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1.
Clin Oral Investig ; 28(8): 417, 2024 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-38972945

RESUMEN

OBJECTIVES: The treatment of fractures prioritizes the restoration of functionality through the realignment of fractured segments. Conventional methods, such as titanium plates, have been employed for this purpose; however, certain limitations have been observed, leading to the development of patient-specific plates. Furthermore, recent advancements in digital technology in dentistry enable the creation of virtual models and simulations of surgical procedures. The aim was to assess the clinical effectiveness of patient-specific plates utilizing digital technology in treating mandibular fractures compared to conventional titanium plates. MATERIALS AND METHODS: Twenty patients diagnosed with mandibular fractures were included and randomly assigned to either the study or control groups. The surgical procedure comprised reduction and internal fixation utilizing patient-specific plates generated through virtual surgery planning with digital models for the study group, while the control group underwent the same procedure with conventional titanium plates. Assessment criteria included the presence of malunion, infection, sensory disturbance, subjective occlusal disturbance and occlusal force in functional maximum intercuspation (MICP). Statistical analysis involved using the Chi-square test and one-way repeated measures analysis of variance. RESULTS: All parameters showed no statistically significant differences between the study and control groups, except for the enhancement in occlusal force in functional MICP, where a statistically significant difference was observed (p = 0.000). CONCLUSION: Using patient-specific plates using digital technology has demonstrated clinical effectiveness in treating mandibular fractures, offering advantages of time efficiency and benefits for less experienced surgeons. CLINICAL RELEVANCE: Patient-specific plates combined with digital technology can be clinically effective in mandibular fracture treatment.


Asunto(s)
Placas Óseas , Fijación Interna de Fracturas , Fracturas Mandibulares , Titanio , Humanos , Fracturas Mandibulares/cirugía , Titanio/química , Masculino , Femenino , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Adulto , Resultado del Tratamiento , Persona de Mediana Edad , Diseño Asistido por Computadora , Cirugía Asistida por Computador/métodos
2.
Aesthetic Plast Surg ; 2024 Aug 12.
Artículo en Inglés | MEDLINE | ID: mdl-39134680

RESUMEN

BACKGROUND: Mandibular genioplasty, a central procedure in oral and maxillofacial surgery, has traditionally relied on surgeon experience with potential limitations in precision. The advent of digital methods, particularly computer-aided design/computer-aided manufacturing (CAD/CAM), offers a promising alternative. This study aims to evaluate the efficacy of digital surgical guides in improving the precision of mandibular genioplasty. METHODS: A prospective analysis of 50 patients undergoing genioplasty was performed, 30 in the experimental group using digital surgical guides and 20 in the control group using traditional methods. Three-dimensional reconstructions were obtained using cone-beam computed tomography (CBCT) and digital scans. Osteotomy guides were 3D-printed based on group assignment. Postoperatively, accuracy was assessed by measuring distances between landmarks. RESULTS: The experimental group showed significantly reduced horizontal positioning errors in genioplasty advancement, with no significant differences in vertical errors. For genioplasty retraction, the experimental group showed fewer vertical positioning errors, while horizontal errors remained consistent. CONCLUSIONS: The use of digital surgical guides in mandibular genioplasty significantly improves surgical accuracy, resulting in improved outcomes and patient satisfaction. This study highlights the potential of digital methods in refining oral and maxillofacial surgical procedures. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

3.
Med J Armed Forces India ; 80(4): 392-398, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39071751

RESUMEN

The capacity of additive manufacturing and three-dimensional (3D) printing to quickly construct intricate structures and accurate geometries sets them apart from traditional production techniques. The fourth industrial revolution and the digitalization of production were fueled by the emergence of 3D printing, which was made possible by the increasing demand for goods with various designs, functions, and materials. The global influence of 3D printing on healthcare has resulted in the replacement of generic implanted medical devices with patient-customized implants. In the field of oral and maxillofacial surgery, where surgeons use precision medicine daily, this revolution has had a huge influence. Treatments enhanced by 3D technology include orthognathic surgery, complete joint replacement therapy, and trauma. Surgical teams now engage in the 3D design and production of devices at point-of-care treatment facilities with internal infrastructure thanks to the growing and broad adoption of 3D technology in clinical settings. The way doctors approach treatment planning and clinical results are affected greatly by 3D technology. While outlining significant clinical applications, the article presents our viewpoint on the use of 3D-based technology in the field of oral and maxillofacial surgery and the road ahead with the advent of Four-dimensional (4D) printing.

