health care industry. The aim of this study was to investigate the body of research on AR and VR applications in rhinology by performing a scoping review. DATA SOURCES PubMed, Scopus, and Embase. REVIEW METHODS According to PRISM-ScR guidelines, a scoping review of literature on the application of AR and/or VR in the context of Rhinology was conducted using PubMed, Scopus, and Embase. RESULTS Forty-nine articles from 1996 to 2023 met the criteria for review. Five broad types of AR and/or VR applications were found: preoperative, intraoperative, training/education, feasibility, and technical. The subsequent clinical domains were recognized: craniovertebral surgery, nasal endoscopy, transsphenoidal surgery, skull base surgery, endoscopic sinus surgery, and sinonasal malignancies. CONCLUSION AR and VR have comprehensive applications in Rhinology. AR for surgical navigation may have the most emerging potential in skull base surgery and endoscopic sinus surgery. VR can be utilized as an engaging training tool for surgeons and residents and as a distraction analgesia for patients undergoing office-based procedures. Additional research is essential to further understand the tangible effects of these technologies on measurable clinical results. Laryngoscope, 134:4433-4440, 2024.
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Affiliation(s)
- Shaun Edalati
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacqueline Slobin
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ariel Harsinay
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vikram Vasan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohamed A Taha
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anthony Del Signore
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alfred Marc Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Keramati H, Lu X, Cabanag M, Wu L, Kushwaha V, Beier S. Applications and advances of immersive technology in cardiology. Curr Probl Cardiol 2024; 49:102762. [PMID: 39067719 DOI: 10.1016/j.cpcardiol.2024.102762] [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: 07/23/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
Different forms of immersive technology, such as Virtual Reality (VR) and Augmented Reality (AR), are getting increasingly invested in medicine. Advances in head-mounted display technology, processing, and rendering power have demonstrated the increasing utility of immersive technology in medicine and the healthcare environment. There are a growing number of publications on using immersive technology in cardiology. We reviewed the articles published within the last decade that reported case studies or research that uses or investigates the application of immersive technology in the broad field of cardiology - from education to preoperative planning and intraoperative guidance. We summarized the advantages and disadvantages of using AR and VR for various application categories. Our review highlights the need for a robust assessment of the effectiveness of the methods and discusses the technical limitations that hinder the complete integration of AR and VR in cardiology, including cost-effectiveness and regulatory compliance. Despite the limitations and gaps that have inhibited us from benefiting from immersive technologies' full potential in cardiology settings to date, its promising, impactful future for standard cardiovascular care is undoubted.
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Affiliation(s)
- Hamed Keramati
- School of Mechanical and Manufacturing Engineering, Faculty of Engineering, The University of New South Wales, Sydney 2052, NSW, Australia.
| | - Xueqing Lu
- Learning and Digital Environments, Deputy Vice-Chancellor Education and Student Experience, The University of New South Wales, Sydney 2052, NSW, Australia
| | - Matt Cabanag
- School of Art and Design, Faculty of Arts, Design and Architecture, The University of New South Wales, Sydney 2052, NSW, Australia
| | - Liao Wu
- School of Mechanical and Manufacturing Engineering, Faculty of Engineering, The University of New South Wales, Sydney 2052, NSW, Australia
| | - Virag Kushwaha
- Eastern Heart Clinic, Prince of Wales Hospital, Barker Street Randwick, NSW 2031, Australia; Faculty of Medicine, The University of New South Wales, Kensington, Sydney 2033, NSW, Australia
| | - Susann Beier
- School of Mechanical and Manufacturing Engineering, Faculty of Engineering, The University of New South Wales, Sydney 2052, NSW, Australia
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11
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Chen S, Huang J, Zhang L, Xu Y, Zhang Z. Simulation-based training in robotic surgery education: bibliometric analysis and visualization. J Robot Surg 2024; 18:324. [PMID: 39153017 DOI: 10.1007/s11701-024-02076-5] [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: 07/28/2024] [Accepted: 08/05/2024] [Indexed: 08/19/2024]
Abstract
Simulation-based robotic surgery training may help surgeons gain operative skills and experience in the simulation environment. This bibliometric analysis examined the development of simulation-based training for robotic surgical education. Articles pertaining to robotic surgical simulation training that were included in the Web of Science Core Collection up to April 25, 2024, were included. The temporal patterns in published paper numbers were evaluated using Microsoft Excel software, and the data regarding co-authorship and keyword co-occurrence were analyzed and visualized using the VOSviewer and SCImago Graphica tools. A total of 594 papers on simulation-based training for robotic surgical education were evaluated in this study. The United States and United Kingdom were the leading contributors in this field. The most published authors were Professor Ahmed Kamran (23 publications) and Prokar Dasgupta (22 publications). The highest number of papers was published in the journal titled "Surgical Endoscopy and Other Interventional Techniques." The most common keywords were "virtual reality," "curriculum," "robotic surgery simulator," "assessment," and "learning curve." Our study offers a detailed overview of international research on simulation-based training for robotic surgical education, including the publishing countries, institutions, authors, journals, and research hotspots. It also methodically summarizes the state of knowledge in the area, and provides definite directions and concepts for further in-depth analysis.
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Affiliation(s)
- Siwei Chen
- Operating Room, The First Affiliated Hospital, Guangzhou Medical University, No 151, Yanjiangxi Rd, Guangdong, 510120, People's Republic of China
| | - Jingjuan Huang
- Operating Room, The First Affiliated Hospital, Guangzhou Medical University, No 151, Yanjiangxi Rd, Guangdong, 510120, People's Republic of China
| | - Lin Zhang
- Operating Room, The First Affiliated Hospital, Guangzhou Medical University, No 151, Yanjiangxi Rd, Guangdong, 510120, People's Republic of China
| | - Yanwen Xu
- Operating Room, The First Affiliated Hospital, Guangzhou Medical University, No 151, Yanjiangxi Rd, Guangdong, 510120, People's Republic of China
| | - Zeyong Zhang
- Operating Room, The First Affiliated Hospital, Guangzhou Medical University, No 151, Yanjiangxi Rd, Guangdong, 510120, People's Republic of China.
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Sun W, Jiang X, Dong X, Yu G, Feng Z, Shuai L. The evolution of simulation-based medical education research: From traditional to virtual simulations. Heliyon 2024; 10:e35627. [PMID: 39170203 PMCID: PMC11337719 DOI: 10.1016/j.heliyon.2024.e35627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/04/2024] [Accepted: 07/31/2024] [Indexed: 08/23/2024] Open
Abstract
Background Simulation-based medical education (SBME) is a widely used method in medical education. This study aims to analyze publications on SBME in terms of countries, institutions, journals, authors, and keyword co-occurrence, as well as to identify trends in SBME research. Methods We retrieved the Publications on SBME from the Web of Science Core Collection (WoSCC) database from its inception to January 27, 2024. Microsoft Excel 2019, CiteSpace, and VOSviewer were used to identify the distribution of countries, journals, and authors, as well as to determine the research hotspots. Results We retrieved a total of 11272 publications from WoSCC. The number of documents published in 2022 was the highest in the last few decades. The USA, the UK, and Canada were three key contributors to this field. The University of Toronto, Stanford University, and Harvard Medical School were the top major institutions with a larger number of publications. Konge, Lars was the most productive author, while McGaghie, William C was the highest cited author. BMC Medical Education has the highest number of publications among journals. The foundational themes of SBME are "Patient simulation," "extending reality," and "surgical skills." Conclusions SBME has attracted considerable attention in medical education. The research hotspot is gradually shifting from traditional simulations with real people or mannequins to virtual, digitally-based simulations and online education. Further studies will be conducted to elucidate the mechanisms of SBME. The utilization of SBME will be more rationalized.
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Affiliation(s)
- Weiming Sun
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, China
- Postdoctoral Innovation Practice Base, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, China
- The First Clinical Medical College, Jiangxi Medical College, Nanchang University, Nanchang 330031, China
| | - Xing Jiang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, China
- The First Clinical Medical College, Jiangxi Medical College, Nanchang University, Nanchang 330031, China
| | - Xiangli Dong
- Department of Psychosomatic Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Guohua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, China
- The First Clinical Medical College, Jiangxi Medical College, Nanchang University, Nanchang 330031, China
| | - Zhen Feng
- Postdoctoral Innovation Practice Base, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, China
- The First Clinical Medical College, Jiangxi Medical College, Nanchang University, Nanchang 330031, China
| | - Lang Shuai
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, China
- The First Clinical Medical College, Jiangxi Medical College, Nanchang University, Nanchang 330031, China
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13
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Doncic N, Zech CJ, Wild D, Bachmann H, Mallaev M, Tsvetkov N, Hojski A, Takes MTL, Lardinois D. CT-guided percutaneous marking of small pulmonary nodules with [ 99mTc]Tc-Macrosalb is very accurate and allows minimally invasive lung-sparing resection: a single-centre quality control. Eur J Nucl Med Mol Imaging 2024; 51:2980-2987. [PMID: 37650931 PMCID: PMC11300552 DOI: 10.1007/s00259-023-06410-1] [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: 05/17/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE The detection of small lung nodules in thoracoscopic procedure is difficult when the lesions are not located within the outer border of the lung. In the case of ground-glass opacities, it is often impossible to palpate the lesion. Marking lung nodules using a radiotracer is a known technique. We analysed the accuracy and safety of the technique and the potential benefits of operating in a hybrid operating room. METHODS 57 patients, including 33 (58%) females with a median age of 67 years (range 21-82) were included. In 27 patients, we marked and resected the lesion in a hybrid room. In 30 patients, the lesion was marked at the department of radiology the day before resection. [99mTc]Tc-Macrosalb (Pulmocis®) was used at an activity of 1 MBq in the hybrid room and at an activity of 3 MBq the day before to get technical feasible results. Radioactivity was detected using the Neoprobe® detection system. RESULTS Precise detection and resection of the nodules was possible in 95% of the lesions and in 93% of the patients. Complete thoracoscopic resection was possible in 90% of the patients. Total conversion rate was 10%, but conversion due to failure of the marking of the nodule was observed in only 5% of the patients. Histology revealed 28 (37%) primary lung cancers, 24 (32%) metastases and 21 (28%) benign lesions. In 13 (23%) patients, minor complications were observed. None of them required additional interventions. CONCLUSION The radio-guided detection of small pulmonary nodules is very accurate and safe after CT-guided injection of [99mTc]Tc-Macrosalb. Performing the operation in a hybrid room has several logistic advantages and allows using lower technetium-99m activities. The technique allows minimally invasive lung sparing resection and prevents overtreatment of benign and metastatic lesions.
