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Żydowicz WM, Skokowski J, Marano L, Polom K. Current Trends and Beyond Conventional Approaches: Advancements in Breast Cancer Surgery through Three-Dimensional Imaging, Virtual Reality, Augmented Reality, and the Emerging Metaverse. J Clin Med 2024; 13:915. [PMID: 38337610 PMCID: PMC10856583 DOI: 10.3390/jcm13030915] [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: 01/11/2024] [Revised: 01/25/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
Breast cancer stands as the most prevalent cancer globally, necessitating comprehensive care. A multidisciplinary approach proves crucial for precise diagnosis and treatment, ultimately leading to effective disease management. While surgical interventions continue to evolve and remain integral for curative treatment, imaging assumes a fundamental role in breast cancer detection. Advanced imaging techniques not only facilitate improved diagnosis but also contribute significantly to the overall enhancement of breast cancer management. This review article aims to provide an overview of innovative technologies such as virtual reality, augmented reality, and three-dimensional imaging, utilized in the medical field to elevate the diagnosis and treatment of breast cancer. Additionally, the article delves into an emerging technology known as the metaverse, still under development. Through the analysis of impactful research and comparison of their findings, this study offers valuable insights into the advantages of each innovative technique. The goal is to provide physicians, surgeons, and radiologists with information on how to enhance breast cancer management.
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Affiliation(s)
- Weronika Magdalena Żydowicz
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, Jana Pawła II 50, 80-462 Gdańsk, Poland; (W.M.Ż.); (J.S.)
| | - Jaroslaw Skokowski
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, Jana Pawła II 50, 80-462 Gdańsk, Poland; (W.M.Ż.); (J.S.)
- Department of Medicine, Academy of Applied Medical and Social Sciences, Akademia Medycznych I Spolecznych Nauk Stosowanych (AMiSNS), 2 Lotnicza Street, 82-300 Elbląg, Poland;
| | - Luigi Marano
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, Jana Pawła II 50, 80-462 Gdańsk, Poland; (W.M.Ż.); (J.S.)
- Department of Medicine, Academy of Applied Medical and Social Sciences, Akademia Medycznych I Spolecznych Nauk Stosowanych (AMiSNS), 2 Lotnicza Street, 82-300 Elbląg, Poland;
| | - Karol Polom
- Department of Medicine, Academy of Applied Medical and Social Sciences, Akademia Medycznych I Spolecznych Nauk Stosowanych (AMiSNS), 2 Lotnicza Street, 82-300 Elbląg, Poland;
- Department of Gastrointestinal Surgical Oncology, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
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Biermann N, Eschenbacher E, Brébant V, Heine N, Brix E, Prantl L, Anker AM. Patient characteristics may affect the lymphatic staining ability of Indocyanine green and Patent blue during lymphaticovenous anastomosis. Clin Hemorheol Microcirc 2024; 86:153-158. [PMID: 37718792 DOI: 10.3233/ch-238112] [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: 09/19/2023]
Abstract
BACKGROUND The use of dyes like Indocyanine green (ICG) and Patent blue facilitates the identification of lymphatic vessels during lymphaticovenous anastomosis (LVA) surgery. However, some patients experience "staining failure". In these cases, no stained lymphatic vessels can be detected, making supermicrosurgical LVA even more complex. OBJECTIVE This study aims to investigate patient-related factors that may interfere with lymphatic vessel staining during LVA. METHODS A retrospective study was conducted on 30 patient charts, focusing on patient characteristics and the staining quality of ICG and Patent blue dye. Statistical analyses were performed to identify correlations between variables. RESULTS Significant correlations were found between higher age and secondary lymphedema, longer duration of lymphedema in male patients until surgery and reoccurring cellulitis and Patent blue staining. Notably, recurrent infections to the lymphatic system resulted in inferior staining ability during LVA surgery. CONCLUSIONS Due to staining failure the detection of functional lymphatic vessels remains challenging in LVA surgery. A more extensive preoperative workup is recommended for patients with recurrent cellulitis to optimize surgical feasibility and procedure quality in LVA treatment for lymphedema.
