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Objective:To analyze the symmetry of different reference planes in the surgical simulation design of patients with protrusive jaw deformity with high and low eyes.Methods:Fifteen patients with partial jaw deformity were selected from January 2019 to June 2020, including 3 males and 12 females, aged 18-26 years, with average 23.78 years. Inclusion criteria were that the patients, aged more than 18 years, were diagnosed as protrusive jaw deformity with maxillary occlusal plane tilt and high and low eyes by clinical and imaging analysis. Three different 3D reference plane systems were established by different modeling methods. The distance between the landmarks of soft and hard tissues and the median sagittal plane was measured. The symmetry of skull was qualitatively analyzed by mirror image technique. The difference of three reference planes in surgical simulation symmetry of patients with protrusion jaw and high and low eyes was evaluated by one-way ANOVA.Results:Qualitative analysis showed that in the three measurement planes, the symmetry of the third reference plane was the best, and the symmetry of the second and the first was poor. Quantitative analysis showed that in measurement index of hard tissue, there was statistical difference between the distance of each landmark in the reference plane established by Method 3 and Method 1, Method 2 [(1.65±1.19) mm; (3.37±1.58) mm; (3.26±2.36) mm, P<0.05], but there was no statistical difference between Method 1 and Method 2 (P > 0.05). The measurement result of soft tissue was consistent with that of hard tissue, and the distance of each landmark in Method 3 from the median sagittal plane was very small, and the mean error was less than 0.5 mm, which was consistent with the clinical results. Conclusions:Digital model surgery technology can assist orthognathic surgeons in the design and prediction of surgical scheme, especially for patients with special partial jaw deformity.
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The teaching of orthognathic surgery is difficult because it is complex and emphasizes the combination of theory and practice. The traditional teaching method focuses on theoretical teaching, but due to the limitation of conditions, it is difficult for students to master the operation. In this paper, we apply the digital three-dimensional surgical simulation system combined with 3D printing in specialist training of orthognathic surgery. Digital software and 3D printing are applied in the theoretical teaching, surgical operation, summary and reflection to combine practical teaching with theoretical teaching, so as to stimulate the subjective initiative of the students. The results showed that the teaching evaluation of the experimental group [(3.89±0.84) points] was better than that of the control group [(2.91±1.21) points]. The application of digital three-dimensional surgical simulation system combined with 3D printing has achieved satisfactory results.
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Clinical application of imaging technology (e.g., CT, MRI and DSA) in craniomaxillofacial surgery, genetic detection and analysis, three-dimensional visualization of panoramic anatomy, rapid and accurate molding of craniofacial skeletal models, precise designing and manufacturing technology, intraoperative real-time navigation system, and the remote consultation system aided by information network technology effectively improve the diagnosis and treatment of craniomaxillofacial malformation.Application of rigid internal fixation improves the stability and accuracy of the fracture treatmentand osteotomy. With the research and application of distraction osteogenesis(DO) in craniomaxillofacial surgery, DO in Le Fort III osteotomy and treatment on hemifacialmicrosomiareduce postoperative recurrence significantly. The combination of craniomaxillofacial surgery and advanced technology of related medical and engineering disciplines has promoted the development of craniomaxillofacial surgery.
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PURPOSE: In order to enhance the goal of premedical education, we developed new clinical educational course of surgery for first-grade premedical students. METHODS: In 2015, from September 4th to December 18th, the educational performance records of firstgrade premedical students were evaluated, who attended the new, optional major class Introduction to surgery for future doctors. The non-compliance score was calculated as the sum of the total frequency of absences, number of late arrivals to class, and failure to submit the pre-lecture homework. This score was correlated with students' educational performance records. The premedical students' feed-back about this new class was summarized. RESULTS: Among 79 first-grade premedical students at Yonsei University College of Medicine, 43 premedical students (54.4%) chose to attend the new class. Premedical students' individual non-compliance scores were inversely and significantly correlated to written test performance (R²=0.237, p=0.001). In survey analysis, the mean score for premedical students' course satisfaction was 8.6. They strongly suggested this new educational course should be continued for first-grade premedical students with a mean rating of 9.1. Premedical students were very impressed and satisfied by laparoscopic surgical simulation and visiting the operating room, with ratings of 9.7 and 9.3, respectively. CONCLUSION: This class is the first movement to introduce the surgery to the premedical students in Yonsei University. In spite of their scanty medical knowledge, this clinical class can provide positive influence on educational motivation as premedical students. Further modification of this class is mandatory based on what we learned from this educational experience.