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Affiliation(s)
- Nikola Doncic
- Department of Thoracic Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Christoph J Zech
- Department of Radiology and Nuclear Medicine, Division of Interventional Radiology, University Hospital Basel, Basel, Switzerland
| | - Damian Wild
- Department of Radiology and Nuclear Medicine, Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Helga Bachmann
- Department of Thoracic Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Makhmudbek Mallaev
- Department of Thoracic Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Nikolay Tsvetkov
- Department of Thoracic Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Aljaz Hojski
- Department of Thoracic Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Martin T L Takes
- Department of Radiology and Nuclear Medicine, Division of Interventional Radiology, University Hospital Basel, Basel, Switzerland
| | - Didier Lardinois
- Department of Thoracic Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
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14
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el Mathari S, Broersen A, Dijkstra J, Sadeghi AH, Grisèl B, de Lind van Wijngaarden RAF, Klautz RJM, Kluin J. First use of a new extended reality tool for preoperative planning in coronary artery bypass surgery: a case-report. J Surg Case Rep 2024; 2024:rjae383. [PMID: 38832054 PMCID: PMC11146210 DOI: 10.1093/jscr/rjae383] [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: 03/22/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024] Open
Abstract
A 73-year-old male presented with angina symptoms and was diagnosed with three-vessel coronary artery disease by use of computed tomography angiography and coronary angiography. This diagnosis necessitated coronary artery bypass grafting (CABG) surgery. A custom made AI-driven algorithm was used to generate a patient-specific three-dimensional coronary artery model from computed tomography angiography imaging data. This framework enabled precise segmentation and reconstruction of the coronary vasculature, yielding an accurate anatomical and pathological representation. Subsequently, this generated model was integrated into a novel extended reality tool for preoperative planning and intraoperative guidance in CABG surgery. Both preoperatively and intraoperatively, the tool augmented spatial orientation and facilitated precise stenosis localization, thereby enhancing the surgeon's operative proficiency. This case report underscores the utility of advanced extended reality tools in cardiovascular surgery, emphasizing their pivotal role in refining surgical planning and execution.
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Affiliation(s)
- Sulayman el Mathari
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Alexander Broersen
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jouke Dijkstra
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Amir H Sadeghi
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | | | | | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
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15
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Li Y, Gunasekeran DV, RaviChandran N, Tan TF, Ong JCL, Thirunavukarasu AJ, Polascik BW, Habash R, Khaderi K, Ting DSW. The next generation of healthcare ecosystem in the metaverse. Biomed J 2024; 47:100679. [PMID: 38048990 PMCID: PMC11245972 DOI: 10.1016/j.bj.2023.100679] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/04/2023] [Accepted: 11/19/2023] [Indexed: 12/06/2023] Open
Abstract
The Metaverse has gained wide attention for being the application interface for the next generation of Internet. The potential of the Metaverse is growing, as Web 3·0 development and adoption continues to advance medicine and healthcare. We define the next generation of interoperable healthcare ecosystem in the Metaverse. We examine the existing literature regarding the Metaverse, explain the technology framework to deliver an immersive experience, along with a technical comparison of legacy and novel Metaverse platforms that are publicly released and in active use. The potential applications of different features of the Metaverse, including avatar-based meetings, immersive simulations, and social interactions are examined with different roles from patients to healthcare providers and healthcare organizations. Present challenges in the development of the Metaverse healthcare ecosystem are discussed, along with potential solutions including capabilities requiring technological innovation, use cases requiring regulatory supervision, and sound governance. This proposed concept and framework of the Metaverse could potentially redefine the traditional healthcare system and enhance digital transformation in healthcare. Similar to AI technology at the beginning of this decade, real-world development and implementation of these capabilities are relatively nascent. Further pragmatic research is needed for the development of an interoperable healthcare ecosystem in the Metaverse.
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Affiliation(s)
- Yong Li
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore; The Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Dinesh Visva Gunasekeran
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore; The Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Ting Fang Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | | | | | - Bryce W Polascik
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Ranya Habash
- Bascom Palmer Eye Institute, University of Miami, Florida, USA
| | - Khizer Khaderi
- Department of Ophthalmology, Stanford University, California, USA
| | - Daniel S W Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore; The Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore; Department of Ophthalmology, Stanford University, California, USA.
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16
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Pozza A, Zanella L, Castaldi B, Di Salvo G. How Will Artificial Intelligence Shape the Future of Decision-Making in Congenital Heart Disease? J Clin Med 2024; 13:2996. [PMID: 38792537 PMCID: PMC11122569 DOI: 10.3390/jcm13102996] [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: 04/09/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Improvements in medical technology have significantly changed the management of congenital heart disease (CHD), offering novel tools to predict outcomes and personalize follow-up care. By using sophisticated imaging modalities, computational models and machine learning algorithms, clinicians can experiment with unprecedented insights into the complex anatomy and physiology of CHD. These tools enable early identification of high-risk patients, thus allowing timely, tailored interventions and improved outcomes. Additionally, the integration of genetic testing offers valuable prognostic information, helping in risk stratification and treatment optimisation. The birth of telemedicine platforms and remote monitoring devices facilitates customised follow-up care, enhancing patient engagement and reducing healthcare disparities. Taking into consideration challenges and ethical issues, clinicians can make the most of the full potential of artificial intelligence (AI) to further refine prognostic models, personalize care and improve long-term outcomes for patients with CHD. This narrative review aims to provide a comprehensive illustration of how AI has been implemented as a new technological method for enhancing the management of CHD.
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Affiliation(s)
- Alice Pozza
- Paediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy; (A.P.)
| | - Luca Zanella
- Heart Surgery, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Cardiac Surgery Unit, Department of Cardiac-Thoracic-Vascular Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Biagio Castaldi
- Paediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy; (A.P.)
| | - Giovanni Di Salvo
- Paediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy; (A.P.)
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17
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Li W, Ma S, Zhou L, Konge L, Pan J, Hui J. The bibliometric analysis of extended reality in surgical training: Global and Chinese perspective. Heliyon 2024; 10:e27340. [PMID: 38495188 PMCID: PMC10943385 DOI: 10.1016/j.heliyon.2024.e27340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 02/12/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
Objectives The prospect of extended reality (XR) being integrated with surgical training curriculum has attracted scholars. However, there is a lack of bibliometric analysis to help them better understand this field. Our aim is to analyze relevant literature focusing on development trajectory and research directions since the 21st century to provide valuable insights. Methods Papers were retrieved from the Web of Science Core Collection. Microsoft Excel, VOSviewer, and CiteSpace were used for bibliometric analysis. Results Of the 3337 papers published worldwide, China contributed 204, ranking fifth. The world's enthusiasm for this field has been growing since 2000, whereas China has been gradually entering since 2001. Although China had a late start, its growth has accelerated since around 2016 due to the reform of the medical postgraduate education system and the rapid development of Chinese information technology, despite no research explosive period has been yet noted. International institutions, notably the University of Toronto, worked closely with others, while Chinese institutions lacked of international and domestic cooperation. Sixteen stable cooperation clusters of international scholars were formed, while the collaboration between Chinese scholars was not yet stable. XR has been primarily applied in orthopedic surgery, cataract surgery, laparoscopic training and intraoperative use in neurosurgery worldwide. Conclusions There is strong enthusiasm and cooperation in the international research on the XR-based surgical training. Chinese scholars are making steady progress and have great potential in this area. There has not been noted an explosive research phase yet in the Chinese pace. The research on several surgical specialties has been summarized at the very first time. AR will gradually to be more involved and take important role of the research.
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Affiliation(s)
- Wei Li
- Medical Simulation Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siyuan Ma
- Medical Simulation Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Zhou
- School of Postgraduate Education, Southern Medical University, Guangzhou, China
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES) Rigshospitalet, Copenhagen, Denmark
| | - Junjun Pan
- State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
- PENG CHENG Laboratory, Shenzhen, China
| | - Jialiang Hui
- Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou City, China
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18
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Nanchahal S, Arjomandi Rad A, Naruka V, Chacko J, Liu G, Afoke J, Miller G, Malawana J, Punjabi P. Mitral valve surgery assisted by virtual and augmented reality: Cardiac surgery at the front of innovation. Perfusion 2024; 39:244-255. [PMID: 36314484 DOI: 10.1177/02676591221137480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND Given the variety in mitral valve (MV) pathology and associated surgical techniques, extended reality (XR) holds great potential to assist MV surgeons. This review aims to systematically evaluate the currently available evidence investigating the use of XR and associated technologies in MV surgery. METHODS A systematic database search was conducted of original articles and case reports that explored the use of XR and MV surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to February 2022. RESULTS Our search yielded 171 articles, of which 15 studies were included in this review, featuring 328 patients. Two main areas of application were identified: (i) pre-operative planning and (ii) predicting post-operative outcomes. The articles reporting outcomes relating to pre-operative planning were further categorised as exploring themes relevant to (i) mitral annular assessment; (ii) training; (iii) evaluation of surgical technique; (iv) surgical approach or plan and (v) selecting ring size or type. Preoperatively, XR has been shown to evaluate mitral annular pathology more accurately than echocardiography, informing the surgeon about the optimal surgical technique, approach and plan for a particular patient's MV pathology. Furthermore, XR could simulate and aid ring size/type selection for MV annuloplasty, creating a personalized surgical plan. Additionally, XR could estimate the postoperative MV biomechanical and physiological characteristics, predicting and pre-empting post-operative complications. CONCLUSION XR demonstrated promising applications for assisting MV surgery, enhancing outcomes and patient-centred care, nevertheless, there remain the need for randomized studies to ascertain its feasibility, safety, and validity in clinical practice.
