Lopez Pauline, Belgacem Alexis, Sarnacki Sabine, Arnaud Alexis, Houari Jenna, Piguet Christophe, Baudouin Maxime, Fourcade Laurent, Lauvray Thomas, Ballouhey Quentin
Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, Limoges Cedex, France.
Service de Chirurgie Pédiatrique Viscérale, Urologique et Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.
Front Pediatr. 2024 May 7;12:1386280. doi: 10.3389/fped.2024.1386280. eCollection 2024.
INTRODUCTION: Preoperative three-dimensional (3D) reconstruction using sectional imaging is increasingly used in challenging pediatric cases to aid in surgical planning. Many case series have described various teams' experiences, discussing feasibility and realism, while emphasizing the technological potential for children. Nonetheless, general knowledge on this topic remains limited compared to the broader research landscape. The aim of this review was to explore the current devices and new opportunities provided by preoperative Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI). METHODS: A systematic review was conducted to screen pediatric cases of abdominal and pelvic tumors with preoperative 3D reconstruction published between 2000 and 2023. DISCUSSION: Surgical planning was facilitated through virtual reconstruction or 3D printing. Virtual reconstruction of complex tumors enables precise delineation of solid masses, formulation of dissection plans, and suggests dedicated vessel ligation, optimizing tissue preservation. Vascular mapping is particularly relevant for liver surgery, large neuroblastoma with imaging-defined risk factors (IDRFs), and tumors encasing major vessels, such as complex median retroperitoneal malignant masses. 3D printing can facilitate specific tissue preservation, now accessible with minimally invasive procedures like partial nephrectomy. The latest advancements enable neural plexus reconstruction to guide surgical nerve sparing, for example, hypogastric nerve modelling, typically adjacent to large pelvic tumors. New insights will soon incorporate nerve plexus images into anatomical segmentation reconstructions, facilitated by non-irradiating imaging modalities like MRI. CONCLUSION: Although not yet published in pediatric surgical procedures, the next anticipated advancement is augmented reality, enhancing real-time intraoperative guidance: the surgeon will use a robotic console overlaying functional and anatomical data onto a magnified surgical field, enhancing robotic precision in confined spaces.
引言：使用断层成像进行术前三维（3D）重建在具有挑战性的儿科病例中越来越多地用于辅助手术规划。许多病例系列描述了不同团队的经验，讨论了可行性和真实性，同时强调了该技术对儿童的潜力。尽管如此，与更广泛的研究领域相比，关于这一主题的一般知识仍然有限。本综述的目的是探讨术前计算机断层扫描（CT）或磁共振成像（MRI）提供的当前设备和新机遇。 方法：进行了一项系统综述，以筛选2000年至2023年间发表的具有术前3D重建的小儿腹部和盆腔肿瘤病例。 讨论：通过虚拟重建或3D打印促进了手术规划。复杂肿瘤的虚拟重建能够精确描绘实体肿块，制定解剖计划，并建议进行专门的血管结扎，以优化组织保留。血管造影对于肝脏手术、具有影像学定义风险因素（IDRFs）的大型神经母细胞瘤以及包裹主要血管的肿瘤（如复杂的腹膜后正中恶性肿块）尤为重要。3D打印可以促进特定组织的保留，现在通过部分肾切除术等微创手术即可实现。最新进展使神经丛重建能够指导手术中保留神经，例如下腹神经建模，通常与大型盆腔肿瘤相邻。新的见解将很快将神经丛图像纳入解剖分割重建中，这得益于MRI等非辐射成像方式。 结论：尽管尚未在小儿外科手术中发表，但下一个预期的进展是增强现实，以增强实时术中指导：外科医生将使用机器人控制台将功能和解剖数据叠加到放大的手术视野上，提高机器人在受限空间中的精度。
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