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@#With the development of computer-aided surgery and rapid prototyping via 3D printing technology, digital surgery has rapidly advanced in clinical practice, especially in the field of oral and maxillofacial surgery. 3D printing technology has been applied to the functional restoration and reconstruction of the jawbone. Before surgery, a 3D digital model is constructed through software to plan the scope of the osteotomy, shape the bone graft and plan the placement of the implant. Additionally, 3D models of personalized surgical instrument guides are printed prior to surgery. With these 3D-printed models and guides, accurate excision of the jaw tumor, accurate placement of the grafted bone and precise placement of implants can be achieved during surgery. Postoperative evaluation of accuracy and function shows that 3D printing technology can aid in achieving the biomechanical goals of simultaneous implant placement in jaw reconstruction, and in combination with dental implant restoration, the technology can improve patients' postoperative occlusal and masticatory functions. Nevertheless, 3D printing technology still has limitations, such as time-consuming preparation before surgery. In the future, further development of 3D printing technology, optimization of surgical plans, and alternative biological materials are needed. Based on domestic and foreign literature and our research results, we have reviewed the process and clinical application prospects of jaw reconstruction via 3D printing technology to provide a reference for oral and maxillofacial surgeons.
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Objective@#To explore the clinical application value of mixed reality technology in locating perforator vessels and assisting perforator vessel dissection to harvest anterolateral thigh flaps.@*Methods@#Six patients who needed anterolateral thigh flap repair after resection of oral and maxillofacial tumors were recruited from the Department of Oral and Maxillofacial Surgery of Nanchong Central Hospital from January 2020 to January 2021. Before surgery, the CT angiography data of the lower limbs of the patients carrying the calibration points were imported into the data workstation to perform 3D reconstruction of the perforator vessels and surrounding tissues of the thigh, and the reconstruction results were imported into Microsoft HoloLens 2 glasses. During the operation, calibration was performed at the calibration point of the operative area so that the preoperative reconstruction results were superimposed on the operative area through Microsoft HoloLens 2 glasses. The clinical application value of mixed reality technology assisted perforator vessel location and anatomy of anterolateral femoral perforator flap was discussed from six aspects: whether the perforator vessel was reconstructed preoperatively, intraoperative calibration time, whether the actual position of the perforating vessels passing through the fascia lata fulcrum deviated from the preoperative reconstruction result within 1 cm, time required to harvest the flap, and whether the actual route of the perforator vessel was consistent with the reconstruction result, and whether the postoperative flap survived.@*Results @# The position and course of perforating vessels were successfully reconstructed in 6 cases before the operation. The actual course of perforating vessels during the operation was consistent with the reconstruction results. The deviation between the actual position of the perforating points and the preoperative reconstruction results was within 1 cm, which met the requirements of the actual asisting of the anterolateral thigh flap. The average time of flap harvest was (70.50 ± 7.20) min. The average calibration time was (13.33 ± 5.50) min. All flaps survived.@* Conclusions @# Mixed reality technology projects the reconstruction results of anterolateral femoral perforator vessels directly into the operative area, which provides a new method for asisting localization and anatomy of anterolateral femoral flap perforator vessels and reduces the possibility of injury to perforator vessels.
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Objective @#To analyze the value of virtual surgical planning in the surgical treatment of osteoradionecrosis of the mandible and to provide a reference for clinical practice.@*.Methods @#From September 2017 to June 2018, 13 patients with mandibular osteoradionecrosis were evaluated preoperatively using the 3D virtual surgery software CMF Proplan 2.0. The surgical guide was designed and 3D printed. Bone resection, fibula shaping and bone graft localization were completed during the operation. In some cases, implants were implanted at the same time, and denture restoration was completed 3 to 6 months after surgery. Patients’ general information, perioperative data, and efficacy evaluation were analyzed.@*Results@#All patients underwent surgery successfully. The survival rate of the free fibula musculocutaneous flap was 100% (13/13), and one patient had complications (partial necrosis at the edge of the flap). The follow-up period was 7 to 15 months, and the median time was 10 months. All patients achieved a healing effect. The number of cases with an increase in mouth opening ≥ 1 cm, 0.5 cm ≤ mouth opening increase < 1 cm, and mouth opening increase < 0.5 cm were 5, 6, and 2, respectively. An imaging examination showed that 12 patients had good bone healing, and 1 patient did not completely heal 7 months after operation. The denture restoration was 92.3% (12/13), of which 3 cases were implanted and repaired at the same time. The average chewing efficiency was 56.11% ± 7.12% (42.03%-67.83%).@*Conclusion@#Virtual surgical planning is an effective method for the surgical treatment of mandibular osteoradionecrosis, which can reduce the risk of surgery and more effectively perform mandibular shape and function repair.