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Humans , Education , Education, Premedical , Motivation , Operating Rooms , Students, PremedicalABSTRACT
Objective To explore the possibility of three-dimensional orbit replications for clinic and teaching of orbital blowout fracture surgical operation.Methods The orbital CT DICOM format data from 10 patients with orbital floor fractures were selected between November 2016 and January 2017 from Wendeng Osteopath Hospital.Thresholding technique,region growing technique,edit mask technique and multiple slice edit technique were used in sequence by Mimics software.And 3D replications were printed by Object 500 3D printer.The sizes of the replications were measured.The model of orbital blowout fracture and surgical implant model were simulated by senior orbital surgeon.Results In the 10 cases,male was 5 cases,and female was 5 eyes.The 3 D replications of the orbits were successfully designed and printed.The sizes of the 3D replications were basically consistent with those of patients' orbits,and there was no statistical difference (all P ＞ O.05).Under operation room surgery simulation environment,the orbital fracture surgical repair operation was demonstrated to the resident by the senior surgeon,3D printing orbital blowout fracture model can be successfully used to simulate the operation and teaching demonstration.Conclusion 3D printing orbital blowout fracture model can restore the true orbital injury and orbital anatomic details,provides the design operation of stereoscopic model for the physician,which has positive significance to understand the scope and surgery teaching simulation of orbital blowout fracture.
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Objective To explore the possibility of three-dimensional (3D) kidney replications for clinical and teaching of percutaneous nephrolithotomy (PCNL).Methods The CT urography (CTU) DICOM format data from 5 patients with kidney calculi were selected from March 1st to June 1st,2015.Thresholding technique,region growing technique,edit mask technique and multiple slice edit technique were used in sequence by Mimics software.And five 3D replications were printed by Object 500 3D printer.The sizes of the replications were measured and the replications were punctured.Results The 3D replications of the kidneys were successfully designed and printed.The average difference of the long axes between 3D replications and patients' kidneys was 0.283cm,the average difference of the diameters was 0.212cm,and the average difference of the diameter of the stones was 0.244cm.The sizes of the 3D replications were basically consistent with those of patients' kidneys.The simulative puncturing was successful.Conclusions After comparing the 3D replications with their original 2D CT images,the anatomical details are found basically the same.The 3D replications could provide 3D visual observations of organ anatomy for surgeons.
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Preoperative surgical simulation in orthognathic surgery has progressed in recent years; the movement of the mandible can be anticipated through three-dimensional (3D) simulation surgery before the actual procedure. In this case report, the mandible was moved to the intended postoperative occlusion through preoperative surgical 3D simulation. Right-side condylar movement change was very slight in the surgical simulation, suggesting the possibility of mandibular surgery that included only left-side ramal osteotomy. This case report describes a patient with a mild asymmetric facial profile in which the mandibular menton had been deviated to the right and the lips canted down to the left. Before surgery, three-dimensional surgical simulation was used to evaluate and confirm a position for the condyle as well as the symmetrical postoperative state of the face. Facial asymmetry was resolved with minimal surgical treatment through unilateral intraoral vertical ramus osteotomy on the left side of the mandible. It would be a valuable complement for the reduction of the surgical treatment if one could decide with good predictability when an isolated intraoral vertical ramus osteotomy can be done without a compensatory osteotomy on the contralateral side.
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Humans , Complement System Proteins , Facial Asymmetry , Lip , Mandible , Orthognathic Surgery , OsteotomyABSTRACT
Computer-assisted spine surgery (CASS) is a new discipline involving application of computer engineering and mechanical engineering to spine surgery. The tools used most commonly include preoperative surgical simulation, intraoperative navigation, and robot-assisted surgery. Surgical simulation has been utilized for both clinical and basic research. Navigation in spine surgery has focused on guidance of screw placement, however, due to limited accuracy and high cost, its use is somewhat sparse. CASS may be combined with minimal invasive spine surgery in the near future. Further validation of clinical accuracy issues and surgical outcomes as well as cost-benefit analysis is required.
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Cost-Benefit Analysis , SpineABSTRACT
Recent advances in fields such as modeling of deformable objects, haptic technologies, immersive technologies, computation capacity and virtual environments have created the conditions to offer novel and suitable training tools and learning methods in the medical area. One of these training tools is the virtual surgical simulator, which has no limitations of time or risk, unlike conventional methods of training. Moreover, these simulators allow for the quantitative evaluation of the surgeon performance, giving the possibility to create performance standards in order to define if the surgeon is well prepared to execute a determined surgical procedure on a real patient.This paper describes the development of a virtual simulator for laparoscopic surgery. The simulator allows the multimodal interaction between the surgeon and the surgical virtual environment using visual and haptic feedback devices. To make the experience of the surgeon closer to the real surgical environment a specific user interface was developed. Additionally in this paper we describe some implementations carried out to face typical challenges presented in surgical simulators related to the tradeoff between real-time performance and high realism; for instance, the deformation of soft tissues are simulated using a GPU (Graphics Processor Unit) -based implementation of the mass-spring model. In this case, we explain the algorithms developed taking into account the particular case of a cholecystectomy procedure in laparoscopic surgery.
