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Hertz P, Bertelsen CA, Houlind K, Bundgaard L, Konge L, Bjerrum F, Svendsen MBS. Developing a phantom for simulating robotic-assisted complete mesocolic excision using 3D printing and medical imaging. BMC Surg 2024; 24:72. [PMID: 38408998 PMCID: PMC10897992 DOI: 10.1186/s12893-024-02353-y] [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: 03/29/2023] [Accepted: 02/07/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Robotic-assisted complete mesocolic excision is an advanced procedure mainly because of the great variability in anatomy. Phantoms can be used for simulation-based training and assessment of competency when learning new surgical procedures. However, no phantoms for robotic complete mesocolic excision have previously been described. This study aimed to develop an anatomically true-to-life phantom, which can be used for training with a robotic system situated in the clinical setting and can be used for the assessment of surgical competency. METHODS Established pathology and surgical assessment tools for complete mesocolic excision and specimens were used for the phantom development. Each assessment item was translated into an engineering development task and evaluated for relevance. Anatomical realism was obtained by extracting relevant organs from preoperative patient scans and 3D printing casting moulds for each organ. Each element of the phantom was evaluated by two experienced complete mesocolic excision surgeons without influencing each other's answers and their feedback was used in an iterative process of prototype development and testing. RESULTS It was possible to integrate 35 out of 48 procedure-specific items from the surgical assessment tool and all elements from the pathological evaluation tool. By adding fluorophores to the mesocolic tissue, we developed an easy way to assess the integrity of the mesocolon using ultraviolet light. The phantom was built using silicone, is easy to store, and can be used in robotic systems designated for patient procedures as it does not contain animal-derived parts. CONCLUSIONS The newly developed phantom could be used for training and competency assessment for robotic-assisted complete mesocolic excision surgery in a simulated setting.
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Affiliation(s)
- Peter Hertz
- Department of Surgery, Hospital Lillebaelt, University of Southern Denmark, Sygehusvej 24, Kolding, 6000, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark.
| | - Claus Anders Bertelsen
- Department of Surgery, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Houlind
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Vascular Surgery, Hospital Lillebaelt, University of Southern Denmark, Kolding, Denmark
| | - Lars Bundgaard
- Department of Surgery, Hospital Lillebaelt Vejle, Colorectal Cancer Center South, University of Southern Denmark, Odense, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Gastrounit, Surgical section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Computer Science, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
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Bracale U, Iacone B, Tedesco A, Gargiulo A, Di Nuzzo MM, Sannino D, Tramontano S, Corcione F. The use of mixed reality in the preoperative planning of colorectal surgery: Preliminary experience with a narrative review. Cir Esp 2024:S2173-5077(24)00037-1. [PMID: 38307256 DOI: 10.1016/j.cireng.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/14/2024] [Indexed: 02/04/2024]
Abstract
New advanced technologies have recently been developed and preliminarily applied to surgery, including virtual reality (VR), augmented reality (AR) and mixed reality (MR). We retrospectively review all colorectal cases in which we used holographic 3D reconstruction from February 2020 to December 2022. This innovative approach was used to identify vascular anomalies, pinpoint tumor locations, evaluate infiltration into neighboring organs and devise surgical plans for both training and educating trainee assistants. We have also provided a state-of-the-art analysis, briefly highlighting what has been stated by the scientific literature to date. VR facilitates training and anatomical assessments, while AR enhances training and laparoscopic performance evaluations. MR, powered by HoloLens, enriches anatomic recognition, navigation, and visualization. Successful implementation was observed in 10 colorectal cancer cases, showcasing the effectiveness of MR in improving preoperative planning and its intraoperative application. This technology holds significant promise for advancing colorectal surgery by elevating safety and reliability standards.
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Affiliation(s)
- Umberto Bracale
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Biancamaria Iacone
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy.
| | - Anna Tedesco
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Antonio Gargiulo
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | | | - Daniele Sannino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Salvatore Tramontano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
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Sørensen PJ, Carlsen JF, Larsen VA, Andersen FL, Ladefoged CN, Nielsen MB, Poulsen HS, Hansen AE. Evaluation of the HD-GLIO Deep Learning Algorithm for Brain Tumour Segmentation on Postoperative MRI. Diagnostics (Basel) 2023; 13:diagnostics13030363. [PMID: 36766468 PMCID: PMC9914320 DOI: 10.3390/diagnostics13030363] [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: 12/12/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
In the context of brain tumour response assessment, deep learning-based three-dimensional (3D) tumour segmentation has shown potential to enter the routine radiological workflow. The purpose of the present study was to perform an external evaluation of a state-of-the-art deep learning 3D brain tumour segmentation algorithm (HD-GLIO) on an independent cohort of consecutive, post-operative patients. For 66 consecutive magnetic resonance imaging examinations, we compared delineations of contrast-enhancing (CE) tumour lesions and non-enhancing T2/FLAIR hyperintense abnormality (NE) lesions by the HD-GLIO algorithm and radiologists using Dice similarity coefficients (Dice). Volume agreement was assessed using concordance correlation coefficients (CCCs) and Bland-Altman plots. The algorithm performed very well regarding the segmentation of NE volumes (median Dice = 0.79) and CE tumour volumes larger than 1.0 cm3 (median Dice = 0.86). If considering all cases with CE tumour lesions, the performance dropped significantly (median Dice = 0.40). Volume agreement was excellent with CCCs of 0.997 (CE tumour volumes) and 0.922 (NE volumes). The findings have implications for the application of the HD-GLIO algorithm in the routine radiological workflow where small contrast-enhancing tumours will constitute a considerable share of the follow-up cases. Our study underlines that independent validations on clinical datasets are key to asserting the robustness of deep learning algorithms.
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Affiliation(s)
- Peter Jagd Sørensen
- Department of Radiology, Centre of Diagnostic Investigation, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
- The DCCC Brain Tumor Center, 2100 Copenhagen, Denmark
- Correspondence:
| | - Jonathan Frederik Carlsen
- Department of Radiology, Centre of Diagnostic Investigation, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Vibeke Andrée Larsen
- Department of Radiology, Centre of Diagnostic Investigation, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Flemming Littrup Andersen
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Centre of Diagnostic Investigation, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Claes Nøhr Ladefoged
- Department of Clinical Physiology and Nuclear Medicine, Centre of Diagnostic Investigation, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Radiology, Centre of Diagnostic Investigation, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Hans Skovgaard Poulsen
- The DCCC Brain Tumor Center, 2100 Copenhagen, Denmark
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Adam Espe Hansen
- Department of Radiology, Centre of Diagnostic Investigation, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
- The DCCC Brain Tumor Center, 2100 Copenhagen, Denmark
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