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Affiliation(s)
- Sukanya Nanchahal
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Vinci Naruka
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Jacob Chacko
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Guiqing Liu
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Jonathan Afoke
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - George Miller
- Research Unit, The Healthcare Leadership Academy, London, UK
| | - Johann Malawana
- Research Unit, The Healthcare Leadership Academy, London, UK
| | - Prakash Punjabi
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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el Mathari S, Hoekman A, Kharbanda RK, Sadeghi AH, de Lind van Wijngaarden R, Götte M, Klautz RJ, Kluin J. Virtual Reality for Pain and Anxiety Management in Cardiac Surgery and Interventional Cardiology. JACC. ADVANCES 2024; 3:100814. [PMID: 38939386 PMCID: PMC11198628 DOI: 10.1016/j.jacadv.2023.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/27/2023] [Accepted: 11/27/2023] [Indexed: 06/29/2024]
Abstract
Pain and anxiety are common in patients undergoing cardiac surgery and percutaneous cardiac interventions. Virtual reality (VR) is an emerging non-pharmacological tool for pain and anxiety management. However, its application around cardiac procedures remains relatively unexplored. In this review, we perform a targeted non-systematic literature review to assess the current state-of-the-art of VR for pain and anxiety management in patients undergoing cardiac procedures. Contexts of interest were preprocedural, periprocedural, and postprocedural applications. Existing trials show inconsistent results. The majority of studies in the preprocedural (7 studies, n = 302), periprocedural (1 study, n = 99), and postprocedural stage (4 studies, n = 214) demonstrate significant reduction of pain and anxiety through VR distraction therapy or VR patient education. However, larger-scale trials (2 preprocedural studies [n = 233], 1 periprocedural study [n = 32], 2 postprocedural studies [n = 300]) report no effect. Current literature on effectiveness of VR for pain and anxiety management in cardiac surgery and interventional cardiology remains inconclusive.
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Affiliation(s)
- Sulayman el Mathari
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anne Hoekman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Rohit K. Kharbanda
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Amir H. Sadeghi
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Marco Götte
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Robert J.M. Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Su JM, Huang WL, Huang HC, Tseng YL, Li MJ. A scenario-based web app to facilitate patient education in lung tumor patients undergoing video-assisted thoracoscopic surgery: Development and usability testing. Digit Health 2024; 10:20552076241239244. [PMID: 38495861 PMCID: PMC10944589 DOI: 10.1177/20552076241239244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
Background Patient education (PE) is essential for improving patients' knowledge, anxiety, and satisfaction, and supporting their postoperative recovery. However, the advantages of video-assisted thoracoscopic surgery (VATS)-smaller incisions and faster recovery-can result in shorter hospital stays, making PE more challenging to implement effectively. Multimedia PE can potentially enhance PE, but its effectiveness for patients undergoing VATS is unclear. Objective This study developed a scenario-based PE web app for lung tumor patients undergoing VATS (SPE-VATS) to facilitate the PE process and evaluated its usability through a clinical trial. Methods The SPE-VATS provided the experimental group (EG: 32 participants) with interactive scenario, query guidance, diagnostic analysis, experience sharing, and active reminder, while the control group (CG: 32 participants) used pamphlets and videos. The usability of SPE-VATS in terms of postoperative anxiety reduction and patient satisfaction with the app was evaluated using self-reported questionnaires based on the state-trait anxiety inventory, technology acceptance model, system usability scale, and task load index. Results There was no statistically significant difference in postoperative anxiety reduction between the EG and CG, possibly because 90% of the participants underwent a low-risk surgical type, and VATS is known to be advantageous in alleviating surgical anxiety. However, females and higher educated EG participants showed a non-significant but favorable reduction than their CG counterparts. Moreover, the EG was highly satisfied with the app (rated 4.2 to 4.4 out of 5.0), with no significant gender and education level difference. They particularly valued the interactive scenario, experience sharing, and diagnostic analysis features of SPE-VATS. Conclusions The SPE-VATS demonstrated its usability and high patient satisfaction, particularly for female and higher educated patients. Low-risk patient predominance and VATS's advantages may explain non-significant postoperative anxiety reduction, warranting further studies on high-risk patients to evaluate the impact of SPE-VATS on clinical practice.
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Affiliation(s)
- Jun-Ming Su
- Department of Information and Learning Technology, National University of Tainan, Tainan, Taiwan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Chen Huang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Jhen Li
- Institute of Learning Sciences, National Tsing Hua University, Hsinchu, Taiwan
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21
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Tsai TY, Kageyama S, He X, Pompilio G, Andreini D, Pontone G, La Meir M, De Mey J, Tanaka K, Doenst T, Puskas J, Teichgräber U, Schneider U, Gupta H, Leipsic J, Garg S, C. Revaiah P, Stanuch M, Skalski A, Onuma Y, Serruys PW. Feasibility and accuracy of real-time 3D-holographic graft length measurements. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:101-104. [PMID: 38264694 PMCID: PMC10802817 DOI: 10.1093/ehjdh/ztad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/08/2023] [Accepted: 10/30/2023] [Indexed: 01/25/2024]
Abstract
Aims Mixed reality (MR) holograms can display high-definition images while preserving the user's situational awareness. New MR software can measure 3D objects with gestures and voice commands; however, these measurements have not been validated. We aimed to assess the feasibility and accuracy of using 3D holograms for measuring the length of coronary artery bypass grafts. Methods and results An independent core lab analyzed follow-up computer tomography coronary angiograms performed 30 days after coronary artery bypass grafting in 30 consecutive cases enrolled in the FASTTRACK CABG trial. Two analysts, blinded to clinical information, performed holographic reconstruction and measurements using the CarnaLife Holo software (Medapp, Krakow, Poland). Inter-observer agreement was assessed in the first 20 cases. Another analyst performed the validation measurements using the CardIQ W8 CT system (GE Healthcare, Milwaukee, Wisconsin). Seventy grafts (30 left internal mammary artery grafts, 31 saphenous vein grafts, and 9 right internal mammary artery grafts) were measured. Holographic measurements were feasible in 97.1% of grafts and took 3 minutes 36 s ± 50.74 s per case. There was an excellent inter-observer agreement [interclass correlation coefficient (ICC) 0.99 (0.97-0.99)]. There was no significant difference between the total graft length on hologram and CT [187.5 mm (157.7-211.4) vs. 183.1 mm (156.8-206.1), P = 0.50], respectively. Hologram and CT measurements are highly correlated (r = 0.97, P < 0.001) with an excellent agreement [ICC 0.98 (0.97-0.99)]. Conclusion Real-time holographic measurements are feasible, quick, and accurate even for tortuous bypass grafts. This new methodology can empower clinicians to visualize and measure 3D images by themselves and may provide insights for procedural strategy.
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Affiliation(s)
- Tsung-Ying Tsai
- Cardiovascular center, Taichung Veterans General Hospital, Taichung, Taiwan
- Corrib Research Centre for Advanced Imaging and Core Laboratory, University of Galway, University Road, H91 TK33, Galway, Ireland
| | - Shigetaka Kageyama
- Corrib Research Centre for Advanced Imaging and Core Laboratory, University of Galway, University Road, H91 TK33, Galway, Ireland
| | - XingQiang He
- Corrib Research Centre for Advanced Imaging and Core Laboratory, University of Galway, University Road, H91 TK33, Galway, Ireland
| | - Giulio Pompilio
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
| | - Daniele Andreini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant’Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
| | - Gianluca Pontone
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mark La Meir
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Belgium
| | - Kaoru Tanaka
- Department of Radiology, University Hospital Brussels, Brussels, Belgium
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, NewYork, USA
| | - Ulf Teichgräber
- Department of Radiology, University Hospital Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
| | - Himanshu Gupta
- Department of Cardiology and Radiology, The Valley Hospital, Ridgewood, NJ, USA
| | - Jonathon Leipsic
- Centre for Cardiovascular Innovation, St.Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Pruthvi C. Revaiah
- Corrib Research Centre for Advanced Imaging and Core Laboratory, University of Galway, University Road, H91 TK33, Galway, Ireland
| | - Maciej Stanuch
- MedApp S.A., Kraków, Poland
- Department of Measurements and Electronics, AGH University of Krakow, Kraków, Poland
| | - Andrzej Skalski
- MedApp S.A., Kraków, Poland
- Department of Measurements and Electronics, AGH University of Krakow, Kraków, Poland
| | - Yoshinobu Onuma
- Corrib Research Centre for Advanced Imaging and Core Laboratory, University of Galway, University Road, H91 TK33, Galway, Ireland
| | - Patrick W Serruys
- Corrib Research Centre for Advanced Imaging and Core Laboratory, University of Galway, University Road, H91 TK33, Galway, Ireland
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22
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Shi X, Guo H, Zhu C, Qiu G, Liang T, Lian J, Ma Y, Wang S, Li X. Mixed reality in primary retroperitoneal tumour surgery: Evaluation of preoperative and intraoperative application value. Int J Med Robot 2023:e2584. [PMID: 37792998 DOI: 10.1002/rcs.2584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/06/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To evaluate the feasibility and application value of mixed reality technology (MR) in Primary retroperitoneal tumour (PRT) surgery. METHODS From 276 patients who underwent PRT resection at the First Affiliated Hospital of Xi'an Jiaotong University, we screened 46 patients who underwent MR-assisted retroperitoneal tumour resection and 46 patients who underwent tumour resection without MR assistance. The intraoperative and postoperative recovery of the patients in both groups were compared, and the reliability and validity of the application of MR were further examined using the Likert scale. RESULTS There was a significant difference in the mean intraoperative bleeding volume between the two groups, but it was reduced in the MR group. The results of the Likert scale showed higher scores in the MR group than non-MR group. CONCLUSIONS MR can be used to assist PRT resection and has great potential to improve the rate of complete retroperitoneal tumour resection.