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Objective@#To review the clinical data of patients who underwent maxillary and mandibular reconstruction with vascularized fibula osteomycutaneous flap, using virtual surgery planning.@*Methods@#From January 2012 to December 2016, 23 patients with mandibular defect and 2 patients with maxillary defect were treated in our department. In virtual surgery planning, the optimal osteotomy line and angle were designed. Segmental maxillectomy and mandibulectomy, as well as mandibular reconstruction were performed using guided templates to practice the virtual planning.Actual reconstruction results were compared with those of virtual surgery.@*Results@#Among the 25 patients, 2 patients were repaired with the ipsilateral fibula myocutaneous flap, 22 patients were lateral fibula myocutaneous flap. One case of maxillary type Ⅱd defect was repaired with left fibular muscle flap. All patients were followed up for 12 to 48 months. Satisfied bony unions and occlusion were observed in 25 patients.All patients reported excellent or good facial appearance. One of them received dental implants at 1 year postoperatively.@*Conclusions@#An ideal contour of maxilla and mandible can be obtained using vascularized fibula osteomycutaneous flap in virtual surgery.
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Objective@#To summarize the effect of simultaneous orthognathic surgery along with mandibular ramus reconstruction using costochondral graft, for adult M3 hemifacial macrosomia.@*Methods@#From November 2015 to October 2017, 5 adults diagnosed with M3 hemifacial macrosomia were treated. There were 3 males and 2 females, aged from 19 to 26 years. Le Fort Ⅰ osteotomy and SSRO with simultaneous mandibular ramus reconstruction using contralateral sixth or seventh costochondral graft was performed to correct the facial asymmetry and occluding relation. The data of clinical examination and CTs were collected at the time point of immediately postoperative, 1, 3, 6, 12 months after surgery. The facial symmetry, joint function, occlusion and 3D measurements in CT image reconstruction were analysed to evaluate the surgery outcome.@*Results@#The length of rib and costal cartilage ranged from 47 mm to 67 mm. All the costal cartilage grafts survived, and 4 patients got primary healing. All patients were followed for 2-13 months (with the mean follow-up of 8 months). The ratio of ramus length of affected side to normal side was over 80%. The occlusion was stable. The facial structures were satisfactory after 6 months.@*Conclusions@#Orthognathic surgery with simultaneous mandibular ramus reconstruction using costochondral graft is suitable for the adult severe hemifacial macrosomia, with satisfactory cosmetic and functional results. This method is easily performed with reliable graft survival rate, aesthetic facial structure and stable occlusion.
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In recent years, the virtual surgery training system with force feedback has provided a new way for young doctors to improve their surgical skills in a safe, efficient and flexible training method. Precise drilling force and realistic hand feeling of manipulation are the cruxes in the virtual surgery training, and the accurate simulation of bone drilling depends on the accurate establishment of drilling force prediction model. The establishment of force prediction model with finite element analysis is the key part in the development of virtual training system. In this paper, the current research status of finite element analysis of bone drilling presented in four aspects: bone model reconstruction, material model, mesh model and prediction of drilling force, especially the construction of bone tissue material model is discussed in detail and several important models are analyzed. This paper presented a relatively complete overview of the approaches commonly used in this research field to promote the establishment of more accurate force prediction models of bone drilling.
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Objective: To investigate the application effect of prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap in repairing and remodeling mandibular defects. Methods: This study is a prospective study, and 50 patients with mandibular tumor were enrolled in the research. And all of them were divided into observation group (25 cases) and control group (25 cases). The patients of observation group were implemented precise remodeling of mandible by using prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap, and that of control group were implemented remodeling of mandible by using virtual surgery assisted to vascularized iliac bone-muscular flap. And the occurrences of surgical effect and adverse reaction between the two groups were compared and analyzed. Results: The surgical effect of observation group (24 cases, 96%) was significantly higher than that of control group (20 cases, 80%) (x2=10.951, P<0.05). And the adverse reaction rate of observation group (5 cases, 20%) was significantly lower than that of control group (13 cases, 52%) (x2=10.624, P<0.05). Conclusion:Prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap can obtain better effect in repairing and reconstructing mandibular defects, and its postoperative adverse reactions are less.