Recientes avances en áreas tales como modelación computacional de objetos deformables, tecnologías hápticas, tecnologías inmersivas, capacidad de procesamiento y ambiente virtuales han proporcionado las bases para el desarrollo de herramientas y métodos de aprendizaje confiables en el entrenamiento médico. Una de estas herramientas de entrenamiento son los simuladores quirúrgicos virtuales, los cuales no tienen limitaciones de tiempo o riesgos a diferencia de los métodos convencionales de entrenamiento. Además, dichos simuladores permiten una evaluación cuantitativa del desempeño del cirujano, dando la posibilidad de crear estándares de desempeño con el fin de definir en qué momento un cirujano está preparado para realizar un determinado procedimiento quirúrgico sobre un paciente. Este artículo describe el desarrollo de un simulador virtual para cirugía laparoscópica. Este simulador permite la interacción multimodal entre el cirujano y el ambiente virtual quirúrgico usando dispositivos de retroalimentación visual y háptica. Para hacer la experiencia del cirujano más cercana a la de una ambiente quirúrgico real se desarrolló una interfaz cirujano-simulador especial. Adicionalmente en este artículo se describen algunas implementaciones que solucionan los problemas típicos cuando se desarrolla un simulador quirúrgico, principalmente relacionados con lograr un desempeño en tiempo real mientras se sacrifica el nivel de realismo de la simulación: por ejemplo, la deformación de los tejidos blandos simulados usando una implementación del modelo masa-resorte en la unidad de procesamiento gráfico. En este caso se describen los algoritmos desarrollados tomando en cuenta la simulación de un procedimiento laparoscópico llamado colecistectomía.
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Mentoring/methods , Laparoscopy , Cholecystectomy, Laparoscopic/education , Cholecystectomy, Laparoscopic/instrumentationABSTRACT
Objective: To simulate the surgical approaches for intracranial aneurysms using three-dimensional CT angiography (3D-CTA) ,so as to assess the value of 3D-CTA in the microneurosurgery for ruptured intracranial aneurysms. Methods1 Totally 134 patients with spontaneous subarachnoid hemorrhage caused by ruptured intracranial aneurysm were confirmed by operation. All the patients were examined by CTA before operation and surgical simulation was conducted. Some patients were examined by the pre-operative DSA (digital subtract angiography). The findings of pre-operation CTA,DSA and intra-operative findings were compared and the clinical value of cerebral 3D-CTA was analyzed. Results1 3D-CTA discovered 162 aneurysms out of a total of 163 in 134 patients. The sensitivity and specificity of 3D-CTA for diagnosis of ruptured intracranial aneurysm were 99. 4% and ioo% , respectively. Moreover, pre-operation examination with 3D-CTA clearly displayed the location,size, and shape of aneurysms, the axis direction of the aneurysmatic summits and the width of aneurysmatic neck. Furthermore,the spatial relations between the parent aneurysm artery, the aneurysm, the periphery vessel and bony structures were also demonstrated. These findings were in accordance with the intra-operative findings. There was no rupture during exploration. The Glasgow outcome score was 5 in 85 patients,4 in 22,3 in 17,2 in 6,and 1 in 4. Conclusion1 The conventional pre-operative 3D-CTA examination can simulate surgery for patients with ruptured intracranial aneurysms, and it can help to design the operative approach and improve the successful rate of operation.
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Objective To apply the three-dimensional pre-operative simulation and intra-operative real-time navigation in the reconstruction of old maxillofacial fractures so as to increase the surgical precision. Methods Six patients with old maxillofacial fractures were enrolled, and the diagnosis of unilateral old maxillofacial fractures was confirmed by clinical and imaging examinations. Virtual three-dimensional skull models were reconstructed from pre-operative CT images. The fractured bone was moved or rotated, and was reposed in a desired site according to the mirrored part from the healthy side. After patient-to-image registration, the surgical instruments and patients were tracked in real-time by optical tracking system during operation, and in this way the maxillofacial fractures were reposed satisfactorily guided by the virtual image. Results Three-dimensional simulation before operation and real-time navigation of patients and instruments during operation were realized. The error of registration was less than 1 mm. The post-operative CT examinations of these six patients revealed that the fracture reposition was same to the pre-operative planning, and the difference between them was less than 1.5 mm. The operations were minimally-invasive, with no complications. Conclusion Computer-aided surgical simulation and navigation system can effectively increase the surgical precision of reconstruction of old maxillofacial fractures.