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Affiliation(s)
- Xiaoqiang Shi
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hainan Guo
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chao Zhu
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of General Surgery, The People's Hospital of Suide County, Suide, Shaanxi, China
| | - Guanglin Qiu
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ting Liang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Biomedical Engineering, the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jie Lian
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yanfei Ma
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Second Department of General Surgery, The Suide Campus, The First Hospital of Yulin, Yulin, Shaanxi, China
| | - Shufeng Wang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xuqi Li
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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23
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Tsai TY, Onuma Y, Złahoda-Huzior A, Kageyama S, Dudek D, Wang Q, Lim RP, Garg S, Poon EKW, Puskas J, Ramponi F, Jung C, Sharif F, Khokhar AA, Serruys PW. Merging virtual and physical experiences: extended realities in cardiovascular medicine. Eur Heart J 2023; 44:3311-3322. [PMID: 37350487 PMCID: PMC10499546 DOI: 10.1093/eurheartj/ehad352] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/27/2023] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
Technological advancement and the COVID-19 pandemic have brought virtual learning and working into our daily lives. Extended realities (XR), an umbrella term for all the immersive technologies that merge virtual and physical experiences, will undoubtedly be an indispensable part of future clinical practice. The intuitive and three-dimensional nature of XR has great potential to benefit healthcare providers and empower patients and physicians. In the past decade, the implementation of XR into cardiovascular medicine has flourished such that it is now integrated into medical training, patient education, pre-procedural planning, intra-procedural visualization, and post-procedural care. This review article discussed how XR could provide innovative care and complement traditional practice, as well as addressing its limitations and considering its future perspectives.
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Affiliation(s)
- Tsung-Ying Tsai
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Xitun District, Taichung 40705, Taiwan
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Adriana Złahoda-Huzior
- Department of Measurement and Electronics, AGH University of Science and Technology, al. A. Mickiewicza 30, 30-059 Kraków, Poland
| | - Shigetaka Kageyama
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Dariusz Dudek
- Interventional Cardiology Unit, Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola RA, Italy
- Center of Digital Medicine and Robotics, Jagiellonian University Medical College, Świętej Anny 12, 31-008 Kraków, Poland
| | - Qingdi Wang
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Ruth P Lim
- Department of Radiology and Surgery (Austin), Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, 161 Barry St, Carlton VIC 3010, Australia
- Department of Radiology, Austin Health, 145 Studley Rd, Heidelberg VIC 3084, Australia
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn BB1 2RB, UK
| | - Eric K W Poon
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, 419 W 114th St, New York, NY 10025, United States
| | - Fabio Ramponi
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, 419 W 114th St, New York, NY 10025, United States
| | - Christian Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Faisal Sharif
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Arif A Khokhar
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Rd, London W12 0HS, UK
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
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24
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Meershoek AJA, Loonen TGJ, Maal TJJ, Hekma EJ, Hugen N. Three Dimensional Printing as a Tool For Anatomical Training in Lung Surgery. MEDICAL SCIENCE EDUCATOR 2023; 33:873-878. [PMID: 37546186 PMCID: PMC10403471 DOI: 10.1007/s40670-023-01807-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 08/08/2023]
Abstract
Objective Pulmonary anatomy is challenging, due to the high variability and its three-dimensional (3D) shape. While demands in thoracic oncologic surgery are increasing, the transition from open to thoracoscopic surgery is hampering anatomical understanding. This study analyzed the value of a 3D printed lung model in understanding and teaching anatomy. Methods A 3D pulmonary model was created and tested among different levels of proficiency: 10 experienced surgeons, 10 fellow surgeons and 10 junior residents. They were tested in interpretation of anatomy based on thoracic CT-scans, either using the 3D model or a 2D anatomical atlas. Accuracy of the given answers, time to complete the task and the self-reported level of certainty were scored in each group. Results In the experienced surgeons group there was no difference in between the 2D-model or 3D-model with a high rate of correct answers in both groups, and no differences in time or certainty. Fellow surgeons highly benefitted from the 3D-model with an improved accuracy from 26.6% to 70.0% (p = 0.001). Time to complete the task was shorter (207 versus 122 s, p < 0.0001) and participants were more secure (median of 4 versus 3, p = 0.007). For junior residents time to complete the task was shorter, the level of certainty was higher, but there was no improvement in accuracy. Conclusions 3D printing may benefit in understanding anatomical relations in the complex anatomy of the bronchiopulmonary tree, especially for surgeons in training and could benefit in teaching anatomy. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-023-01807-x.
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Affiliation(s)
| | - Tom G. J. Loonen
- 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas J. J. Maal
- 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edo J. Hekma
- Department of Surgery, Rijnstate, Arnhem, the Netherlands
| | - Niek Hugen
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
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25
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Worlikar H, Coleman S, Kelly J, O'Connor S, Murray A, McVeigh T, Doran J, McCabe I, O'Keeffe D. Mixed Reality Platforms in Telehealth Delivery: Scoping Review. JMIR BIOMEDICAL ENGINEERING 2023; 8:e42709. [PMID: 38875694 PMCID: PMC11041465 DOI: 10.2196/42709] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/03/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The distinctive features of the digital reality platforms, namely augmented reality (AR), virtual reality (VR), and mixed reality (MR) have extended to medical education, training, simulation, and patient care. Furthermore, this digital reality technology seamlessly merges with information and communication technology creating an enriched telehealth ecosystem. This review provides a composite overview of the prospects of telehealth delivered using the MR platform in clinical settings. OBJECTIVE This review identifies various clinical applications of high-fidelity digital display technology, namely AR, VR, and MR, delivered using telehealth capabilities. Next, the review focuses on the technical characteristics, hardware, and software technologies used in the composition of AR, VR, and MR in telehealth. METHODS We conducted a scoping review using the methodological framework and reporting design using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Full-length articles in English were obtained from the Embase, PubMed, and Web of Science databases. The search protocol was based on the following keywords and Medical Subject Headings to obtain relevant results: "augmented reality," "virtual reality," "mixed-reality," "telemedicine," "telehealth," and "digital health." A predefined inclusion-exclusion criterion was developed in filtering the obtained results and the final selection of the articles, followed by data extraction and construction of the review. RESULTS We identified 4407 articles, of which 320 were eligible for full-text screening. A total of 134 full-text articles were included in the review. Telerehabilitation, telementoring, teleconsultation, telemonitoring, telepsychiatry, telesurgery, and telediagnosis were the segments of the telehealth division that explored the use of AR, VR, and MR platforms. Telerehabilitation using VR was the most commonly recurring segment in the included studies. AR and MR has been mainly used for telementoring and teleconsultation. The most important technical features of digital reality technology to emerge with telehealth were virtual environment, exergaming, 3D avatars, telepresence, anchoring annotations, and first-person viewpoint. Different arrangements of technology-3D modeling and viewing tools, communication and streaming platforms, file transfer and sharing platforms, sensors, high-fidelity displays, and controllers-formed the basis of most systems. CONCLUSIONS This review constitutes a recent overview of the evolving digital AR and VR in various clinical applications using the telehealth setup. This combination of telehealth with AR, VR, and MR allows for remote facilitation of clinical expertise and further development of home-based treatment. This review explores the rapidly growing suite of technologies available to users within the digital health sector and examines the opportunities and challenges they present.
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Affiliation(s)
- Hemendra Worlikar
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Sean Coleman
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
- Department of Medicine, University Hospital Galway, Galway, Ireland
| | - Jack Kelly
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
- Department of Medicine, University Hospital Galway, Galway, Ireland
| | - Sadhbh O'Connor
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
- Department of Medicine, University Hospital Galway, Galway, Ireland
| | - Aoife Murray
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Terri McVeigh
- Cancer Genetics Unit, The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Jennifer Doran
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Ian McCabe
- Health Innovation Via Engineering Laboratory, Cúram Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Derek O'Keeffe
- Department of Medicine, University Hospital Galway, Galway, Ireland
- School of Medicine, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
- Lero, Science Foundation Ireland Centre for Software Research, University of Limerick, Limerick, Ireland
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26
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Lan L, Mao RQ, Qiu RY, Kay J, de Sa D. Immersive Virtual Reality for Patient-Specific Preoperative Planning: A Systematic Review. Surg Innov 2023; 30:109-122. [PMID: 36448920 PMCID: PMC9925905 DOI: 10.1177/15533506221143235] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background. Immersive virtual reality (iVR) facilitates surgical decision-making by enabling surgeons to interact with complex anatomic structures in realistic 3-dimensional environments. With emerging interest in its applications, its effects on patients and providers should be clarified. This systematic review examines the current literature on iVR for patient-specific preoperative planning. Materials and Methods. A literature search was performed on five databases for publications from January 1, 2000 through March 21, 2021. Primary studies on the use of iVR simulators by surgeons at any level of training for patient-specific preoperative planning were eligible. Two reviewers independently screened titles, abstracts, and full texts, extracted data, and assessed quality using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results were qualitatively synthesized, and descriptive statistics were calculated. Results. The systematic search yielded 2,555 studies in total, with 24 full-texts subsequently included for qualitative synthesis, representing 264 medical personnel and 460 patients. Neurosurgery was the most frequently represented discipline (10/24; 42%). Preoperative iVR did not significantly improve patient-specific outcomes of operative time, blood loss, complications, and length of stay, but may decrease fluoroscopy time. In contrast, iVR improved surgeon-specific outcomes of surgical strategy, anatomy visualization, and confidence. Validity, reliability, and feasibility of patient-specific iVR models were assessed. The mean QATSDD score of included studies was 32.9%. Conclusions. Immersive VR improves surgeon experiences of preoperative planning, with minimal evidence for impact on short-term patient outcomes. Future work should focus on high-quality studies investigating long-term patient outcomes, and utility of preoperative iVR for trainees.
