Effect of navigation endoscopy combined with threedimensional printing technology in the treatment of orbital blowout fractures

●AIM:To explore the combined application of surgical navigation nasal endoscopy(NNE)and three-dimensional printing technology(3DPT)for the adjunctive treatment of orbital blowout fractures(OBF).●METHODS:Retrospective analysis was conducted on the data of patients with OBF who underwent surgical treatment at the Affiliated Eye Hospital of Nanchang University between July 2012 and November 2022.The control group consisted of patients who received traditional surgical treatment(n=43),while the new surgical group(n=52)consisted of patients who received NNE with 3DPT.The difference in therapeutic effects between the two groups was evaluated by comparing the duration of the operation,best corrected visual acuity(BCVA),enophthalmos difference,recovery rate of eye movement disorder,recovery rate of diplopia,and incidence of postoperative complications.●RESULTS:The study included 95 cases(95 eyes),with 63 men and 32 women.The patients’age ranged from 5 to 67y(35.21±15.75y).The new surgical group and the control group exhibited no statistically significant differences in the duration of the operation,BCVA and enophthalmos difference.The recovery rates of diplopia in the new surgical group were significantly higher than those in the control group at 1mo[OR=0.03,95%CI(0.01–0.15),P<0.0000]and 3mo[OR=0.11,95%CI(0.03–0.36),P<0.0000]postoperation.Additionally,the recovery rates of eye movement disorders at 1 and 3mo after surgery were OR=0.08,95%CI(0.03–0.24),P<0.0000;and OR=0.01,95%CI(0.00–0.18),P<0.0000.The incidence of postoperative complications was lower in the new surgical group compared to the control group[OR=4.86,95%CI(0.95–24.78),P<0.05].●CONCLUSION:The combination of NNE and 3DPT can shorten the recovery time of diplopia and eye movement disorder in patients with OBF.

Analysis and Design of Surgical Instrument Localization Algorithm

With the help of surgical navigation system,doctors can operate on patients more intuitively and accurately.The positioning accuracy and real-time performance of surgical instruments are very important to the whole system.In this paper,we analyze and design the detection algorithm of surgical instrument location mark,and estimate the posture of surgical instrument.In addition,we optimized the pose by remapping.Finally,the algorithm of location mark detection proposed in this paper and the posture analysis data of surgical instruments are verified and analyzed through experiments.The final result shows a high accuracy.

Current and future role of three-dimensional modelling technology in rectal cancer surgery:A systematic review

BACKGROUND Three-dimensional(3D)modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models,which more closely resemble the complex environment encountered during surgery.It has been successfully applied to surgical planning and navigation,as well as surgical training and patient education in several surgical specialties,but its uptake lags behind in colorectal surgery.Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis,which is difficult to comprehend and visualise.AIM To review the current and emerging applications of the 3D models,both virtual and physical,in rectal cancer surgery。METHODS Medline/PubMed,Embase and Scopus databases were searched using the keywords“rectal surgery”,“colorectal surgery”,“three-dimensional”,“3D”,“modelling”,“3D printing”,“surgical planning”,“surgical navigation”,“surgical education”,“patient education”to identify the eligible full-text studies published in English between 2001 and 2020.Reference list from each article was manually reviewed to identify additional relevant papers.The conference abstracts,animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded.Data were extracted from the retrieved manuscripts and summarised in a descriptive way.The manuscript was prepared and revised in accordance with PRISMA 2009 checklist.RESULTS Sixteen studies,including 9 feasibility studies,were included in the systematic review.The studies were classified into four categories:feasibility of the use of 3D modelling technology in rectal cancer surgery,preoperative planning and intraoperative navigation,surgical education and surgical device design.Thirteen studies used virtual models,one 3D printed model and 2 both types of models.The construction of virtual and physical models depicting the normal pelvic anatomy and rectal cancer,was shown to be feasible.Within the clinical context,3D models were used to identify vascular anomalies,for surgical planning and navigation in lateral pelvic wall lymph node dissection and in management of recurrent rectal cancer.Both physical and virtual 3D models were found to be valuable in surgical education,with a preference for 3D printed models.The main limitations of the current technology identified in the studies were related to the restrictions of the segmentation process and the lack of 3D printing materials that could mimic the soft and deformable tissues.CONCLUSION 3D modelling technology has potential to be utilised in multiple aspects of rectal cancer surgery,however,it is still at the experimental stage of application in this setting.