4.
Eur Heart J Suppl ; 25(Suppl B): B104-B107, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-37091647

RESUMEN

The metaverse is an alternative digital world, accessed by means of dedicated audiovisual devices. In this parallel world, various forms of artificial intelligence meet, including individuals in the form of digital copies of real people (avatars), able to interact socially. Metaverse in medicine may be used in many different ways. The possibility to perform surgery at a distance of thousands of miles separating the patient from the surgeon, who could have also the possibility to visualize in real-time patient's clinical data, including diagnostic images, obviously is very appealing. It would be also possible to perform medical treatments and to adopt pharmacological protocols on human avatars clinically similar to the patients, thus observing treatment effects in advance and significantly reducing the clinical trials duration. Metaverse may reveal an exceptional educational tool, offering the possibility of interactive digital lessons, allowing to dissect and to study an anatomical apparatus in detail, to navigate within it, not only to study, but also to see the evolution of the pathological process, and to simulate in advance surgical or medical procedures on virtual patients. However, while artificial intelligence is now an established reality in the clinical practice, the metaverse is still in its initial stages, and to figure out its potential usefulness and reliability, further developments are expected.

5.
J Hand Surg Am ; 48(5): 499-505, 2023 05.
Artículo en Inglés | MEDLINE | ID: mdl-36764847

RESUMEN

Accelerated in part by the coronavirus disease 2019 pandemic, medical education has increasingly moved into the virtual sphere in recent years. Virtual surgical education encompasses several domains, including live virtual surgery and virtual and augmented reality. These technologies range in complexity from streaming audio and video of surgeries in real-time to fully immersive virtual simulations of surgery. This article reviews the current use of virtual surgical education and its possible applications in hand surgery. Applications of virtual technologies for preoperative planning and intraoperative guidance, as well as care in underresourced settings, are discussed. The authors describe their experience creating a virtual surgery subinternship with live virtual surgeries. There are many roles virtual technology can have in surgery, and this review explores potential value these technologies may have in hand surgery.


Asunto(s)
Realidad Aumentada , COVID-19 , Especialidades Quirúrgicas , Realidad Virtual , Humanos , Mano/cirugía
6.
BMC Oral Health ; 23(1): 13, 2023 01 10.
Artículo en Inglés | MEDLINE | ID: mdl-36627621

RESUMEN

PURPOSE: To explore the outcomes of bone augmentation in the aesthetic zone of the anterior teeth using computer-aided design and a 3D-printed template. METHODS: Ten patients with severe bone defects in the aesthetic zone of anterior teeth were included in the study; CT data were collected before surgery. The design of the osteotomy line in the bone defect area was determined under computer simulation. The position parameters and osteotomy line of the free bone were determined via virtual surgery. A 3D-printed template was prepared to guide the accurate placement of the bone graft. Reexamination was conducted to evaluate the position of the bone graft immediately after the operation and the resorbed capacity of the bone graft before implant restoration. RESULTS: The position of the bone graft was consistent with the preoperative design. The amount of bone graft resorbed was within the acceptable range three months after the operation, and the effect of implant restoration was satisfactory. CLINICAL SIGNIFICANCE: Use of computer-aided design and a 3D-printed template can be an effective approach for accurate bone augmentation in the aesthetic zone of the anterior teeth.


Asunto(s)
Diseño Asistido por Computadora , Estética Dental , Impresión Tridimensional , Humanos , Simulación por Computador , Osteotomía
7.
BMC Oral Health ; 23(1): 255, 2023 05 03.
Artículo en Inglés | MEDLINE | ID: mdl-37138237

