ObjectiveTo observe the clinical efficacy of digital 3D heads-up display viewing system (3D viewing system) and intraoperative OCT (iOCT) in vitrectomy for myopic foveoschisis (MF).MethodsA retrospective, consecutive case series. From October 2018 to May 2019, Nineteen eyes of 19 consecutive patients with MF diagnosed in Xiamen Eye Center of Xiamen University who underwent vitrectomy were included in this study. There were 7 males and 12 females, with the mean age of 54.47±11.38 years. The average axial length was 30.40±2.30 mm, the mean logMAR BCVA was 0.56±0.31, the mean central foveal thickness (CFT) was 317.80±151.9.32 μm, the mean max retinal thickness (maxRT) was 556.7±143.7 μm. All the surgeries performed combined with 3D viewing system with iOCT. The standard 25G pars planar vitrectomy were performed with removing the posterior vitreous and indocyanine green (ICG) staining of internal limiting membrane (ILM) and air-fluid exchange. Thirteen of 19 eyes underwent fovea-sparing ILM peeling and the other 6 eyes not. The average follow-up was 4.2±1.4 months. All the patients were on regular follow-up to document the changes on BCVA, anatomical changes in macula, CFT and maxRT. Paired t test was used to compare BCVA, CFT and maxRT before and after surgery.ResultsThe fine images of macula were clearly shown on the 3D viewing system in all eyes. The electronic green filter enhanced the contrast sensitivity of ICG stained images. Clear images of macula were captured by iOCT in all eyes. The average surgical time was 35.5±8.2 min. On the last follow-up, 16 of 19 eyes with MF resolved. The mean CFT was 178.5±103.5 μm, the maxRT was 341.8±83.8.16 μm, and the mean logMAR BCVA was 0.35±0.22. The differences of CFT, maxRT and logMAR BCVA before and after surgery were statistically significant (t=4.181, 7.154, 5.129; P＜0.001). Minimal invisible full thickness macular hole were detected in 2 eyes by iOCT and repaired with auto serum or ILM flap covering. There was no complication associated with the 3D viewing system.Conclusions3D viewing system provides improved contrast and crystal clear macular image stain with ICG in pathological myopia. iOCT can detect the minimal invisible full thickness macular hole during surgery. Both may contribute to improved MF closure rate and BCVA.
ObjectivesTo systematically review the efficacy and safety of 3D laparoscopic in the treatment of colorectal cancer.MethodsPubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were electronically searched online to collect clinical trials of 3D laparoscopic in the treatment of colorectal cancer from inception to September 1st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 26 trials, including 4 randomized controlled trials and 22 cohort studies were included. The results of meta-analysis showed that: compared with 2D laparoscopic, 3D laparoscopic had shorter operative time (MD=–16.32, 95%CI –22.61 to –10.03, P<0.000 01), less amount of blood transfusion in operation (MD=–10.80, 95%CI –19.93 to –1.66, P=0.02), more lymph node dissection (MD=0.88, 95%CI 0.30 to 1.45, P=0.003), shorter recovery time of gastrointestinal function (MD=–0.18, 95%CI –0.31 to –0.04, P=0.01), lower incidence of postoperative complication (OR=0.63, 95%CI 0.44 to 0.89, P=0.009), and fewer days in hospital (MD=–0.84, 95%CI –1.40 to –0.28, P=0.003). Additionally, there was no significant difference in hospitalization costs (MD=–0.01, 95%CI –0.23 to 0.21, P=0.94).ConclusionsCurrent evidence shows that, compared with 2D laparoscopy, 3D laparoscopy assisted colorectal cancer surgery has obvious advantages such as less bleeding during operation, shorter operation time, lower incidence of complications after operation, shorter hospitalization time and no increase in hospitalization expenses. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo investigate the safety and efficacy of 3D single-portal inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer.MethodsClinical data of 28 patients, including 25 males and 3 females, aged 51-76 years, with esophageal squamous cell carcinoma undergoing single-portal inflatable mediastinoscopic and laparoscopic esophagectomy from June 2018 to June 2019 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods including a 3D mediastinoscopic group (3D group, 10 patients) and a 2D mediastinoscopic group (2D group, 18 patients). The perioperative outcome of the two groups were compared.ResultsCompared with the 2D group, the 3D group had shorter operation time (P=0.017), more lymph nodes resected (P=0.005) and less estimated blood loss (P=0.015). There was no significant difference between the two groups in the main surgeon's vertigo and visual ghosting (P>0.05). The other aspects including the indwelling time, postoperative hospital stay, pulmonary infection, arrhythmia, anastomotic fistula, recurrent laryngeal nerve injury were not statistically significant between the two groups (P>0.05).ConclusionThe 3D inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer, which optimizes the surgical procedures of 2D, is safe and feasible, and is worthy of clinical promotion in the future.