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Affiliation(s)
- Lucy Lan
- Michael G. DeGroote School of
Medicine, McMaster University, Hamilton, ON, Canada,Lucy Lan, Michael G. DeGroote School of
Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8N 3Z5,
Canada.
| | - Randi Q. Mao
- Michael G. DeGroote School of
Medicine, McMaster University, Hamilton, ON, Canada
| | - Reva Y. Qiu
- Michael G. DeGroote School of
Medicine, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, ON, Canada
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27
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Govender S, Cronjé JY, Keough N, Oberholster AJ, van Schoor AN, de Jager EJ, Naicker J. Emerging Imaging Techniques in Anatomy: For Teaching, Research and Clinical Practice. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1392:19-42. [DOI: 10.1007/978-3-031-13021-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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28
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Bakhuis W, Kersten CM, Sadeghi AH, Mank QJ, Wijnen RMH, Ciet P, Bogers AJJC, Schnater JM, Mahtab EAF. Preoperative visualization of congenital lung abnormalities: hybridizing artificial intelligence and virtual reality. Eur J Cardiothorac Surg 2022; 63:ezad014. [PMID: 36645240 PMCID: PMC10481780 DOI: 10.1093/ejcts/ezad014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/16/2022] [Accepted: 01/15/2023] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES When surgical resection is indicated for a congenital lung abnormality (CLA), lobectomy is often preferred over segmentectomy, mostly because the latter is associated with more residual disease. Presumably, this occurs in children because sublobar surgery often does not adhere to anatomical borders (wedge resection instead of segmentectomy), thus increasing the risk of residual disease. This study investigated the feasibility of identifying eligible cases for anatomical segmentectomy by combining virtual reality (VR) and artificial intelligence (AI). METHODS Semi-automated segmentation of bronchovascular structures and lesions were visualized with VR and AI technology. Two specialists independently evaluated via a questionnaire the informative value of regular computed tomography versus three-dimensional (3D) VR images. RESULTS Five asymptomatic, non-operated cases were selected. Bronchovascular segmentation, volume calculation and image visualization in the VR environment were successful in all cases. Based on the computed tomography images, assignment of the CLA lesion to specific lung segments matched between the consulted specialists in only 1 out of the cases. Based on the three 3D VR images, however, the localization matched in 3 of the 5 cases. If the patients would have been operated, adding the 3D VR tool to the preoperative workup would have resulted in changing the surgical strategy (i.e. lobectomy versus segmentectomy) in 4 cases. CONCLUSIONS This study demonstrated the technical feasibility of a hybridized AI-VR visualization of segment-level lung anatomy in patients with CLA. Further exploration of the value of 3D VR in identifying eligible cases for anatomical segmentectomy is therefore warranted.
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Affiliation(s)
- Wouter Bakhuis
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
| | - Casper M Kersten
- Department of Pediatric Surgery, Erasmus MC—Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Amir H Sadeghi
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
| | - Quinten J Mank
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
- Technical Medicine, Delft University of Technology, Delft, Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery, Erasmus MC—Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Pierluigi Ciet
- Department of Radiology and Nuclear Medicine, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
| | - J Marco Schnater
- Department of Pediatric Surgery, Erasmus MC—Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Edris A F Mahtab
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
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Yoo SJ, Hussein N, Barron DJ. Congenital Heart Surgery Skill Training Using Simulation Models: Not an Option but a Necessity. J Korean Med Sci 2022; 37:e293. [PMID: 36193641 PMCID: PMC9530313 DOI: 10.3346/jkms.2022.37.e293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/20/2022] Open
Abstract
Congenital heart surgery (CHS) is technically demanding, and its training is extremely complex and challenging. Training of the surgeon's technical skills has relied on a preceptorship format in which the trainees are gradually exposed to patients in the operating room under the close tutelage of senior staff surgeons. Training in the operating room is an inefficient process and the concept of a learning curve is no longer acceptable in terms of patient outcomes. The benefits of surgical simulation in training of congenital heart surgeons are well known and appreciated. However, adequate surgical simulation models and equipment for training have been scarce until the recent development of three-dimensionally (3D) printed models. Using comprehensive 3D printing and silicone-molding techniques, realistic simulation training models for most congenital heart surgical procedures have been produced. Newly developed silicone-molded models allow efficient CHS training in a stress-free environment with instantaneous feedback from the proctors and avoids risk to patients. The time has arrived when all congenital heart surgeons should consider surgical simulation training before progressing to real-life operating in a similar fashion to the aviation industry where all pilots are required to complete simulation training before flying a real aircraft. It is argued here that simulation training is not an option anymore but should be a mandatory component of CHS training.
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Affiliation(s)
- Shi-Joon Yoo
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada
- Division of Cardiology, Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Nabil Hussein
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, England, UK
| | - David J Barron
- Division of Cardiovascular Surgery, Department of Surgery, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Tadlock MD, Olson EJ, Gasques D, Champagne R, Krzyzaniak MJ, Belverud SA, Ravindra V, Kerns J, Choi PM, Deveraux J, Johnson J, Sharkey T, Yip M, Weibel N, Davis K. Mixed reality surgical mentoring of combat casualty care related procedures in a perfused cadaver model: Initial results of a randomized feasibility study. Surgery 2022; 172:1337-1345. [PMID: 36038376 DOI: 10.1016/j.surg.2022.06.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Most telemedicine modalities have limited ability to enhance procedural and operative care. We developed a novel system to provide synchronous bidirectional expert mixed reality-enabled virtual procedural mentoring. In this feasibility study, we evaluated mixed reality mentoring of combat casualty care related procedures in a re-perfused cadaver model. METHODS Novices received real-time holographic mentoring from experts using augmented reality via Hololens (Microsoft Inc, Redmond, WA). The experts maintained real-time awareness of the novice's operative environment using virtual reality via HTC-Vive (HTC Corp, Xindian District, Taiwan). Additional cameras (both environments) and novel software created the immersive, shared, 3-dimensional mixed reality environment in which the novice and expert collaborated. The novices were prospectively randomized to either mixed reality or audio-only mentoring. Blinded experts independently evaluated novice procedural videos using a 5-point Likert scale-based questionnaire. Nonparametric variables were evaluated using the Wilcoxon rank-sum test and comparisons using the χ2 analysis; significance was defined at P < .05. RESULTS Surgeon and nonsurgeon novices (14) performed 69 combat casualty care-related procedures (38 mixed reality, 31 audio), including various vascular exposures, 4-compartment lower leg fasciotomy, and emergency neurosurgical procedures; 85% were performed correctly with no difference in either group. Upon video review, mixed reality-mentored novices showed no difference in procedural flow and forward planning (3.67 vs 3.28, P = .21) or the likelihood of performing individual procedural steps correctly (4.12 vs 3.59, P = .06). CONCLUSION In this initial feasibility study, our novel mixed reality-based mentoring system successfully facilitated the performance of a wide variety of combat casualty care relevant procedures using a high fidelity re-perfused cadaver model. The small sample size and limited variety of novice types likely impacted the ability of holographically mentored novices to demonstrate improvement over the audio-only control group. Despite this, using virtual, augmented, and mixed reality technologies for procedural mentoring demonstrated promise, and further study is needed.
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Affiliation(s)
- Matthew D Tadlock
- 1st Medical Battalion, 1st Marine Logistics Group, Camp Pendleton, CA; Department of Surgery, Navy Medicine Readiness and Training Command (NMRTC), San Diego, CA; Bioskills Training Center, NMRTC, San Diego, CA.
| | - Erik J Olson
- Department of Surgery, Navy Medicine Readiness and Training Command (NMRTC), San Diego, CA
| | - Danilo Gasques
- Department of Computer Science and Engineering, University of California San Diego, CA
| | | | - Michael J Krzyzaniak
- Department of Surgery, Navy Medicine Readiness and Training Command (NMRTC), San Diego, CA
| | | | | | - Jakob Kerns
- Virtual Medical Center, NMRTC, San Diego, CA
| | - Pamela M Choi
- Department of Surgery, Navy Medicine Readiness and Training Command (NMRTC), San Diego, CA
| | | | - Janet Johnson
- Department of Computer Science and Engineering, University of California San Diego, CA
| | - Thomas Sharkey
- Department of Computer Science and Engineering, University of California San Diego, CA
| | - Michael Yip
- Department of Electrical and Computer Engineering, University of California San Diego, CA
| | - Nadir Weibel
- Department of Computer Science and Engineering, University of California San Diego, CA
| | - Konrad Davis
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Medical Group, Scripps Health System, San Diego, CA
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van Schaagen F, van Steenis YP, Sadeghi AH, Bogers AJ, Taverne YJ. Immersive 3D Virtual Reality-Based Clip Sizing for Thoracoscopic Left Atrial Appendage Closure. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:304-309. [PMID: 35912487 PMCID: PMC9403374 DOI: 10.1177/15569845221114344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: Surgical left atrial appendage (LAA) closure using epicardial clips has become popular in stroke prevention in patients with atrial fibrillation. Optimal placement of the clip is essential to achieve complete LAA occlusion and to prevent complications due to compression of the circumflex artery. We determine the added value of immersive virtual reality (VR) in accurately assessing LAA base size and selection of an appropriately sized clip. Methods: We studied the feasibility of measuring the LAA base using VR and conventional computed tomography (CT). A retrospective analysis was performed of LAA base measurements in 15 patients who had undergone thoracoscopic LAA clipping. Subsequently, we compared the placed clip size with imaging-acquired LAA base size to retrospectively evaluate intraprocedural sizing. Results: We successfully applied a VR platform to measure LAA base size. The median LAA base size measured in CT (23.8 mm, interquartile range [IQR] 22.3 to 26.4 mm) and intracardial virtual reality (23.4 mm, IQR 21.6 to 25.5 mm) did not differ significantly (P = 0.416). VR measurements of the LAA base in surgeon's view (25.7 mm, IQR 24.2 to 29.2) were significantly higher than those of 2-dimensional CT (P = 0.037) and intracardial 3-dimensional (3D) VR (P < 0.05) measurements. All measurements differed significantly with placed clip sizes (P < 0.05). There were no clip malpositioning-related events. Conclusions: Immersive VR is a feasible method for obtaining anatomical information on LAA base size. In this retrospective analysis, CT and VR-based measurements of LAA base size differed significantly from intraoperatively placed LAA clips, indicating potential oversizing when measured intraoperatively. Using intuitive 3D VR-based imaging might be a useful method to assist in accurate preprocedural sizing of LAA base and can potentially prevent oversizing.