RESUMEN

BACKGROUND: Computer-aided design/manufacturing (CAD/CAM) technology was developed to improve surgical accuracy and minimize errors in surgical planning and orthognathic surgery. However, its accurate implementation during surgery remains a challenge. Hence, we compared the accuracy and stability of conventional orthognathic surgery and the novel modalities, such as virtual simulation and three-dimensional (3D) titanium-printed customized surgical osteotomy guides and plates. METHODS: This prospective study included 12 patients who were willing to undergo orthognathic surgery. The study group consisted of patients who underwent orthognathic two-jaw surgery using 3D-printed patient-specific plates processed by selective laser melting and an osteotomy guide; orthognathic surgery was also performed by the surgeon directly bending the ready-made plate in the control group. Based on the preoperative computed tomography images and intraoral 3D scan data, a 3D virtual surgery plan was implemented in the virtual simulation module, and the surgical guide and bone fixation plate were fabricated. The accuracy and stability were evaluated by comparing the results of the preoperative virtual simulation (T0) to those at 7 days (T1) and 6 months (T2) post-surgery. RESULT: The accuracy (ΔT1‒T0) and stability (ΔT2‒T1) measurements, using 11 anatomical references, both demonstrated more accurate results in the study group. The mean difference of accuracy for the study group (0.485 ± 0.280 mm) was significantly lower than in the control group (1.213 ± 0.716 mm) (P < 0.01). The mean operation time (6.83 ± 0.72 h) in the control group was longer than in the study group (5.76 ± 0.43 h) (P < 0.05). CONCLUSION: This prospective clinical study demonstrated the accuracy, stability, and effectiveness of using virtual preoperative simulation and patient-customized osteotomy guides and plates for orthognathic surgery.


Asunto(s)
Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Humanos , Titanio , Estudios Prospectivos , Procedimientos Quirúrgicos Ortognáticos/métodos , Diseño Asistido por Computadora , Imagenología Tridimensional
8.
Acta Chir Plast ; 65(3-4): 128-139, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-38538300

RESUMEN

Nowadays, techniques and the use of patient specific implants seem to be the recent high technology standard in reconstructive surgery. Surgery planning is as old as the surgery procedures themselves. Any good surgeon, before entering the operating theatre, has a plan for how to proceed. It is based on knowledge and experience in combination of evaluation of all case relevant information. In fact, virtual surgery planning and CAD/CAM reflects the technological "state of the art" into the medical daily practice. Recently, 3D printing technologies became easy and accessible for everyone. Virtual 3D images substituted the plaster models, the film profile analysis switched to digital, 3D printed bone models of the case helped to understand the morphology of the deformity and prepare the osteotomies with "hands on the bone". The authors' own 20 years of experience on surgical planning, the development of digital technologies in oral and maxillofacial surgery is traced and comments on case examples are presented.


Asunto(s)
Procedimientos de Cirugía Plástica , Cirugía Bucal , Humanos , Peroné/cirugía , Impresión Tridimensional , Diseño Asistido por Computadora
9.
Childs Nerv Syst ; 37(8): 2487-2495, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-33779807

RESUMEN

OVERVIEW: The goal of this study was to review the current application and status of three-dimensional printing for craniosynostosis surgery. METHODS: A literature review was performed using the PubMed/MEDLINE databases for studies published between 2010 and 2020. All studies demonstrating the utilization of three-dimensional printing for craniosynostosis surgery were included. RESULTS: A total of 15 studies were ultimately selected. This includes studies demonstrating novel three-dimensional simulation and printing workflows, studies utilizing three-dimensional printing for surgical simulation, as well as case reports describing prior experiences. CONCLUSION: The incorporation of three-dimensional printing into the domain of craniosynostosis surgery has many potential benefits. This includes streamlining surgical planning, developing patient-specific template guides, enhancing residency training, as well as aiding in patient counseling. However, the current state of the literature remains in the validation stage. Further study with larger case series, direct comparisons with control groups, and prolonged follow-up times is necessary before more widespread implementation is justified.


Asunto(s)
Craneosinostosis , Cirugía Asistida por Computador , Craneosinostosis/diagnóstico por imagen , Craneosinostosis/cirugía , Humanos , Impresión Tridimensional
10.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 52(2): 182-187, 2021 Mar.
Artículo en Zh | MEDLINE | ID: mdl-33829689

RESUMEN

According to Healthy China, a national strategy of the Government of China, new requirements were put forward for high-quality medical education, high-level surgical research, and precise clinical diagnosis and treatment. In the context of Emerging Medical Discipline, a strategic blueprint of medical education in China, this paper reviews the concept and core value of virtual reality (VR) and its significant role in the medical industry. On that basis, we explore the role of VR technology in medical training against the background of Emerging Medicine Discipline. Furthermore, typical cases are presented to help analyze and illustrate in detail the important role of VR technology in the teaching and training of stomatological and clinical procedures, skills assessment, online self-directed training, and clinical thinking skills training. We herein summarize useful information from past experience so as to help build innovative models of medical education in the context of Emerging Medical Discipline.