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Objective To investigate the application value of three-dimensional (3D) reconstruction virtual surgery planning in the surgical treatment of hilar cholangiocarcinoma.Methods The retrospective crosssectional study was conducted.The clinical data of 36 patients with hilar cholangiocarcinoma who were admitted to the First Affiliated Hospital of Fujian Medical University between January 2014 and September 2017 was collected.Before operation,images of 3D virtual surgery planning were respectively reconstructed and determined using IQQA-Liver imaging analysis system,and then precise resection of tumor was performed based on results of virtual surgical planning and intraoperative conditions.Observation indicators:(1) virtual surgical planning;(2) surgical and postoperative situations;(3) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival and tumor recurrence or metastasis up to November 2017.Measurement data with normal distribution were represented as (x)±s.Comparison between indicator of preoperative virtual surgical planning and surgical indicators was analyzed by the t test.The postoperative survival time was calculated by the Kaplan-Meier method.Results (1) Virtual surgical planning:36 patients accomplished 3D visualization reconstruction and virtual surgical planning.Three D visualization reconstruction clearly showed adjacent relationship between tumor size and surrounding vessels or bile duct space.Type Ⅱ,Ⅲ a,Ⅲb and Ⅳ of Bismuth-Corlette Classification were detected in 2,13,14 and 7 patients by 3D visualization system,respectively.The tumor volume,whole liver volume,predicted liver resection volume and remnant liver volume were respectively (76± 26) mL,(1 319± 306) mL,(588± 128) mL and (731± 269) mL.(2) Surgical and postoperative situations:of 36 patients,16,12,5 and 3 patients underwent left hemigepatectomy,right hemigepatectomy,extended left hemigepatectomy and extended right hemigepatectomy,respectively,and all of them were combined with caudate lobectomy of liver.Combined resection and reconstruction of hepatic artery,combined wedge resection and repair of the portal vein and combined end-to-end anastomosis after resection of the portal vein were detected in 1,2 and 1 patients,respectively.Operation time and volume of intraoperative blood loss of 36 patients were respectively (368± 134)minutes and (474±288)mL.Thirty-six patients with postoperative complications were cured by conservative treatment,including 3 with pulmonary infection,3 with intra-abdominal infection and 2 with intra-abdominal lymphatic fistula.Duration of hospital stay of 36 patients was (19±7) days.Type Ⅱ,Ⅲ a,Ⅲ b and Ⅳ of postoperative Bismuth-Corlette Classification were detected in 2,11,13 and 10 patients,respectively.Accuracy of tumor classification through 3D visualization reconstruction was 91.7％ (33/36).Actual liver resection volume of 36 patients was (551± 141)mL,and was not significantly different from predicted liver resection volume (t =1.148,P＞0.05).(3) Follow-up and survival:31 of 36 patients were followed up for 2-39 months after surgery,with a median time of 16 months.The postoperative median survival time was 13 months,and 9 patients had tumor recurrence or metastasis during the follow-up.Conclusion The 3D reconstruction virtual surgery planning can accurately complete the preoperative evaluation,meanwhile,it can also provide important reference for the surgical therapy of hilar cholangiocarcinoma.
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In recent years,the virtual surgery training system with force feedback has provided a new way for young doctors to improve their surgical skills in a safe,efficient and flexible training method.Precise drilling force and realistic hand feeling of manipulation are the cruxes in the virtual surgery training,and the accurate simulation of bone drilling depends on the accurate establishment of drilling force prediction model.The establishment of force prediction model with finite element analysis is the key part in the development of virtual training system.In this paper,the current research status of finite element analysis of bone drilling presented in four aspects:bone model reconstruction,material model,mesh model and prediction of drilling force,especially the construction of bone tissue material model is discussed in detail and several important models are analyzed.This paper presented a relatively complete overview of the approaches commonly used in this research field to promote the establishment of more accurate force prediction models of bone drilling.