Integrating visualization toolkit and the capability of interaction, bidirectional communication and graphics rendering which provided by HTML5, we explored and experimented on the feasibility of remote medical image reconstruction and interaction in pure Web. We prompted server-centric method which did not need to download the big medical data to local connections and avoided considering network transmission pressure and the three-dimensional (3D) rendering capability of client hardware. The method integrated remote medical image reconstruction and interaction into Web seamlessly, which was applicable to lower-end computers and mobile devices. Finally, we tested this method in the Internet and achieved real-time effects. This Web-based 3D reconstruction and interaction method, which crosses over internet terminals and performance limited devices, may be useful for remote medical assistant.
ObjectiveTo investigate the safety and efficacy of 3D thoracoscopic surgery in uniportal lobectomy.MethodsClinical data of 248 patients with lung cancer who underwent uniportal thoracoscopic lobectomy in our hospital from September 2018 to May 2019 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods, a 3D thoracoscopic group (76 patients, including 52 males and 24 females with an average age of 58.59±7.62 years) and a 2D thoracoscopic group (172 patients, including 102 males and 70 females with an average age of 57.75±8.59 years). Statistical analysis of clinical and pathological data, lymph node dissection, surgical complications, postoperative hospital stay, etc was performed.ResultsCompared with the 2D thoracoscopic group, the 3D thoracoscopic group had shorter operation time, more lymph nodes dissected and pleural effusion on the first day after operation (P<0.05). There was no significant difference in the postoperative chest tube duration, postoperative hospital stay, incidence of pulmonary infection, arrhythmia, bronchopleural fistula, or recurrent laryngeal nerve injury between the two groups.ConclusionCompared with the traditional 2D thoracoscopic minimally invasive surgery, uniportal lobectomy with 3D thoracoscopic surgery is safer and more efficient during operation, and lymph node dissection is more thorough, which is worth promoting.
ObjectiveTo explore the safety and feasibility of 3D precise localization based on anatomical markers in the treatment of pulmonary nodules during video-assisted thoracoscopic surgery (VATS).MethodsFrom June 2019 to April 2015, 27 patients with pulmonary nodules underwent VATS in our Hospital were collected in the study, including 3 males and 24 females aged 51.8±13.7 years. The surgical data were retrospectively reviewed and analyzed, such as localization time, localization accuracy rate, pathological results, complication rate and postoperative hospital stay.ResultsA total of 28 pulmonary nodules were localized via this method. All patients received surgery successfully. No mortality or major morbidity occurred. The general mean localization time was 17.6±5.8 min, with an accuracy of 96.4%. The mean diameter of pulmonary nodules was 14.0±8.0 mm with a mean distance from visceral pleura of 6.5±5.4 mm. There was no localization related complication. The mean postoperative hospital stay was 6.7±4.3 d. The routine pathological result showed that 78.6% of the pulmonary nodules were adenocarcinoma.Conclusion3D precise localization based on anatomical markers in the treatment of pulmonary nodules during thoracoscopic surgery is accurate, safe, effective, economical and practical, and it is easy to master with a short learning curve.
Objective To compare the effect of three-dimensional visual (3DV) model, three-dimensional printing (3DP) model and computer-aided design (CAD) modified 3DP model in video-assisted thoracoscopic surgery (VATS) sublobular resection. MethodsThe clinical data of patients who underwent VATS sublobular resection in the Affiliated Hospital of Hebei University from November 2021 to August 2022 were retrospectively analyzed. The patients were divided into 3 groups including a 3DV group, a 3DP group and a CAD-3DP group according to the tools used. The perioperative indexes and subjective evaluation of operators, patients and their families were compared. ResultsA total of 22 patients were included. There were 5 males and 17 females aged 32-77 (56.95±12.50) years. There were 9 patients in the 3DV group, 6 patients in the 3DP group, and 7 patients in the CAD-3DP group. There was no statistical difference in the operation time, intraoperative blood loss, drainage volume, hospital stay time or postoperative complications among the groups (P>0.05). Based on the subjective evaluations of 4 surgeons, the CAD-3DP group was better than the 3DV group in the preoperative planning efficiency (P=0.025), intuitiveness (P=0.045) and doctor-patient communication difficulty (P=0.034); the CAD-3DP group was also better than the 3DP group in the overall satisfaction (P=0.023), preoperative planning difficulty (P=0.046) and efficiency (P=0.014). Based on the subjective evaluations of patients and their families, the CAD-3DP group was better than the 3DP group in helping understand the vessel around the tumor (P=0.016), surgical procedure (P=0.020), procedure selection (P=0.029), and overall satisfaction (P=0.048); the CAD-3DP group was better than the 3DV group in helping understand the tumor size (P=0.038). ConclusionCAD-modified 3DP model has certain advantages in pre-planning, intraoperative navigation and doctor-patient communication in the VATS sublobectomy.