Asunto(s)
Educación Médica , Realidad Virtual , China , Competencia Clínica , Tecnología
11.
J Biol Regul Homeost Agents ; 34(5 Suppl. 3): 185-194. Technology in Medicine, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33386048

RESUMEN

Three-dimensional virtual surgical planning has become routine practice in orthognatic and reconstructive surgery for the possibility to realize presurgical evaluation of intraoperative bones movements, the prediction of postoperative results and the high level of accuracy. Thanks to surface superimposition between 3D planned and 3D postoperative model of maxillo-facial skeleton, a medium discrepancy less than 1 mm was found in scientific literature, considering 15 different points of maxillofacial skeleton. In our study we decided to evaluate different factors that could invalidate that result in the same cohort of patients, such as sex, kind of dentofacial deformity, asymmetry, type of surgical approach and entity of maxillo-mandibular movements (more or less than 1 mm). We found out no significant differences among groups. We can state that virtual surgical planning and 3D surgical splints are a valid means of diagnosis, treatment and predictivity regardless factors that could influence post-operative results. In conclusion, virtual surgical planning and 3D surgical splints facilitated diagnosis, treatment planning and accuracy regardless of sex, dentofacial deformity class, surgery techniques, entity of advancement and asymmetry.


Asunto(s)
Procedimientos de Cirugía Plástica , Cirugía Asistida por Computador , Humanos , Imagenología Tridimensional , Mandíbula , Planificación de Atención al Paciente
12.
Langenbecks Arch Surg ; 405(2): 173-179, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32215728

RESUMEN

PURPOSE: In hepatobiliary surgery, preoperative three-dimensional reconstruction based on CT or MRI can be provided externally or by local, semi-automatic software. We analyzed the time expense and quality of external versus local three-dimensional reconstructions. METHODS: Three first-year residents reconstructed data from 20 patients with liver pathologies using a local, semi-automatic, server-based program. Initially, five randomly selected patient datasets were segmented, with the visualization of an established external company available for comparison at all times (learning phase). The other fifteen cases were compared with the external datasets after completing local reconstruction (control phase). Total time expense/case and for specific manual and semi-automated reconstruction steps were recorded. Segmentation quality was analyzed by testing the equivalence for liver and tumor volumes, portal vein sectors, and hepatic vein territories. RESULTS: The median total reconstruction time was reduced from 2.5 h (learning phase) to 1.5 h (control phase) (- 42%; p < 0.001). Comparing the total and detailed liver volumes (sectors and territories) as well as the tumor volumes in the control phase equivalence was proven. In addition, a highly significant correlation between the external and local analysis was obtained over all analyzed segments with a very high ICC (median [IQR]: 0.98 [0.97; 0.99]; p < 0.01). CONCLUSION: Local, semi-automatic reconstruction performed by inexperienced residents was feasible with an expert level time expense and the quality of the three-dimensional images was comparable with those from an external provider.


Asunto(s)
Imagenología Tridimensional , Neoplasias Hepáticas/diagnóstico por imagen , Adulto , Anciano , Femenino , Hepatectomía , Venas Hepáticas/diagnóstico por imagen , Humanos , Neoplasias Hepáticas/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Vena Porta/diagnóstico por imagen , Factores de Tiempo , Tomografía Computarizada por Rayos X , Adulto Joven
13.
Artículo en Inglés | MEDLINE | ID: mdl-32354542

RESUMEN

Many of the advances in congenital heart surgery were built upon lessons and insights gained from model simulations. While animal and mock-circuit models have historically been the main arena to test new operative techniques and concepts, the recognition that complex cardiovascular anatomy and circulation can be modeled mathematically ushered a new era of collaboration between surgeons and engineers. In 1996, the computational age in congenital heart surgery began when investigators in London and Milan tapped the power of the computer to simulate the Fontan procedure and introduced operative improvements. Since then, computational modeling has led to numerous contributions in congenial heart surgery as continuing sophistication and advances in numerical and imaging methods furthered the ability to refine anatomic and physiologic details. Idealized generic models have given way to precise patient-specific simulations of the 3-dimensional anatomy, reconstructed circulation, affected hemodynamics, and altered physiology. Tools to perform virtual surgery, and predict flow dynamic and circulatory results, have been developed for some of the most complex defects, such as those requiring single ventricle palliation. In today's quest for personalized medicine and precision care, computational modeling's role to assist surgical planning in complex congenital heart surgery will continue to grow and evolve. With ever closer collaboration between surgeons and engineers, and clear understanding of modeling limitations, computational simulations can be a valuable adjunct to support preoperative surgical decision making.


