Imaged guided surgery during arteriovenous malformation of gastrointestinal stromal tumor using hyperspectral and indocyanine green visualization techniques:A case report

BACKGROUND This case report demonstrates the simultaneous development of a gastrointestinal stromal tumour(GIST)with arteriovenous malformations(AVMs)within the jejunal mesentery.A 74-year-old male presented to the department of surgery at our institution with a one-month history of abdominal pain.Contrast-enhanced computed tomography revealed an AVM.During exploratory laparotomy,hyperspectral imaging(HSI)and indocyanine green(ICG)fluorescence were used to evaluate the extent of the tumour and determine the resection margins.Intraoperative imaging confirmed AVM,while histopathological evaluation showed an epithelioid,partially spindle cell GIST.CASE SUMMARY This is the first case reporting the use of HSI and ICG to image GIST intermingled with an AVM.The resection margins were planned using intraoperative analysis of additional optical data.Image-guided surgery enhances the clinician’s knowledge of tissue composition and facilitates tissue differentiation.CONCLUSION Since image-guided surgery is safe,this procedure should increase in popularity among the next generation of surgeons as it is associated with better postoperative outcomes.

The Relationship between Implant Size and Success Rate in Computer Guided Implant Surgery

Guided implant surgery gained acceptance and credit in implant dentistry. The aim of this study is to find out and evaluate the relationship between implant size and success rate following computed tomography scan guided implant surgery. Sixty-four (36 females, 28 males) completely and partially edentulous patients aged between 42 and 65 years old were participated and fulfilled the inclusion criteria of the study. Two hundred and seventeen dental implants (length: 10, 11.5, and 13 mm;Diameter: 3.3, 3.75, and 4.2 mm) were placed using computed tomography scan guided implant surgery, 117 implants were placed in the maxilla, while 100 implants were placed in the mandible. The implants were evaluated for clinical parameters at 2, 4, and 12 weeks intervals after installation. The overall success rate was 95.4%. Clinical stability of the implant size (Diameter 3.3 mm, Length 10 mm) was the least as compared to other dimensions (P ≤ 0.05). Medium and large size implants (Diameter 3.75 and 4.2 mm, Length 11.5 and 13 mm) were the highest success rate in implant surgery. Implants width (diameter 3.3 mm) and length (10 mm) are best avoided in guided computed tomography surgery as compared with other implant sizes especially in atrophic bony areas. Computer-guided implant surgery remains exciting. Watchful planning and precise stability of the surgical guide are mandatory for successful protocol. Further investigations should be performed to assess such technique among dental patients from satisfactory point of view. Intensive cooperation between dentists and software engineering discipline should be aimed to maximize the success of such technique.

Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients

Background:Modern surgical medicine strives to manage trauma while improving outcomes using functional imaging.Identification of viable tissues is crucial for the surgical management of polytrauma and burn patients presenting with soft tissue and hollow viscus injuries.Bowel anastomosis after traumarelated resection is associated with a high rate of leakage.The ability of the surgeon’s bare eye to determine bowel viability remains limited,and the need for a more standardized objective assessment has not yet been fulfilled.Hence,there is a need for more precise diagnostic tools to enhance surgical evaluation and visualization to aid early diagnosis and timely management to minimize traumaassociated complications.Indocyanine green(ICG)coupled with fluorescence angiography is a potential solution for this problem.ICG is a fluorescent dye that responds to near-infrared irradiation.Methods:We conducted a narrative review to address the utility of ICG in the surgical management of patients with trauma as well as elective surgery.Discussion:ICG has many applications in different medical fields and has recently become an important clinical indicator for surgical guidance.However,there is a paucity of information regarding the use of this technology to treat traumas.Recently,angiography with ICG has been introduced in clinical practice to visualize and quantify organ perfusion under several conditions,leading to fewer cases of anastomotic insufficiency.This has great potential to bridge this gap and enhance the clinical outcomes of surgery and patient safety.However,there is no consensus on the ideal dose,time,and manner of administration nor the indications that ICG provides a genuine advantage through greater safety in trauma surgical settings.Conclusions:There is a scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy to facilitate intraoperative decisions and to limit the extent of surgical resection.This review will improve our understanding of the utility of intraoperative ICG fluorescence in guiding and assisting trauma surgeons to deal with the intraoperative challenges and thus improve the patients’operative care and safety in the field of trauma surgery.