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Affiliation(s)
- Frank van Schaagen
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yvar P. van Steenis
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Amir H. Sadeghi
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ad J.J.C. Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yannick J.H.J. Taverne
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
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Ivanov VM, Krivtsov AM, Strelkov SV, Smirnov AY, Shipov RY, Grebenkov VG, Rumyantsev VN, Gheleznyak IS, Surov DA, Korzhuk MS, Koskin VS. Practical Application of Augmented/Mixed Reality Technologies in Surgery of Abdominal Cancer Patients. J Imaging 2022; 8:jimaging8070183. [PMID: 35877627 PMCID: PMC9319177 DOI: 10.3390/jimaging8070183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023] Open
Abstract
The technology of augmented and mixed reality (AR/MR) is useful in various areas of modern surgery. We considered the use of augmented and mixed reality technologies as a method of preoperative planning and intraoperative navigation in abdominal cancer patients. Practical use of AM/MR raises a range questions, which demand suitable solutions. The difficulties and obstacles we encountered in the practical use of AR/MR are presented, along with the ways we chose to overcome them. The most demonstrative case is covered in detail. The three-dimensional anatomical model obtained from the CT scan needed to be rigidly attached to the patient’s body, and therefore an invasive approach was developed, using an orthopedic pin fixed to the pelvic bones. The pin is used both similarly to an X-ray contrast marker and as a marker for augmented reality. This solution made it possible, not only to visualize the anatomical structures of the patient and the border zone of the tumor, but also to change the position of the patient during the operation. In addition, a noninvasive (skin-based) marking method was developed that allows the application of mixed and augmented reality during operation. Both techniques were used (8 clinical cases) for preoperative planning and intraoperative navigation, which allowed surgeons to verify the radicality of the operation, to have visual control of all anatomical structures near the zone of interest, and to reduce the time of surgical intervention, thereby reducing the complication rate and improving the rehabilitation period.
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Affiliation(s)
- Vladimir M. Ivanov
- Higher School of Theoretical Mechanics and Mathematical Physics, Peter the Great Saint Petersburg Polytechnic University, 195251 St. Petersburg, Russia or (A.M.K.); (S.V.S.); (A.Y.S.); (R.Y.S.)
- Correspondence:
| | - Anton M. Krivtsov
- Higher School of Theoretical Mechanics and Mathematical Physics, Peter the Great Saint Petersburg Polytechnic University, 195251 St. Petersburg, Russia or (A.M.K.); (S.V.S.); (A.Y.S.); (R.Y.S.)
| | - Sergey V. Strelkov
- Higher School of Theoretical Mechanics and Mathematical Physics, Peter the Great Saint Petersburg Polytechnic University, 195251 St. Petersburg, Russia or (A.M.K.); (S.V.S.); (A.Y.S.); (R.Y.S.)
| | - Anton Yu. Smirnov
- Higher School of Theoretical Mechanics and Mathematical Physics, Peter the Great Saint Petersburg Polytechnic University, 195251 St. Petersburg, Russia or (A.M.K.); (S.V.S.); (A.Y.S.); (R.Y.S.)
| | - Roman Yu. Shipov
- Higher School of Theoretical Mechanics and Mathematical Physics, Peter the Great Saint Petersburg Polytechnic University, 195251 St. Petersburg, Russia or (A.M.K.); (S.V.S.); (A.Y.S.); (R.Y.S.)
| | - Vladimir G. Grebenkov
- Department & Clinic of Naval Surgery, Military Medical Academy Named after S. M. Kirov, Academic Lebedev Street 6, 194044 St. Petersburg, Russia; (V.G.G.); (V.N.R.); (D.A.S.); (M.S.K.)
| | - Valery N. Rumyantsev
- Department & Clinic of Naval Surgery, Military Medical Academy Named after S. M. Kirov, Academic Lebedev Street 6, 194044 St. Petersburg, Russia; (V.G.G.); (V.N.R.); (D.A.S.); (M.S.K.)
| | - Igor S. Gheleznyak
- Department & Clinic of Roentgenology & Radiology, Military Medical Academy Named after S. M. Kirov, Academic Lebedev Street 6, 194044 St. Petersburg, Russia;
| | - Dmitry A. Surov
- Department & Clinic of Naval Surgery, Military Medical Academy Named after S. M. Kirov, Academic Lebedev Street 6, 194044 St. Petersburg, Russia; (V.G.G.); (V.N.R.); (D.A.S.); (M.S.K.)
| | - Michail S. Korzhuk
- Department & Clinic of Naval Surgery, Military Medical Academy Named after S. M. Kirov, Academic Lebedev Street 6, 194044 St. Petersburg, Russia; (V.G.G.); (V.N.R.); (D.A.S.); (M.S.K.)
- Department of General Surgery, Omsk State Medical University, ul. Lenina, 12, 644099 Omsk, Russia
| | - Valery S. Koskin
- Department & Clinic of Military Field Surgery, Military Medical Academy Named after S. M. Kirov, Academic Lebedev Street 6, 194044 St. Petersburg, Russia;
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Chikwe J. Editor’s Choice: Strengths, Challenges, and Opportunities. Ann Thorac Surg 2022; 113:1761-1766. [DOI: 10.1016/j.athoracsur.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Indexed: 11/01/2022]
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Sureshkumar H, Xu R, Erukulla N, Wadhwa A, Zhao L. "Snap on" or Not? A Validation on the Measurement Tool in a Virtual Reality Application. J Digit Imaging 2022; 35:692-703. [PMID: 35088186 PMCID: PMC9156653 DOI: 10.1007/s10278-022-00582-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/04/2021] [Accepted: 01/03/2022] [Indexed: 12/15/2022] Open
Abstract
This multi-rater comparison study aims to validate the measurement tool with a "snap" feature option (SNAP ON vs. SNAP OFF), in a virtual reality (VR) application, ImmersiveView v. 2.1, against a conventional software Mimics Innovation Suite v.22 (MIS). It is hypothesized that these measurement tools are equivalent between SNAP ON, and SNAP OFF, and when compared to MIS, in terms of basic linear and angular measurements. Six (6) raters conducted a set of 40 linear and 15 angular measurements using CT scan data of three objects (L-block, hand model, and dry skull) with fiducial markers. Inter-rater repeatability and intra-rater reproducibility were assessed via inter-class coefficient (ICC). Equivalency between each pair of modules (SNAP ON, SNAP OFF, and MIS) was analyzed via Bland-Altman plots and two one-sided t-tests (TOST) procedure. The ICC for intra-rater repeatability yielded 0.999 to 1.000, and inter-rater reproducibility yielded 0.998 to 1.000, which suggests high degree of intra- and inter-rater reliability. The Bland-Altman plots demonstrated that measurements acquired from SNAP ON, SNAP OFF, and MIS were equivalent. The TOST procedure yielded that the measurements through all three modules are equivalent within ± 0.2 mm interval for distance, and ± 0.3° interval for angular measurements. The measurement tool with the "snap" feature in a newly developed VR application (ImmersiveView v.2.1) has been validated through a multi-rater comparison study. In terms of linear and angular measurements, this VR application, whether the "snap" feature was on or off, was equivalent to each other and to the control software (MIS) under the condition of this study. A strong reliability, both intra-rater repeatability and inter-rater reproducibility, has been found.
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Affiliation(s)
- Haarisudhan Sureshkumar
- Department of Biomedical Engineering, University of Illinois at Chicago, 851 S Morgan St, Chicago, IL, 60607, USA
| | - Ruidi Xu
- Department of Biomedical Engineering, University of Illinois at Chicago, 851 S Morgan St, Chicago, IL, 60607, USA
| | - Nikith Erukulla
- Department of Biomedical Engineering, University of Illinois at Chicago, 851 S Morgan St, Chicago, IL, 60607, USA
| | - Aditi Wadhwa
- Department of Biomedical Engineering, University of Illinois at Chicago, 851 S Morgan St, Chicago, IL, 60607, USA
| | - Linping Zhao
- Virtual Surgical Simulation Laboratory, Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois at Chicago, 811 S. Paulina St, Chicago, IL, 60612, USA.
- Shriners Hospitals for Children at Chicago, 2211 N. Oak Park Ave, Chicago, IL, 60707, USA.
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Technology Behavior Model—Impact of Extended Reality on Patient Surgery. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Smart surgery is a new way to utilize smart devices to change existing surgeries. Smart glasses can enhance the surgical procedure so that the patient can understand the procedure more intuitively. Surgery is for patients, and patient acceptance of extended reality surgery is the purpose of this study. This study uses the technology behavior model, which is more in line with the user’s assessment of the acceptance behavior of the new technology. A triangulated research approach was used, which applies to this study for a specific patient population. Primary data were collected from hospitals through questionnaires and were statistically analyzed by CB&PLS-SEM multimodel using SmartPLS software. It was concluded that patients were influenced by operational emotional factors in undergoing extended reality surgery. The study provides a basis for future research related to the practical application of smart surgery from the patient’s perspective in viewing and accepting surgery.
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Roberts S, Desai A, Checcucci E, Puliatti S, Taratkin M, Kowalewski KF, Gomez Rivas J, Rivero I, Veneziano D, Autorino R, Porpiglia F, Gill IS, Cacciamani GE. "Augmented reality" applications in urology: a systematic review. Minerva Urol Nephrol 2022; 74:528-537. [PMID: 35383432 DOI: 10.23736/s2724-6051.22.04726-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Augmented reality (AR) applied to surgical procedures refers to the superimposition of preoperative or intra-operative images onto the operative field. Augmented reality has been increasingly used in myriad surgical specialties including Urology. The following study reviews advances in the use of AR for improvements in urologic outcomes. EVIDENCE ACQUISITION We identified all descriptive, validity, prospective randomized/nonrandomized trials and retrospective comparative/noncomparative studies about the use of AR in Urology up until March 2021. The MEDLINE, Scopus, and Web of Science databases were used for literature search. We conducted the study selection according to the PRISMA (Preferred Reporting Items for Systematic Reviews and meta-analysis statement) guidelines. We limited included studies to only those using AR, excluding all that used virtual reality technology. EVIDENCE SYNTHESIS A total of 60 studies were identified and included in the present analysis. Overall, 19 studies were descriptive/validity/phantom studies for specific AR methodologies, 4 studies were case reports, and 37 studies included clinical prospective/retrospective comparative studies. CONCLUSIONS Advances in AR have led to increasing registration accuracy as well as increased ability to identify anatomic landmarks and improve outcomes during Urologic procedures such as RARP and robot-assisted partial nephrectomy.