Asunto(s)
Simulación por Computador , Toma de Decisiones , Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/anomalías , Hemodinámica , Humanos , Lactante , Modelos Cardiovasculares
14.
Knee Surg Sports Traumatol Arthrosc ; 28(5): 1425-1435, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-31119339

RESUMEN

PURPOSE: (1) To analyse popliteal artery (PA) movement in a three-dimensional (3D) coordinate system in relation to knee flexion and high tibial osteotomy (HTO) techniques (lateral closed wedge HTO [LCHTO], uniplane medial open wedge HTO [UP-MOHTO], biplane medial open wedge HTO [BP-MOHTO]) and (2) to identify safe zones of the PA in each osteotomy plane. METHODS: Sixteen knees of patients who underwent magnetic resonance imaging with extension and 90° flexion were used to develop subject-specific 3D knee flexion models. Displacement of the PA during knee flexion was measured along the X- and Y-axis, as was the distance between the posterior tibial cortex and PA parallel to the Y-axis (d-PCA). Frontal plane safety index (FPSI) and maximal axial safe angles (MASA) of osteotomy, which represented safe zones for the osteotomy from the PA injury, were analysed. All measurements were performed along virtual osteotomy planes. Differences among the three osteotomy methods were analysed for each flexion angle using a linear mixed model. RESULTS: The average increments in d-PCA during knee flexion were 1.3 ± 2.3 mm in LCHTO (n.s.), 1.4 ± 1.2 mm in UP-MOHTO (P < 0.0001), and 1.7 ± 2.0 mm in BP-MOHTO (P = 0.015). The mean FPSIs in knee extension were 37.6 ± 5.9%, 46.4 ± 5.8%, and 45.1 ± 8.1% for LCHTO, UP-MOHTO, and BP-MOHTO, respectively. The mean MASA values in knee extension were 45.8° ± 4.4°, 37.3° ± 6.1°, and 38.9° ± 6.5° for LCHTO, UP-MOHTO, and BP-MOHTO, respectively. CONCLUSION: Although the PA moved posteriorly during knee flexion, the small (1.7 mm) increment thereof and inconsistent movements in subjects would not be of clinical relevance to PA safety during HTO. LEVEL OF EVIDENCE: Diagnostic study, Level II.


Asunto(s)
Osteoartritis de la Rodilla/cirugía , Osteotomía/efectos adversos , Osteotomía/métodos , Arteria Poplítea/lesiones , Lesiones del Sistema Vascular/prevención & control , Adulto , Simulación por Computador , Femenino , Humanos , Imagenología Tridimensional , Rodilla/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico por imagen , Rango del Movimiento Articular , Lesiones del Sistema Vascular/etiología , Adulto Joven
15.
Knee Surg Sports Traumatol Arthrosc ; 28(5): 1365-1371, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-30809721

RESUMEN

PURPOSE: Popliteal artery injury is a rare but devastating complication of open-wedge high tibial osteotomy (OWHTO). The objectives of this study were: to document the location of the artery in the virtual osteotomy plane (VOP), to measure the minimal distance between the popliteal artery and three virtual saw-progression lines (VSLs), and to present a safe sawing technique for OWHTO. METHOD: In total, 45 computed tomography angiographies were reconstructed and virtual osteotomy was simulated using 3D image-processing software. The VOP was defined as an inclined plane commencing 3.5 cm below the articular plane towards the fibular head. VSLs were defined as saw-progression guidelines that lie on the VOP: "VSL-mid" runs from the midpoint of the tibial medial cortex towards the fibular head; "VSL-ant" starts from the same point as VSL-mid, but runs 10° anterior to the fibular head; and "VSL-post" runs 10° posterior to the fibular head. The distances between the popliteal artery and the three VSLs were measured, and the risk of injury was assessed. RESULTS: The popliteal artery was located 20.7° posterior to VSL-mid and 51 mm from the starting point. The minimum distance between the popliteal artery and VSL-mid was 18 mm (99% confidence interval 9-27 mm). When the saw was moved along VSL-mid, 42% of the arteries were susceptible to injury. However, when it followed VSL-ant, there was no risk of injury. CONCLUSIONS: Sawing toward the fibular head carries a risk of popliteal artery injury and should not be performed. When sawing in OWHTO, the recommended target should be 10° anterior to the fibular head. This technique eliminates the risk of popliteal artery injury.