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Objective To study the clinical value of virtual segmentectomy based on three-dimensional computed tomography bronchography and angiography (3D-CTBA) in thoracoscopic segmentectomy for early-stage lung cancer. Methods Totally 18 patients received thoracoscopic segmentectomy from July 2015 to July 2016 were performed virtual segmentectomy based on 3D-CTBA. The preoperative planning depended on the simulation result. Results All of the 18 cases(1 right Sl, 2 right S3, 3 right S6, 1 right S8 +9, 1 right S9 + 10, 3 left S1 +2 +3, 3 left S4 +5, 4 left S6 segmentectomies)were received thoracoscopic segmentectomy successfully. The mean operation time and intraoperative blood loss were (126.8士19.4) mins and(76.6±21.4) ml respectively. Pathological examination revealed no residual tumor cells at the surgical margins and no lymph node metastases in any patients. The actual surgical margins were all larger than 2 cm(2.37±0.39)cm. Conclusion Virtual segmentectomy based on 3D-CTBA can non-invasively visualize the relationship between the safe margin and segmental vessels and bronchi. It facilitates the preoperative planning of suitable segmentectomy procedure for patients with early-stage lung cancer.
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Objective @#To review the patients who underwent accurate maxillary and mandibular reconstruction with vascularized osteomyocutaneous flap using virtual surgery and evaluate the postoperative results.@*Methods@# From June of 2009 to December of 2014, ninety-four patients were treated in our department. In virtual surgical planning, maxillectomy and mandibulectomy were simulated and donor site bone was superimposed mirror image of normal maxilla and mandible to complete accurate maxillary and mandibular reconstruction. Maxillectomy, mandibulectomy and bone reconstruction were performed using stereomodels and guided templates to replicate the virtual planning. Actual reconstruction result was compared with that of virtual surgery. The patients were asked to assess their satisfaction with facial appearance at 1 year postoperatively. @*Results@#Good bony unions and occlusion were observed in 94 patients. The actual results were basically in accordance with that of virtual surgery. The actual deviation between postoperative CT and preoperative virtual surgical planning was no more than 1 mm matched by computer software. All patients reported their facial appearance were excellent or good at 1 year postoperatively.@*Conclusion@#The ideal contour of neomaxilla and neomandible and good function with dental rehabilitation can be gained after accurate maxillary and mandibular reconstruction with vascularized osteomyocutaneous flap using virtual surgery.
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Recently, virtual reality (VR) and augmented reality (AR) have received increasing attention, with the development of VR/AR devices such as head-mounted displays, haptic devices, and AR glasses. Medicine is considered to be one of the most effective applications of VR/AR. In this article, we describe a systematic literature review conducted to investigate the state-of-the-art VR/AR technology relevant to plastic surgery. The 35 studies that were ultimately selected were categorized into 3 representative topics: VR/AR-based preoperative planning, navigation, and training. In addition, future trends of VR/AR technology associated with plastic surgery and related fields are discussed.
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Anteojos , Vidrio , Plásticos , Cirugía PlásticaRESUMEN
Virtual reality technology and force feedback technology are novel human-machine interaction technologies. The virtual surgery simulation training system combined with these two technologies provides a new method for orthopedic surgery training, which can improve the training efficiency,thereby reducing the training costs and shortening the growth cycle of young orthopedic surgeons. In recent years, the virtual drilling bone surgery simulation technology have been researched broadly and obtained a preliminary application. In this paper, the existing research statusof virtual bone drilling operation depended on visuo-haptic techniques were studied, classified and summarized, the main content focused on three key techniques: bone modeling, drilling bone force prediction model and tactile simulation, and then analyzed the advantages and disadvantages of existing methods. Finally,some perspectives for related technology development trend of the virtual simulation bone drilling surgery in future was pointed out.
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Objective To explore the feasibility of constructing three-dimensional model after the unicompartmental knee arthroplasty using the point-to-point image registration technology,so as to provide experimental basis for further application and optimization.Methods Patients of medial compartment knee osteoarthritis undergoing UKA were chosen and their postoperative three-dimensional knee models were established based on the MRI and CT scans.The virtual prosthetic replacement and finite element models were constructed using point-to-point image registration technology,and the kinematic changes were analyzed.Results The complete postoperative three-dimensional knee models of UKA were established,and the kinematic charateristics were similar to those conducted in traditional methods.Conclusion The virtual surgery can be performed using the point-to-point image registration technology,and it is both easier and more convenient than the traditional methods.