The orthopedic bone tumor section is a difficult and key point in clinical teaching. 3D disease models have become a new tool for teaching clinical difficulties due to their intuitive and visual advantages. At present, in the standardized residents training clinical teaching of bone tumors, diversified teaching modes have accumulated a lot of experience, and the combination of 3D disease models can provide new strategies for clinical teaching of bone tumors. Therefore, this article introduces the current situation of clinical teaching in orthopedics, the current situation and challenges of bone tumor teaching, and the exploration and practice of using diversified teaching modes combined with 3D disease models at West China Hospital of Sichuan University, aiming to improve the quality of standardized residents training bone tumor teaching.
Objective To explore the early clinical effect of 3D printing external fixed guide combined with video-assisted thoracic surgery (VATS) in the treatment of flail chest, and to provide evidence for the promotion of this technology. Methods Patients with flail chest treated in our hospital from January 2010 to January 2023 were retrospectively selected as the study objects. The trial group was treated with 3D printed external fixation guide combined with VATS, and the control group was treated with open reduction internal fixation. Operation time, intraoperative blood loss, closed thoracic drainage time, thoracic volume recovery, visual analogue scale (VAS) score 1 month after surgery and complications were compared between the two groups. Results A total of 40 patients were included, 20 in each group. In the experimental group, there were 13 males and 7 females, with an average age of 45.7±3.8 years. In the control group, there were 14 males and 6 females, with an average age of 47.3±4.1 years. There was no statistical difference in gender, age, number of rib fractures or VAS between the two groups (P>0.05). The surgery was successful in both groups, the wounds healed in stage Ⅰ, and the pain symptoms were significantly reduced. No postoperative complications occurred in the trial group, while chronic pain occurred in 1 patient, fracture malunion occurred in 1 patient and incision infection occurred in 1 patient in the control group, with a complication rate of 15.0%. Operation time, intraoperative blood loss and closed thoracic drainage time in trial group were lower than those in control group (P<0.05). There was no statistical difference in the recovery of thoracic volume and VAS at 1 month after operation (P>0.05). Conclusion 3D printing external fixation guide combined with VATS in the treatment of flail chest has satisfactory early curative effect, which has the advantages of minimally invasive, high efficiency, rapid recovery and reducing postoperative complications. This method can effectively reconstruct the shape of the chest, restore the volume of the chest.
ObjectiveTo evaluate the clinical value of three-dimensional (3D) printing model in accurate and minimally invasive treatment of double outlet right ventricle (DORV).MethodsFrom August 2018 to August 2019, 35 patients (22 males and 13 females) with DORV aged from 5 months to 17 years were included in the study. Their mean weight was 21.35±8.48 kg. Ten patients who received operations guided by 3D printing model were allocated to a 3D printing model group, and the other 25 patients who received operations without guidance by 3D printing model were allocated to a non-3D printing model group. Preoperative transthoracic echocardiography and CT angiography were performed to observe the location and diameter of ventricular septal defect (VSD), and to confirm the relationship between VSD and double arteries.ResultsThe McGoon index of patients in the 3D printing model group was 1.91±0.70. There was no statistical difference in the size of VSD (13.20±4.57 mm vs. 13.40±5.04 mm, t=?0.612, P=0.555), diameter of the ascending aorta (17.10±2.92 mm vs. 16.90±3.51 mm, t=0.514, P=0.619) or diameter of pulmonary trunk (12.50±5.23 mm vs. 12.90±4.63 mm, t=?1.246, P=0.244) between CT and 3D printing model measurements. The Pearson correlation coefficients were 0.982, 0.943 and 0.975, respectively. The operation time, endotracheal intubation time, ICU stay time and hospital stay time in the 3D printing model group were all shorter than those in the non-3D printing model group (P<0.05).ConclusionThe relationship between VSD and aorta and pulmonary artery can be observed from a 3D perspective by 3D printing technology, which can guide the preoperative surgical plans, assist physicians to make reasonable and effective decisions, shorten intraoperative exploration time and operation time, and decrease the surgery-related risks.
