University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
Intermountain Healthcare, 5171 S. Cottonwood Street, Suite 720, Murray, UT, 84107, USA.
World J Urol. 2018 May;36(5):733-743. doi: 10.1007/s00345-018-2260-4. Epub 2018 Mar 15.
Despite the increasing use of advanced 3D imaging techniques and 3D printing, these techniques have not yet been comprehensively compared in a surgical setting. The purpose of this study is to explore the effectiveness of five different advanced imaging modalities during a complex renal surgical procedure.
A patient with a horseshoe kidney and multiple large, symptomatic stones that had failed Extracorporeal Shock Wave Lithotripsy (ESWL) and ureteroscopy treatment was used for this evaluation. CT data were used to generate five different imaging modalities, including a 3D printed model, three different volume rendered models, and a geometric CAD model. A survey was used to evaluate the quality and breadth of the imaging modalities during four different phases of the laparoscopic procedure.
In the case of a complex kidney procedure, the CAD model, 3D print, volume render on an autostereoscopic 3D display, interactive and basic volume render models demonstrated added insight and complemented the surgical procedure. CAD manual segmentation allowed tissue layers and/or kidney stones to be made colorful and semi-transparent, allowing easier navigation through abnormal vasculature. The 3D print allowed for simultaneous visualization of renal pelvis and surrounding vasculature.
Our preliminary exploration indicates that various advanced imaging modalities, when properly utilized and supported during surgery, can be useful in complementing the CT data and laparoscopic display. This study suggests that various imaging modalities, such as ones utilized in this case, can be beneficial intraoperatively depending on the surgical step involved and may be more helpful than 3D printed models. We also present factors to consider when evaluating advanced imaging modalities during complex surgery.
尽管越来越多地使用先进的 3D 成像技术和 3D 打印技术，但这些技术在手术环境中尚未得到全面比较。本研究的目的是探讨在复杂肾脏手术过程中使用五种不同的先进成像方式的效果。
使用一位马蹄肾和多个大的、有症状的结石患者，这些结石经体外冲击波碎石术（ESWL）和输尿管镜治疗失败，用于本评估。使用 CT 数据生成五种不同的成像方式，包括 3D 打印模型、三种不同的体积渲染模型和几何 CAD 模型。使用问卷调查评估在腹腔镜手术的四个不同阶段中五种成像方式的质量和广度。
在复杂的肾脏手术中，CAD 模型、3D 打印、自动立体 3D 显示器上的体积渲染、交互和基本体积渲染模型提供了额外的见解，并补充了手术过程。CAD 手动分割允许组织层和/或肾结石被制成彩色半透明，使在异常血管中更容易导航。3D 打印允许同时可视化肾盂和周围血管。
我们的初步探索表明，各种先进的成像方式，在手术中正确使用和支持，可以补充 CT 数据和腹腔镜显示。本研究表明，各种成像方式，如本案例中使用的方式，根据所涉及的手术步骤，在手术过程中可能是有益的，并且可能比 3D 打印模型更有帮助。我们还提出了在复杂手术中评估先进成像方式时需要考虑的因素。