Nanomaterials for visualized tumor surgical navigation and postoperative recurrence inhibition

Preoperative localization of the tumor sites and intraoperative real-time monitoring are essential for precise surgery but are meanwhile challenging due to the lack of high-resolution,easy-to-operate,and fast visualization techniques.On the other hand,tumor recurrence and metastasis after surgery greatly reduce the survival rate of patients.Intervening tumor recurrence during surgery is a future direction of tumor treatment.Nanomaterials with external condition responsiveness(light,ultrasound,and magnetic field)can accurately assist intraoperative detection and surgical resection due to their functions such as tumor cell targeting,fluorescence imaging,and real time monitoring,providing a more accurate,shorter duration,and visualization method of surgical resection.Moreover,nanomaterials are versatile and can easily be tailored for application in different tumors.Locally filled or systemically circulating nanomaterials with slow drug release and residual tumor cell-targeting ability have promising applications in inhibiting tumor recurrence.Here,we review surgical navigation and postoperative recurrence interventional nanomaterials and their landscape in guiding tumor treatment.We summarize the classification and characteristics of these nanomaterials and discuss their application in the surgical navigation and recurrence inhibition of different tumors.We also provide an outlook on the challenges and future development of nanomaterials for visualized tumor surgical navigation and postoperative recurrence inhibition.

A retrospective study to compare the treatment outcomes with and without surgical navigation for fracture of the orbital wall

Purpose To evaluate the outcomes with and without aid of a computer-assisted surgical navigation system(CASNS)for treatment of unilateral orbital wall fracture(OWF).Methods Patients who came to our hospital for repairing unilateral traumatic OWF from 2014 to 2017 were included in this study.The patients were divided into the navigation group who accepted orbital wall reconstruction aided by CASNS and the conventional group.We evaluated the surgical precision in the navigation group by analyzing the difference between actual postoperative computed tomography data and preoperative virtual surgical plan through color order ratios.We also compared the duration of surgery,enophthalmos correction,restoration of orbital volumes,and improvement of clinical symptoms in both groups systemically.Quantitative data were presented as mean±SD.Significance was determined by the two-sample t-test using SPSS Version 19.0 A p<0.05 was considered statistically significant.Results Seventy patients with unilateral OWF were included in the study cohort.The mean difference between preoperative virtual planning and actual reconstruction outcome was(0.869±0.472)mm,which means the reconstruction result could match the navigation planning accurately.The mean duration of surgery in the navigation group was shorter than it is in the control group,but not significantly.Discrepancies between the reconstructed and unaffected orbital-cavity volume and eyeball projection in the navigation group were significantly less than that in the conventional group.One patient had remnant diplopia and two patients had enophthalmos after surgery in the navigation group;two patients had postoperative diplopia and four patients had postoperative enophthalmos in the conventional group.Conclusion Compare with the conventional treatment for OWF,the use of CASNS can provide a significantly better surgical precision,greater improvements in orbital-cavity volume and eyeball projection,and better clinical results,without increasing the duration of surgery.

Application of a Fast Connected Components Labeling Algorithm in Processing Landmark Images

Extracting geometric data of landmarks from fluoroscopic images plays an important role in camera calibration process of a fluoroscopic-image-based surgical navigation system. Connected components labeling is the essential technique for the extraction. A new fast connected components labeling algorithm was presented. The definition of upward concave set was introduced to explain the algorithm. Feasibility and efficiency of the algorithm were verified with experiments. This algorithm performs well in labeling non-upward concave set connected components and applies to landmarks labeling well. Moreover, the proposed algorithm possesses a desirable characteristic that will facilitate the subsequent processing of fluoroscopic images.

LIMITATIONS OF CANCER MARGIN DELINEATION BY MEANS OF AUTOFLUORESCENCE IMAGING UNDER CONDITIONS OF LASER SURGERY

Limitations of cancer margin delineation and surgical guidance by means of autofluorescence imaging under conditions of laser ablation were investigated and preliminary results are presented.PinPoint^(TM)(Novadaq Technologies Inc.,Canada)was used to capture digital images and Er:YAG laser(2.94μm,Glissando,WaveLight^(TM),Germany)was exploited to cause laser ablation on both normal and cancer sites of the specimen.It was shown that changes of the autofluorescence image after ablation extend beyond the actual sizes of the ablation loci.The tumor tissue after the laser ablation starts to emit fluorescent light within the green wavelength band(490-550nm)similar to normal tissue stating that the current technology of in-process tissue classification fails.However,when the autofluorescence was collected in the red range(600-750nm),then the abnormal/normal contrast was reduced,but still present even after the laser ablation.The present study highlights the importance of finding a proper technology for surgical navigation of cancer removal under conditions of high power effects in biological tissues.

Imaging-guided precision oncotherapy mediated by nanoprobes: From seeing to curing

Malignant tumors are the main diseases threatening human life. Using precise theranostics to diagnose and cure tumors has emerged as a new method to improve patient survival. Based on the current development of precise tumor imaging, image-guided tumor therapy has received widespread attention because it is beneficial for developing precise treatment of tumors, has the potential to improve the efficacy of tumor therapy and reduce the incidence of adverse side effects. Nanoprobes, which are nanomaterial functionalized with specific biomolecules, have intrigued intense interest due to their great potential in monitoring biorecognition and biodetection evens. Benefiting from the unique advantages of nanomaterials, including the easy surface functionalization, the unique imaging performances, and the high drug loading capacity, nanoprobes have become a powerful tool to simultaneously realize tumor precise imaging, diagnosis, and therapy. This review introduces the non-invasive tumor precise imaging and highlights the recent advances of image-guided oncotherapy mediated by nanoprobes in anti-tumor drug delivery, tumor precise surgical navigation, chemodynamic therapy, and phototherapy. Finally, a perspective on the challenge and future direction of nanoprobes in imaging-guided tumor theranostics is also discussed.