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Affiliation(s)
- Niklas Biermann
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Elisabeth Eschenbacher
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Vanessa Brébant
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Norbert Heine
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Eva Brix
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Alexandra M Anker
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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Brockmeyer P, Wiechens B, Schliephake H. The Role of Augmented Reality in the Advancement of Minimally Invasive Surgery Procedures: A Scoping Review. Bioengineering (Basel) 2023; 10:bioengineering10040501. [PMID: 37106688 PMCID: PMC10136262 DOI: 10.3390/bioengineering10040501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
The purpose of this review was to analyze the evidence on the role of augmented reality (AR) in the improvement of minimally invasive surgical (MIS) procedures. A scoping literature search of the PubMed and ScienceDirect databases was performed to identify articles published in the last five years that addressed the direct impact of AR technology on MIS procedures or that addressed an area of education or clinical care that could potentially be used for MIS development. A total of 359 studies were screened and 31 articles were reviewed in depth and categorized into three main groups: Navigation, education and training, and user-environment interfaces. A comparison of studies within the different application groups showed that AR technology can be useful in various disciplines to advance the development of MIS. Although AR-guided navigation systems do not yet offer a precision advantage, benefits include improved ergonomics and visualization, as well as reduced surgical time and blood loss. Benefits can also be seen in improved education and training conditions and improved user-environment interfaces that can indirectly influence MIS procedures. However, there are still technical challenges that need to be addressed to demonstrate added value to patient care and should be evaluated in clinical trials with sufficient patient numbers or even in systematic reviews or meta-analyses.
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Affiliation(s)
- Phillipp Brockmeyer
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, D-37075 Goettingen, Germany
| | - Bernhard Wiechens
- Department of Orthodontics, University Medical Center Goettingen, D-37075 Goettingen, Germany
| | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, D-37075 Goettingen, Germany
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Use of fluorescence imaging during lymphatic surgery: A Delphi survey of experts worldwide. Surgery 2022; 172:S14-S20. [PMID: 36427924 DOI: 10.1016/j.surg.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fluorescence imaging with indocyanine green is increasingly used during lymphedema patient management. However, to date, no guidelines exist on when it should and should not be used or how it should be performed. Our objective was to have an international panel of experts identify areas of consensus and nonconsensus in current attitudes and practices in fluorescence imaging with indocyanine green use during lymphedema surgery patient management. METHODS A 2-round Delphi study was conducted involving 18 experts in the use of fluorescence imaging during lymphatic surgery, all asked to vote on 49 statements on patient preparation and contraindications (n = 7 statements), indocyanine green dosing and administration (n = 10), fluorescence imaging uses and potential advantages (n = 16), and potential disadvantages and training needs (n = 16). RESULTS Consensus ultimately was reached on 40/49 statements, including consistent consensus regarding the value of fluorescence imaging with indocyanine green in almost all facets of lymphedema patient management, including early detection, assessing disease extent, preoperative work-up, surgical planning, intraoperative guidance, monitoring short- and longer-term outcomes, quality control, and resident training. All experts felt it was very safe, while 94% felt it should be part of routine care and that indocyanine green was superior to colored dyes and ultrasound. Nonetheless, there also was consensus that limited high-quality evidence remains a barrier to its widespread use and that patients should still be provided with specific information and asked to sign specific consent for both fluorescence imaging and indocyanine green. CONCLUSION Fluorescence imaging with or without indocyanine green appears to have several roles in lymphedema prevention, diagnosis, assessment, and treatment.