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Affiliation(s)
- Sidney Roberts
- Keck School of Medicine, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Los Angeles, CA, USA
| | - Aditya Desai
- Keck School of Medicine, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Los Angeles, CA, USA
| | - Enrico Checcucci
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.,European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands
| | - Stefano Puliatti
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Mark Taratkin
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Karl-Friedrich Kowalewski
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Virgen Macarena University Hospital, Seville, Spain.,Department of Urology and Urosurgery, University Hospital of Mannheim, Mannheim, Germany
| | - Juan Gomez Rivas
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Ines Rivero
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Department of Urology and Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - Domenico Veneziano
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Department of Urology, Riuniti Hospital, Reggio Calabria, Reggio Calabria, Italy
| | | | - Francesco Porpiglia
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands
| | - Inderbir S Gill
- Keck School of Medicine, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Los Angeles, CA, USA.,Artificial Intelligence (AI) Center at USC Urology, USC Institute of Urology, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- Keck School of Medicine, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Los Angeles, CA, USA - .,European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Artificial Intelligence (AI) Center at USC Urology, USC Institute of Urology, Los Angeles, CA, USA.,Keck School of Medicine, Department of Radiology, University of Southern California, Los Angeles, CA, USA
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Laudanski K. Quo Vadis Anesthesiologist? The Value Proposition of Future Anesthesiologists Lies in Preserving or Restoring Presurgical Health after Surgical Insult. J Clin Med 2022; 11:1135. [PMID: 35207406 PMCID: PMC8879076 DOI: 10.3390/jcm11041135] [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: 01/30/2022] [Accepted: 02/18/2022] [Indexed: 12/26/2022] Open
Abstract
This Special Issue of the Journal of Clinical Medicine is devoted to anesthesia and perioperative care [...].
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Affiliation(s)
- Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA 19104, USA; ; Tel.: +1-215-662-8000
- Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
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Abjigitova D, Sadeghi AH, Peek JJ, Bekkers JA, Bogers AJJC, Mahtab EAF. Virtual Reality in the Preoperative Planning of Adult Aortic Surgery: A Feasibility Study. J Cardiovasc Dev Dis 2022; 9:31. [PMID: 35200685 PMCID: PMC8879426 DOI: 10.3390/jcdd9020031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Complex aortic anatomy needs careful preoperative planning in which a patient-tailored approach with novel immersive techniques could serve as a valuable addition to current preoperative imaging. This pilot study aimed to investigate the technical feasibility of virtual reality (VR) as an additional imaging tool for preoperative planning in ascending aortic surgery. Methods: Ten cardiothoracic surgeons were presented with six patients who had each undergone a recent repair of the ascending aorta. Two-dimensional computed tomography images of each patient were assessed prior to the VR session. After three-dimensional (3D) VR rendering and 3D segmentation of the ascending aorta and aortic arch, the reconstructions were analyzed by each surgeon in VR via a head-mounted display. Each cardiothoracic surgeon completed a questionnaire after each planning procedure. The results of their assessments were compared to the performed operations. The primary endpoint of the present study was a change of surgical approach from open to clamped distal anastomosis, and vice versa. Results: Compared with conventional imaging, 80% of surgeons found that VR prepared them better for surgery. In 33% of cases (two out of six), the preoperative decision was adjusted due to the 3D VR-based evaluation of the anatomy. Surgeons rated CardioVR usefulness, user-friendliness, and satisfaction with median scores of 3.8 (IQR: 3.5-4.1), 4.2 (IQR: 3.8-4.6,) and 4.1 (IQR: 3.8-4.7) on a five-point Likert scale, respectively. Conclusions: Three-dimensional VR imaging was associated with improved anatomical understanding among surgeons and could be helpful in the future preoperative planning of ascending aortic surgery.
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Affiliation(s)
- Djamila Abjigitova
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Room Rg-619, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (A.H.S.); (J.J.P.); (J.A.B.); (A.J.J.C.B.); (E.A.F.M.)
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Peng M, Yu L, Zhou Y, Yang Y, Luo Q, Cheng X. Augmented reality-assisted localization of solitary pulmonary nodules for precise sublobar lung resection: a preliminary study using an animal model. Transl Lung Cancer Res 2022; 10:4174-4184. [PMID: 35004248 PMCID: PMC8674605 DOI: 10.21037/tlcr-21-554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/08/2021] [Indexed: 11/06/2022]
Abstract
Background Accurate localization of early lung cancer, manifested as solitary pulmonary nodules (SPNs) on computed tomography (CT), is critical in sublobar lung resection. The AR-assisted localization of SPNs was evaluated using a pig animal model. Methods A Microsoft HoloLens AR system was used. First, a plastic thoracic model was used for the pilot study. Three female 12 months 45 kg Danish Landrace Pigs were then used for the animal study. Thirty natural pulmonary structures, such as lymphonodus and bifurcated bronchioles or bronchial vessels, were chosen as simulated SPNs. The average angle between the actual puncturing needle and the expected path, the average distance between the puncture point and the plan point, and the difference between the actual puncturing depth and expected depth were recorded, and the accuracy rate was calculated. Results The point selected in the plastic thoracic model could be hit accurately with the assistance from the AR system in the pilot study. Moreover, the average angle between the actual puncturing needle and the expected path was 14.52°±6.04°. Meanwhile, the average distance between the puncture point and the expected point was 8.74±5.07 mm, and the difference between the actual and expected depths was 9.42±7.95 mm. Puncturing within a 1 cm3 area around the SPN using a hook-wire was considered a successful hit. The puncture accuracy was calculated. The average hit rate within a spherical area with a diameter of 1 cm range was 76.67%, and within a diameter of 2 cm range was 100%. Conclusions The HoloLens AR-assisted localization of SPNs may become a promising technique to improve the surgical treatment of early-stage lung cancer. Here, we evaluated its feasibility in an animal model. Nevertheless, its safety and effectiveness require further investigation in clinical trials.
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Affiliation(s)
- Mingzheng Peng
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lingming Yu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Zhou
- Department of Equipment, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yunhai Yang
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qingquan Luo
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xinghua Cheng
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Affiliation(s)
- Edris A. F. Mahtab
- grid.5645.2000000040459992XDepartment of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Anastasia D. Egorova
- grid.10419.3d0000000089452978Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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41
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Grebenkov VG, Rumyantsev VN, Ivanov VM, Strelkov SV, Balyura OV, Dymnikov DA, Markevich VY, Kushnarev SV, Zheleznyak IS, Pugacheva VS, Korzhuk MS, Demko AE, Surov DA. [Perioperative augmented reality technology in surgical treatment of locally advanced recurrent rectal cancer]. Khirurgiia (Mosk) 2022:44-53. [PMID: 36562672 DOI: 10.17116/hirurgia202212244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Rectal cancer occupies the leading position among cancers, and incidence of locally advanced recurrences is still high despite comprehensive treatment. Combined resections are usually associated with high perioperative risks. These procedures are technically complex interventions requiring further improvement. Virtual reality technology in surgical treatment of locally advanced rectal cancer recurrence has not been widely discussed. The authors present multidisciplinary construction of the matched topographic-anatomical virtual model and virtual planning of the combined surgical intervention. Intraoperative use of augmented reality allowed specifying topographic and anatomical features of surgical area, level of vascular ligation, localization of tumor fixation points and resection borders. These data ensured safety and quality of resection. Further research of augmented reality technology and improvement of its technical aspects will improve the results of surgical treatment of patients with locally advanced pelvic tumors and recurrences.
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Affiliation(s)
- V G Grebenkov
- Kirov Military Medical Academy, St. Petersburg, Russia
| | | | - V M Ivanov
- Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia
| | - S V Strelkov
- Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia
| | - O V Balyura
- Kirov Military Medical Academy, St. Petersburg, Russia
| | - D A Dymnikov
- Kirov Military Medical Academy, St. Petersburg, Russia
| | | | - S V Kushnarev
- Kirov Military Medical Academy, St. Petersburg, Russia
| | | | - V S Pugacheva
- Kirov Military Medical Academy, St. Petersburg, Russia
| | - M S Korzhuk
- Kirov Military Medical Academy, St. Petersburg, Russia
| | - A E Demko
- Dzhanelidze St. Petersburg Research Institute for Emergency Care, St. Petersburg, Russia
| | - D A Surov
- Kirov Military Medical Academy, St. Petersburg, Russia
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Effects of Prehabilitation on Functional Capacity in Aged Patients Undergoing Cardiothoracic Surgeries: A Systematic Review. Healthcare (Basel) 2021; 9:healthcare9111602. [PMID: 34828647 PMCID: PMC8625473 DOI: 10.3390/healthcare9111602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background: an increasing number of advanced age patients are considered for cardiothoracic surgeries. Prehabilitation optimizes the patients’ functional capacity and physiological reserve. However, the effectiveness of prehabilitation on physical functioning and postoperative recovery in the scope of cardiothoracic surgery is still uncertain. Objective: to assess the effectiveness of prehabilitation on pre- and/or postoperative functional capacity and physiological reserve in aged patients that are considered for cardiothoracic surgeries. Methods: this systematic review was registered in PROSPERO (CRD42021247117). The searches were conducted in PubMed, Web of Science, Scopus, and Cochrane CENTRAL until 18 April 2021. Randomized clinical trials that compared different prehabilitation strategies with usual care on the pre- and-postoperative results in aged patients undergoing cardiothoracic surgeries were included. Methodological quality was assessed by means of the Jadad scale, and the effectiveness of the interventions according to the Consensus on Therapeutic Exercise Training. Results: nine studies with 876 participants aged from 64 to 71.5 years old were included. Risk of bias was moderate due to the absence of double-blinding. The content of the interventions (multimodal prehabilitation n = 3; based on physical exercises n = 6) and the result measures presented wide variation, which hindered comparison across the studies. In general, the trials with better therapeutic quality (n = 6) reported more significant improvements in physical functioning, cardiorespiratory capacity, and in the postoperative results in the participants under-going prehabilitation. Conclusions: prehabilitation seems to improve functional capacity and postoperative recovery in aged patients undergoing cardiothoracic surgeries. However, due to the significant heterogeneity and questionable quality of the trials, both the effectiveness of prehabilitation and the optimum content are still to be determined.