NIR-Ⅱ Fluorophores:From Synthesis to Biological Applications

Fluorescence imaging is a useful tool in the field of biomedical applications.However,its imaging capacity is limited by the depth of tissue that can be penetrated when using visible light(400-700 nm)or the first near-infrared window(NIR-Ⅰ,700-900 nm).To overcome the problem,fluorescence imaging in the second near-infrared window(NIR-Ⅱ,1000-1700 nm)has been developed to reduce photon scattering,auto-absorption and tissue autofluorescence to achieve high spatiotemporal resolution and deep imaging penetration.The key to NIR-Ⅱimaging is obtaining and analyzing highly selective information from functional fluorophores that emit in the 1000-1700 nm range.With the rapid development of multidisciplinary research,various types of NIR-Ⅱfluorophores have been produced and used in non-invasive,real-time NIR-Ⅱbiomedical applications.This review summarizes some of the most prevalent NIR-Ⅱfluorophores and their synthesis,such as organic fluorophores(OFs),single-walled carbon nanotubes(SWCNTs),quantum dots(QDs),and rare-earth nanoparticles(RENPs).On this basis,we describe the applications of these fluorophores in biomedical fields,including bioimaging,biosensing,phototherapy and surgical navigation.Additionally,major challenges and prospects of NIR-Ⅱbiomedical application will be further explored.

Advancing theranostics with tumor-targeting peptides for precision otolaryngology

Worldwide, about 600,000 head and neck squamous cell carcinoma (HNSCC) are de-tected annually, many of which involve high risk human papilloma virus (HPV). Surgery is the primary and desired first treatment option. Following surgery, the existence of cancer cells at the surgical margin is strongly associated with eventual recurrence of cancer and a poor outcome. Despite improved surgical methods (robotics, microsurgery, endoscopic/laparo-scopic, and external imaging), surgeons rely only on their vision and touch to locate tumors during surgery. Diagnostic imaging systems like computed tomography (CT), magnetic reso-nance imaging (MRI), single-photon emission computed tomography (SPECT) and positron-emission tomography (PET) are too large, slow and costly to use efficiently during most sur-geries and, ultrasound imaging, while fast and portable, is not cancer specific. This purpose of this article is to review the fundamental technologies that will radically advance Precision Otolaryngology practices to the benefit of patients with HNSCC. In particular, this article will address the potential for tumor-targeting peptides to enable more precise diagnostic imaging while simultaneously advancing new therapeutic paradigms for next generation image-guided surgery, tumor-specific chemotherapeutic delivery and tumor-selective targeted radiotherapy (i.e., theranostic).

Augmented reality(AR)and fracture mapping model on middle-aged femoral neck fracture:A proof-of-concept towards interactive visualization

A thorough understanding of the fracture characteristics can assist the decision-making process for surgery.This study aimed to characterize the femoral neck fractures among middle-aged patients and illustrated a biomedical visualization method using a fracture mapping model and augmented reality.We collected plain radiography and computed tomography(CT)data from 156 adult patients with a femoral neck fracture.The descriptive study showed that Type I and Type II fractures accounted for 8(5%)and 64(41%)cases.In comparison,Type IV fractures accounted for 44(28%)and 40(25%)cases according to the Garden classification.Comminuted fractures and cortical defects were identified in 14.74%and 29.49%of the cases.A fracture mapping model was reconstructed based on the CT data and demonstrated the location and distribution of the major fracture lines surrounding the head-neck junction.We also illustrated the application of augmented reality technology to visualize and interact with the patient-specific fracture model and the fracture mapping model that facilitated education,training,and surgical planning.Future studies may consider mapping other biomechanical data,such as joint loading and stress distribution,and exploring artificial intelligence via deep reinforcement learning for computer-aided fracture reduction and procedure planning.

The evolution of anatomical hepatectomy:Past,present,and future

The liver contains a complex structure of blood vessels and bile ducts,and the vascular structure is highly variable.The anatomical segmentation of the liver is still controversial,and the Couinaud segmentation method based on the portal vein is more widely used in clinical practice.The treatment of liver tumors and other lesions is closely related to the liver anatomy.The mechanism of liver tumor invasion and metastasis is complex,and it is currently believed that tumor invasion mainly spreads along the portal vein.Anatomic liver resection is an important surgical method for liver diseases,especially liver tumors.This article reviews the vascular structure of the liver,the development of anatomical hepatectomy,blood flow control,surgical planning,intraoperative navigation,minimally invasive surgery,and precise hepatectomy.Anatomic liver resection is a part of precision liver surgery,which is becoming increasingly more precise in terms of surgical evaluation,surgical planning,and surgical operation.New technologies will facilitate precision surgery with less trauma and greater benefits for patients.With the development and advancement of technology,image-based surgical planning and intraoperative surgical navigation will become more widely used in precision liver surgery.