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Vasella M, Guidi M, Waldner M, Calcagni M, Giovanoli P, Frueh FS. Fluorescence angiography-assisted debridement of critically perfused glabrous skin in degloving foot injuries: Two case reports. Medicine (Baltimore) 2021; 100:e26235. [PMID: 34087908 PMCID: PMC8183782 DOI: 10.1097/md.0000000000026235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Degloving foot injuries are challenging to treat and associated with life-long sequelae for patients. An appropriate debridement of ischemic soft tissues with maximal preservation of glabrous skin is key during the reconstruction of these injuries. Indocyanine green (ICG) fluorescence angiography is an established technique for the intraoperative evaluation of tissue perfusion. PATIENT CONCERNS Two patients sustained complex foot injuries in traffic accidents, including multiple fracture dislocations and extensive degloving of the plantar skin. DIAGNOSIS Clinical inspection revealed significant degloving of the glabrous skin in both patients. INTERVENTIONS After fracture fixation, ICG fluorescence angiography-assisted debridement with immediate latissimus dorsi free flap reconstruction was performed. OUTCOMES In both cases, this technique allowed a precise debridement with maximal preservation of the glabrous skin. The healing of the remaining glabrous skin was uneventful and the 6-month follow-up was characterized by stable soft tissues and satisfying ambulation. LESSONS ICG fluorescence angiography is a safe, user-friendly, and quick procedure with minimal risks, expanding the armamentarium of the reconstructive surgeon. It is highly useful for the debridement of extensive plantar degloving injuries and may also help to minimize the number of procedures and the risk of infection.
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Thammineedi SR, Saksena AR, Nusrath S, Iyer RR, Shukla S, Patnaik SC, Reddy RP, Boleneni N, Sharma RM, Smith L, Are C. Fluorescence-guided cancer surgery-A new paradigm. J Surg Oncol 2021; 123:1679-1698. [PMID: 33765329 DOI: 10.1002/jso.26469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
Fluorescence-guided surgery is an emerging and promising operative adjunct to assist the surgeon in various aspects of oncosurgery, ranging from assessing perfusion, identification, and characterization of tumors and peritoneal metastases, mapping of lymph nodes/leaks, and assistance for fluorescence-guided surgery (FGS). This study aims to provide an overview of principles, currently available dyes, platforms, and surgical applications and summarizes the available literature on the utility of FGS with a focus on abdomino-thoracic malignancies.
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Affiliation(s)
- Subramanyeshwar Rao Thammineedi
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Ajesh Raj Saksena
- Division of Colorectal Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Syed Nusrath
- Division of Upper GI Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - R Rajagopalan Iyer
- Division of Gynecologic Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Srijan Shukla
- Division of Thoracic Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Sujit Chyau Patnaik
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - R Pratap Reddy
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Naren Boleneni
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Rakesh M Sharma
- Division of Urologic Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Centre, Omaha, Nebraska, USA
| | - Chandrakanth Are
- Department of Surgery, University of Nebraska Medical Centre, Omaha, Nebraska, USA
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Abstract
Lymphedema is a chronic, progressive disease caused by primary or secondary reasons. It is currently uncurable and conservative compression therapy is generally applied. Lymphovenous anastomosis and vascularized lymph node transfer (VLNT) are two main surgical treatment that are used in addition to conservative therapy. Lymphovenous anastomosis involves the anastomosing remaining functional lymphatic vessels to vein. When the lymphatic vessels are greatly damaged and in no case can they be used for anastomosis, VLNT provide the affected area with lymph nodes from elsewhere to restore the drainage function. During all these procedures, a clear image to identify related lymphatic structures and venous vessels can be greatly useful for preoperative planning, intraoperative navigation, and postoperative evaluation. Lymphoscintigraphy used to be the gold standard in evaluating lymphedema and mapping lymphatic systems. But due to the downside of radiation, invasive operation and complication, other modalities are gaining attention. In this article, we reviewed the application of Indocyanine green (ICG) lymphography, ultrasound, magnetic resonance lymphography (MRL), and single-photon emission computed tomography-computed tomography (SPECT-CT) in the field of surgical therapy in lymphedema.
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Affiliation(s)
- Xingyi Du
- Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100043, China
| | - Chunjun Liu
- Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100043, China
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