Navigated liver surgery:State of the art and future perspectives

Background:In recent years,the development of digital imaging technology has had a significant influence in liver surgery.The ability to obtain a 3-dimensional(3D)visualization of the liver anatomy has provided surgery with virtual reality of simulation 3D computer models,3D printing models and more recently holograms and augmented reality(when virtual reality knowledge is superimposed onto reality).In addition,the utilization of real-time fluorescent imaging techniques based on indocyanine green(ICG)uptake allows clinicians to precisely delineate the liver anatomy and/or tumors within the parenchyma,applying the knowledge obtained preoperatively through digital imaging.The combination of both has transformed the abstract thinking until now based on 2D imaging into a 3D preoperative conception(virtual reality),enhanced with real-time visualization of the fluorescent liver structures,effectively facilitating intraoperative navigated liver surgery(augmented reality).Data sources:A literature search was performed from inception until January 2021 in MEDLINE(Pub Med),Embase,Cochrane library and database for systematic reviews(CDSR),Google Scholar,and National Institute for Health and Clinical Excellence(NICE)databases.Results:Fifty-one pertinent articles were retrieved and included.The different types of digital imaging technologies and the real-time navigated liver surgery were estimated and compared.Conclusions:ICG fluorescent imaging techniques can contribute essentially to the real-time definition of liver segments;as a result,precise hepatic resection can be guided by the presence of fluorescence.Furthermore,3D models can help essentially to further advancing of precision in hepatic surgery by permitting estimation of liver volume and functional liver remnant,delineation of resection lines along the liver segments and evaluation of tumor margins.In liver transplantation and especially in living donor liver transplantation(LDLT),3D printed models of the donor’s liver and models of the recipient’s hilar anatomy can contribute further to improving the results.In particular,pediatric LDLT abdominal cavity models can help to manage the largest challenge of this procedure,namely large-for-size syndrome.

Fluorescence image-guided lymphadenectomy using indocyanine green and near infrared technology in robotic gastrectomy

In recent years, some researchers have tried to find a way to improve the surgical identification of the lymphatic drainage routes and lymph node stations during radical gastrectomy, thus starting a new research frontier in this field called ＂navigation surgery＂. Among the different reported solutions, the introduction of the indocyanine green （ICG） has drawn attention for its characteristics, a fluorescence dye that can be detected in the near infrared spectral band （NIR）. A fluorescence imaging technology has been integrated in the latest version of the Da Vinci robotic system and surgeons have extensively reported their experiences in colorectal and hepato-biliary surgery for tumors, vascular and lymphatic structures visualization. However, up to date, the combined use of fluorescence imaging and robotic technology has not been adequately investigated during lymphadenectomy in gastric cancer.

A new projection model based robust 2D-3D registration method on Fourier-Mellin space for image guided intervention

An automatic method is proposed to solve the registration problem,which aligns a single 2D fluoroscopic image to a 3D image volume without demanding any additional media like calibration plate or user interactions.First,a mathematic projection model is designed which can reduce the influence of projection distortion on parameter optimization and improve the registration accuracy.Then,a two stage optimization method is proposed,which enables a robust registration in a wide parameter space.Furthermore,an automatic registration framework is proposed based on the FourierMellin robust image comparison descriptor.Experimental results show that the registration method has a high accuracy with average rotation error of 0.6 degree and average translation error of 1.4mm.

Clinical use of augmented reality,mixed reality,three-dimensionalnavigation and artificial intelligence in liver surgery

A precise knowledge of intra-parenchymal vascular and biliary architecture and the location of lesions in relation to the complex anatomy is indispensable to perform liver surgery.Therefore,virtual three-dimensional(3D)-reconstruction models from computed tomography/magnetic resonance imaging scans of the liver might be helpful for visualization.Augmented reality,mixed reality and 3Dnavigation could transfer such 3D-image data directly into the operation theater to support the surgeon.This review examines the literature about the clinical and intraoperative use of these image guidance techniques in liver surgery and provides the reader with the opportunity to learn about these techniques.Augmented reality and mixed reality have been shown to be feasible for the use in open and minimally invasive liver surgery.3D-navigation facilitated targeting of intraparenchymal lesions.The existing data is limited to small cohorts and description about technical details e.g.,accordance between the virtual 3D-model and the real liver anatomy.Randomized controlled trials regarding clinical data or oncological outcome are not available.Up to now there is no intraoperative application of artificial intelligence in liver surgery.The usability of all these sophisticated image guidance tools has still not reached the grade of immersion which would be necessary for a widespread use in the daily surgical routine.Although there are many challenges,augmented reality,mixed reality,3Dnavigation and artificial intelligence are emerging fields in hepato-biliary surgery.

Short-term postoperative discomfort in patients receiving flapless contra open implant surgery

Purpose: The aim of this pilot study was to evaluate subjective and objective findings on short-term post-operative discomfort in patients receiving flapless implant surgery compared to traditional open flap surgery. Materials and Methods: A two-centre, prospective survey study was conducted, using a customized questionnaire. Between December 2010 and January 2012, 20 patients were consecutively included. Eleven received conventional open-flap surgery and nine received flapless surgery. Inflammatory signs, analgesic consumption and sleeping difficulties were evaluated up to seven days postoperatively. A clinical examination was made one week postoperatively. Results: Significantly less experienced swelling was noted 24 hours after flapless surgery compared to open flap surgery for patients receiving four implants or more, and at three days postoperatively for patients receiving single implants. No difference concerning sleeping difficulties, pain or analgesic consumption was found. Clinical examination one week postoperatively showed no differences in wound gaps, redness of the mucosa, or presence of pus between the groups. Conclusions: In conclusion, flapless surgery seems to have a limited effect on postoperative comfort and short-term post-operative signs of soft tissue healing compared to open flap surgery. There is a need for larger randomized trials for evaluating differences in postoperative discomfort between the two surgical techniques.