Asunto(s)
Osteotomía/efectos adversos , Osteotomía/métodos , Arteria Poplítea/lesiones , Tibia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Angiografía por Tomografía Computarizada , Femenino , Peroné , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Arteria Poplítea/anatomía & histología , Arteria Poplítea/diagnóstico por imagen , Complicaciones Posoperatorias , Factores de Riesgo , Tibia/diagnóstico por imagen
16.
J Minim Access Surg ; 16(4): 355-359, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31793451

RESUMEN

INTRODUCTION: To objectively assess the quality of laparoscopic camera navigation (LCN), the structured assessment of LCN skills (SALAS) score was developed and validated for laparoscopic cholecystectomy. The aim of this pre-clinical study was to investigate the influence of LCN on surgical performance during virtual cholecystectomy (vCHE) using this score. METHODS: A total of 84 medical students were included in this prospective study. Individual characteristics were assessed with questionnaires. Participants completed a structured 2-day training course on a validated virtual reality laparoscopic simulator. At the end of the course, all students took over LCN during vCHE, all performed by the same surgeon. The numbers of errors regarding centering, horizon adjustment and instrument visualisation as well as manual and verbal corrections by the surgeon were recorded to calculate the SALAS score (range 5-25) to investigate the influence of LCN on surgical performance. The study population was divided by the recorded SALAS score into low and medium performers (Group A; 1st-3rd quartile; n = 60) and high performers (Group B, 4th quartile, n = 21). RESULTS: The SALAS score of the camera assistant correlates positively with the surgeon's overall performance in vCHE (P < 0.001), and the surgeon's virtual laparoscopic performance was significantly better in Group B (P < 0.001). Moreover, a significantly shorter operation time during vCHE was shown for Group B (Median (IQR); Group A: 508 s [429 s; 601 s]; Group B: 422 s [365 s; 493 s]; P = 0.001). Frequent gaming and a higher self-confidence to assist during a basic laparoscopic procedure were associated with a higher SALAS score (P = 0.013). CONCLUSION: In this pre-clinical setting, the surgeon's virtual performance is significantly influenced by the LCN quality. LCN by high performers resulted in a shorter operation time and a lower error rate.

17.
BMC Oral Health ; 19(1): 18, 2019 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-30646896

RESUMEN

BACKGROUND: Many reports have been published on orthognathic surgery (OGS) using computer-aided surgical simulation (CASS). The purpose of this study was to evaluate the accuracy of the maxillary repositioning and the stability of the maxilla in patients who underwent OGS using a newly developed CASS program, a customized osteotomy guide, and a customized miniplate. METHODS: Thirteen patients who underwent OGS from 2015 to 2017 were included. All patients underwent a bimaxillary operation. First, a skull-dentition hybrid 3D image was rendered by merging the cone beam computed tomography (CBCT) images with the dentition scan file. After virtual surgery (VS) using the FaceGide® program, patient-customized osteotomy guides and miniplates were then fabricated and used in the actual operation. To compare the VS with the actual surgery and postoperative skeletal changes, each reference point marked on the image was compared before the operation (T0) and three days (T1), four months (T2), and a year (T3) after the operation, and with the VS (Tv). The differences between ΔTv (Tv-T0) and ΔT1 (T1-T0) were statistically compared using tooth-based reference points. The superimposed images of Tv and T1 were also investigated at eight bone-based reference points. The differences between the reference points of the bone surface were examined to evaluate the stability of the miniplate on the maxilla over time. RESULTS: None of the patients experienced complications. There were no significant differences between the reference points based on the cusp tip between ΔTv and ΔT1 (p > 0.01). Additionally, there were no significant differences between the Tv and T1 values of the bone surface (p > 0.01). The mean difference in the bone surface between Tv and T1 was 1.01 ± 0.3 mm. Regarding the stability of the miniplate, there were no significant differences between the groups. The difference in the bone surface between T1 and T3 was - 0.37 ± 0.29 mm. CONCLUSIONS: VS was performed using the FaceGide® program, and customized materials produced based on the VS were applied in actual OGS. The maxilla was repositioned in almost the same manner as in the VSP plan, and the maxillary position remained stable for a year.