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van de Woestijne PC, Bakhuis W, Sadeghi AH, Peek JJ, Taverne YJ, Bogers AJ. 3D Virtual Reality Imaging of Major Aortopulmonary Collateral Arteries: A Novel Diagnostic Modality. World J Pediatr Congenit Heart Surg 2021; 12:765-772. [PMID: 34812684 PMCID: PMC8637380 DOI: 10.1177/21501351211045064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/19/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Major aortopulmonary collateral arteries (MAPCAs), as seen in patients with pulmonary atresia, are arteries that supply blood from the aorta to the lungs and often require surgical intervention. To achieve complete repair in the least number of interventions, optimal imaging of the pulmonary arterial anatomy and MAPCAs is critical. 3D virtual reality (3D-VR) is a promising and upcoming new technology that could potentially ameliorate current imaging shortcomings. METHODS A retrospective, proof-of-concept study was performed of all operated patients with pulmonary atresia and MAPCAs at our center between 2010 and 2020 with a preoperative computed tomography (CT) scan. CT images were reviewed by two congenital cardiac surgeons in 3D-VR to determine additional value of VR for MAPCA imaging compared to conventional CT and for preoperative planning of MAPCA repair. RESULTS 3D-VR visualizations were reconstructed from CT scans of seven newborns where the enhanced topographic anatomy resulted in improved visualization of MAPCA. In addition, surgical planning was improved since new observations or different preoperative plans were apparent in 4 out of 7 cases. After the initial setup, VR software and hardware was reported to be easy and intuitive to use. CONCLUSIONS This study showed technical feasibility of 3D-VR reconstruction of children with immersive visualization of topographic anatomy in an easy-to-use format leading to an improved surgical planning of MAPCA surgery. Future prospective studies are required to investigate the clinical benefits in larger populations.
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Affiliation(s)
| | - Wouter Bakhuis
- Thoraxcenter, Erasmus University Medical
Center, Rotterdam, the Netherlands
| | - Amir H. Sadeghi
- Thoraxcenter, Erasmus University Medical
Center, Rotterdam, the Netherlands
| | - Jette J. Peek
- Thoraxcenter, Erasmus University Medical
Center, Rotterdam, the Netherlands
| | | | - Ad J.J.C. Bogers
- Thoraxcenter, Erasmus University Medical
Center, Rotterdam, the Netherlands
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Arjomandi Rad A, Vardanyan R, Thavarajasingam SG, Zubarevich A, Van den Eynde J, Sá MPBO, Zhigalov K, Sardiari Nia P, Ruhparwar A, Weymann A. Extended, virtual and augmented reality in thoracic surgery: a systematic review. Interact Cardiovasc Thorac Surg 2021; 34:201-211. [PMID: 34542639 PMCID: PMC8766198 DOI: 10.1093/icvts/ivab241] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Extended reality (XR), encompassing both virtual reality (VR) and augmented reality, allows the user to interact with a computer-generated environment based on reality. In essence, the immersive nature of VR and augmented reality technology has been warmly welcomed in all aspects of medicine, gradually becoming increasingly feasible to incorporate into everyday practice. In recent years, XR has become increasingly adopted in thoracic surgery, although the extent of its applications is unclear. Here, we aim to review the current applications of XR in thoracic surgery. METHODS A systematic database search was conducted of original articles that explored the use of VR and/or augmented reality in thoracic surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to December 2020. RESULTS Our search yielded 1494 citations, of which 21 studies published from 2007 to 2019 were included in this review. Three main areas were identified: (i) the application of XR in thoracic surgery training; (ii) preoperative planning of thoracic procedures; and (iii) intraoperative assistance. Overall, XR could produce progression along the learning curve, enabling trainees to reach acceptable standards before performing in the operating theatre. Preoperatively, through the generation of 3D-renderings of the thoracic cavity and lung anatomy, VR increases procedural accuracy and surgical confidence through familiarization of the patient's anatomy. XR-assisted surgery may have therapeutic use particularly for complex cases, where conventional methods would yield inadequate outcomes due to inferior accuracy. CONCLUSION XR represents a salient step towards improving thoracic surgical training, as well as enhancing preoperative planning and intraoperative guidance.
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Affiliation(s)
- Arian Arjomandi Rad
- Corresponding author. Department of Medicine, Faculty of Medicine, Imperial College London, London, UK. Tel:+447397572231; e-mail: (A. Arjomandi Rad)
| | | | | | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Michel Pompeu B O Sá
- Department of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, University of Pernambuco, Recife, Brazil
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Peyman Sardiari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
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Cocchieri R, van de Wetering B, Stijnen M, Riezebos R, de Mol B. The Impact of Biomedical Engineering on the Development of Minimally Invasive Cardio-Thoracic Surgery. J Clin Med 2021; 10:jcm10173877. [PMID: 34501325 PMCID: PMC8432110 DOI: 10.3390/jcm10173877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022] Open
Abstract
(1) We describe the boundary conditions for minimally invasive cardiac surgery (MICS) with the aim to reduce procedure-related patient injury and discomfort. (2) The analysis of the MICS work process and its demand for improved tools and devices is followed by a description of the relevant sub-specialties of bio-medical engineering: electronics, biomechanics, and materials sciences. (3) Innovations can represent a desired adaptation of an existing work process or a radical redesign of procedure and devices such as in transcutaneous procedures. Focused interaction between engineers, industry, and surgeons is always mandatory (i.e., a therapeutic alliance for addressing 'unmet patient or professional needs'. (4) Novel techniques in MICS lean heavily on usability and safe and effective use in dedicated hands. Therefore, the use of training and simulation models should enable skills selection, a safe learning curve, and maintenance of proficiency. (5) The critical technical steps and cost-benefit trade-offs during the journey from invention to application will be explained. Business considerations such as time-to-market and returns on investment do shape the cost-benefit room for commercial use of technology. Proof of clinical safety and effectiveness by physicians remains important, but establishing the technical reliability of MICS tools and warranting appropriate surgical skills come first.
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Affiliation(s)
- Riccardo Cocchieri
- Heart Center, OLVG Hospital, 1091 AC Amsterdam, The Netherlands; (R.C.); (R.R.)
| | - Bertus van de Wetering
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands;
- LifeTec Group BV, 5611 ZS Eindhoven, The Netherlands
- Correspondence: (B.v.d.W.); (B.d.M.)
| | - Marco Stijnen
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands;
- LifeTec Group BV, 5611 ZS Eindhoven, The Netherlands
| | - Robert Riezebos
- Heart Center, OLVG Hospital, 1091 AC Amsterdam, The Netherlands; (R.C.); (R.R.)
| | - Bastian de Mol
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands;
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Correspondence: (B.v.d.W.); (B.d.M.)
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Mitzman B. Commentary: A new "lost" generation. ACTA ACUST UNITED AC 2021; 7:411-412. [PMID: 34401860 PMCID: PMC8358138 DOI: 10.1016/j.xjon.2021.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Brian Mitzman
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Utah
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47
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Sadeghi AH, Maat APM, Taverne YJJ, Cornelissen R, Dingemans AMC, Bogers AJC, Mahtab EA. Virtual reality and artificial intelligence for 3-dimensional planning of lung segmentectomies. JTCVS Tech 2021; 7:309-321. [PMID: 34318279 PMCID: PMC8312141 DOI: 10.1016/j.xjtc.2021.03.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There has been an increasing trend toward pulmonary segmentectomies to treat early-stage lung cancer, small intrapulmonary metastases, and localized benign pathology. A complete preoperative understanding of pulmonary anatomy is essential for accurate surgical planning and case selection. Identifying intersegmental divisions is extremely difficult when performed on computed tomography. For the preoperative planning of segmentectomies, virtual reality (VR) and artificial intelligence could allow 3-dimensional visualization of the complex anatomy of pulmonary segmental divisions, vascular arborization, and bronchial anatomy. This technology can be applied by surgeons preoperatively to gain better insight into a patient's anatomy for planning segmentectomy. METHODS In this prospective observational pilot study, we aim to assess and demonstrate the technical feasibility and clinical applicability of the first dedicated artificial intelligence-based and immersive 3-dimensional-VR platform (PulmoVR; jointly developed and manufactured by Department of Cardiothoracic Surgery [Erasmus Medical Center, Rotterdam, The Netherlands], MedicalVR [Amsterdam, The Netherlands], EVOCS Medical Image Communication [Fysicon BV, Oss, The Netherlands], and Thirona [Nijmegen, The Netherlands]) for preoperative planning of video-assisted thoracoscopic segmentectomies. RESULTS A total of 10 eligible patients for segmentectomy were included in this study after referral through the institutional thoracic oncology multidisciplinary team. PulmoVR was successfully applied as a supplementary imaging tool to perform video-assisted thoracoscopic segmentectomies. In 40% of the cases, the surgical strategy was adjusted due to the 3-dimensional-VR-based evaluation of anatomy. This underlines the potential benefit of additional VR-guided planning of segmentectomy for both surgeon and patient. CONCLUSIONS Our study demonstrates the successful development and clinical application of the first dedicated artificial intelligence and VR platform for the planning of pulmonary segmentectomy. This is the first study that shows an immersive virtual reality-based application for preoperative planning of segmentectomy to the best of our knowledge.
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Affiliation(s)
- Amir H. Sadeghi
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexander P.W. M. Maat
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Yannick J.H. J. Taverne
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Anne-Marie C. Dingemans
- Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Ad J.J. C. Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edris A.F. Mahtab
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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48
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Sadeghi AH, Wahadat AR, Dereci A, Budde RPJ, Tanis W, Roos-Hesselink JW, Takkenberg H, Taverne YJHJ, Mahtab EAF, Bogers AJJC. Remote multidisciplinary heart team meetings in immersive virtual reality: a first experience during the COVID-19 pandemic. ACTA ACUST UNITED AC 2021; 7:311-315. [PMID: 34192017 PMCID: PMC7938471 DOI: 10.1136/bmjinnov-2021-000662] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Amir H Sadeghi
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ali R Wahadat
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Cardiology, Haga Hospital, Den Haag, The Netherlands
| | - Adem Dereci
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wilco Tanis
- Department of Cardiology, Haga Hospital, Den Haag, The Netherlands
| | | | - Hanneke Takkenberg
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Edris A F Mahtab
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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49
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Ayers B, Kilic A. Extended Reality Platforms: A Technological Solution Still Finding the Right Problem. Ann Thorac Surg 2021; 113:691. [PMID: 33524345 DOI: 10.1016/j.athoracsur.2020.11.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 11/29/2020] [Indexed: 11/01/2022]
Affiliation(s)
- Brian Ayers
- Department of Surgery, The Massachusetts General Hospital, Boston, MA
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, 200Lothrop Street Pittsburgh, PA 15213.
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