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Virtual reality technology is a kind of information technology,which can achieve the interaction between the users and the virtual environment by using relevant devices.This article introduces the application and validity of virtual reality technology in surgery of orthopedics,general surgery,neurosurgery and urology surgery and surgical training.It discusses the advantages and disadvantages and development prospects of the virtual reality technology in the field of surgery and surgical training as well.
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Objective To record the drilling feed force on different layers of fresh porcine femur, so as to provide reference for collecting and outputting the feedback signals of drilling feed force for orthopedic virtual surgery system. Methods The biological bone drilling feed force testing system was established by modifying the universal material testing machine and adjustable speed electric drill (drill bit Φ5.0 mm). The feed forces on 6 fresh porcine femoral shafts with a total of 162 drilling markers were collected at 3 different rotate speeds (n＝500, 800, 1 200 r/min) and 3 feed speeds (v＝30, 50, 70 mm/min), and their variation with corresponding tissues and locations were also analyzed. Results At the same drill marker of the fresh porcine femur, the drilling feed force on bilateral cortical bone was the largest (fmax＝103.63~142.59 N), while that on marrow cavity was the smallest, which was almost close to zero, and the drilling feed force on the middle part (f4,5,6＝124.69 N) was larger than that at two ends (f1,2,3,7,8,9＝121.84 N); the drilling feed force was smallest (f＝106.04 N) at v＝30 mm/min, n＝1 200 r/min, while the largest drilling feed force (fmax＝139.84 N) appeared at v＝70 mm/min、n＝500 r/min. Conclusions The modified drilling feed force testing system could efficiently collect the biological bone drilling data. The drilling feed force had a close relationship with bone structure, feed speed and rotate speed of electric drill as well. A larger bone density, smaller rotate speed of electric drill and higher feeding speed would lead to a larger drilling feed force, and vice versa. The accurate drilling feed force data and its variation tendency on porcine femoral obtained in this experiment could provide a reliable basis for force-feedback signal output in the virtual orthopedic surgery system.
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Virtual technology of cardiovascular interventional surgery can be used for surgical training, surgical navigation, surgical optimization and postoperative evaluation in cardiovascular interventional procedures. In this paper, the composition of virtual cardiovascular interventional operation system was introduced, and the research status of virtual cardiovascular interventional operation both at home and abroad was discussed, including detailed analysis on working principles of several representative products. Through the intensive study on force feedback used as the key techniques in virtual cardiovascular interventional surgery, the author investigated its future development as well as how to improve the training effect and success rate of cardiovascular interventional operation.
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Objective To establish a set of digital robot-aided surgery system to represent the real surgery process, and realize robot control and force feedback in virtual environment by digital human tissue simulation combined with outer force feedback instrument. Methods The digital robot aided-surgery system design includes human tissue biomechanical modeling, biomechanical model calculation, force feedback instrument design, control algorithm, digital robot-aided surgery system based on biomechanical information. Results After local area network was successfully connected between haptic device control system and virtual environment, the system completed closed-loop information transfer process. Conclusions The robot-aided surgery system can realize the master-slave control, visual feedback and force feedback in virtual environment, which will contribute to the development of digital surgery simulation technology and gain advantages in the aspects of improving surgery success rate and training new doctors.
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Objective To conduct the operation of capture and deformation in virtual three-dimensional (3D) environment with force feedback device and simulate the coronary artery bypass operation. Methods Based on data collected from real CT images of the patient with heart disease, digitized visual model of the heart was reconstructed. Then the bypass vessel was built and the vessel model was sculptured by force feedback device to simulate the bypass surgery from pulmonary artery to ventriculus dexter in Fontan operation. Results Space structure of the heart was shown in the virtual 3D reconstructed environment. Bypass vessel with any diameter and angle was transformed to simulate the coronary artery bypass operation. Heart patch with any size was built to repair the heart model. The satisfactory model and parameters of the postoperative model were finally achieved. Conclusions The application of force feedback device in virtual coronary artery bypass operation sets the stage for cardiovascular surgery planning system with mechanical characteristics to simulate multiple modalities of such operation.
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