Asunto(s)
Tomografía Computarizada de Haz Cónico , Maxilar/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Cirugía Asistida por Computador/métodos , Cefalometría , Humanos , Imagenología Tridimensional , Maxilar/diagnóstico por imagen , Cirugía Ortognática
18.
Surg Innov ; 25(3): 280-285, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29504470

RESUMEN

INTRODUCTION: Immersive virtual reality (VR) laparoscopy simulation connects VR simulation with head-mounted displays to increase presence during VR training. The goal of the present study was the comparison of 2 different surroundings according to performance and users' preference. METHODS: With a custom immersive virtual reality laparoscopy simulator, an artificially created VR operating room (AVR) and a highly immersive VR operating room (IVR) were compared. Participants (n = 30) performed 3 tasks (peg transfer, fine dissection, and cholecystectomy) in AVR and IVR in a crossover study design. RESULTS: No overall difference in virtual laparoscopic performance was obtained when comparing results from AVR with IVR. Most participants preferred the IVR surrounding (n = 24). Experienced participants (n = 10) performed significantly better than novices (n = 10) in all tasks regardless of the surrounding ( P < .05). Participants with limited experience (n = 10) showed differing results. Presence, immersion, and exhilaration were significantly higher in IVR. Two thirds assumed that IVR would have a positive influence on their laparoscopic simulator use. CONCLUSION: This first study comparing AVR and IVR did not reveal differences in virtual laparoscopic performance. IVR is considered the more realistic surrounding and is therefore preferred by the participants.


Asunto(s)
Educación Médica/métodos , Laparoscopía/educación , Cirujanos/educación , Realidad Virtual , Adulto , Competencia Clínica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven
19.
Surg Endosc ; 31(11): 4472-4477, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-28378077

RESUMEN

INTRODUCTION: Virtual reality (VR) and head mount displays (HMDs) have been advanced for multimedia and information technologies but have scarcely been used in surgical training. Motion sickness and individual psychological changes have been associated with VR. The goal was to observe first experiences and performance scores using a new combined highly immersive virtual reality (IVR) laparoscopy setup. METHODS: During the study, 10 members of the surgical department performed three tasks (fine dissection, peg transfer, and cholecystectomy) on a VR simulator. We then combined a VR HMD with the VR laparoscopic simulator and displayed the simulation on a 360° video of a laparoscopic operation to create an IVR laparoscopic simulation. The tasks were then repeated. Validated questionnaires on immersion and motion sickness were used for the study. RESULTS: Participants' times for fine dissection were significantly longer during the IVR session (regular: 86.51 s [62.57 s; 119.62 s] vs. IVR: 112.35 s [82.08 s; 179.40 s]; p = 0.022). The cholecystectomy task had higher error rates during IVR. Motion sickness did not occur at any time for any participant. Participants experienced a high level of exhilaration, rarely thought about others in the room, and had a high impression of presence in the generated IVR world. CONCLUSION: This is the first clinical and technical feasibility study using the full IVR laparoscopy setup combined with the latest laparoscopic simulator in a 360° surrounding. Participants were exhilarated by the high level of immersion. The setup enables a completely new generation of surgical training.


Asunto(s)
Personal de Salud/educación , Laparoscopía/educación , Entrenamiento Simulado/métodos , Realidad Virtual , Competencia Clínica/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Humanos , Laparoscopía/métodos , Masculino , Encuestas y Cuestionarios
20.
Surg Radiol Anat ; 39(4): 441-449, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27663868

RESUMEN

PURPOSE: Human anatomy learning confronts many difficulties, including the lack of anatomical specimens and limitations in anatomical dissection techniques that can destroy and change the shape and position of anatomic structures. A Virtual Anatomy System can help to overcome these difficulties. METHODS: Based on the high-resolution thin-sectional anatomical images of the Chinese Visible Human data set, we created a Virtual Anatomical System, including nearly all male and female anatomical structures. RESULTS: With this system, medical students can freely observe the detailed anatomical information of the coronal, sagittal, and transverse sections through a 3D-reconstructed realistic model on a personal computer in the local network. CONCLUSIONS: This Virtual Anatomy System is an easy and direct way for students to learn and understand the shape and the relationship of anatomic structures, which can also make the anatomy learning more interesting. Furthermore, it can help students synthetically master the anatomical knowledge.


Asunto(s)
Anatomía/educación , Educación Médica/métodos , Aprendizaje , Interfaz Usuario-Computador , Proyectos Humanos Visibles , China , Disección , Femenino , Humanos , Imagenología Tridimensional , Masculino , Modelos Anatómicos
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