Laparoscopy for living donor left nephrectomy: Comparison of three‐dimensional and two‐dimensional vision

The main objective of this preliminary study was to evaluate the feasibility and safety of 3‐D laparoscopic living donor left nephrectomy (LDLN). The secondary objective was to compare intraoperative and postoperative outcomes between 3‐D and 2‐D laparoscopic LDLN. All patients who underwent a laparoscopic LDLN from January 2015 to April 2018 in a university center were included. All surgeries were performed by three experienced surgeons. Seventy three patients were included the following: 16 underwent a 3‐D laparoscopic LDLN (3‐D group), and 57 underwent a 2‐D laparoscopic LDLN (2‐D group). Operative time and warm ischemia time (WIT) were significantly lower in the 3‐D group (operative time: 80.9 ± 10.2 vs 114.1 ± 32.3 minutes in the 3‐D and 2‐D groups, P = .0002) (WIT: 1.7 ± 0.6 vs 2.3 ± 0.9 minutes in the 3‐D and 2‐D groups, P = .02). No conversion to open surgery occurred in both groups. Length of hospital stay was significantly shorter in the 3‐D group. No major postoperative complications (Clavien ≥ III) occurred. One‐year postoperative GFR was similar to 3‐D and 2‐D groups. Our preliminary study demonstrates that 3‐D laparoscopic LDLN is a feasible and safe surgical procedure. Intraoperative and postoperative outcomes were similar in both 2‐D and 3‐D vision systems, but 3‐D vision systems allow reduction in WIT and operative time.     

Applications of three‐dimensional printing technology in urological practice

A rapid expansion in the medical applications of three‐dimensional (3D)‐printing technology has been seen in recent years. This technology is capable of manufacturing low‐cost and customisable surgical devices, 3D models for use in preoperative planning and surgical education, and fabricated biomaterials. While several studies have suggested 3D printers may be a useful and cost‐effective tool in urological practice, few studies are available that clearly demonstrate the clinical benefit of 3D‐printed materials. Nevertheless, 3D‐printing technology continues to advance rapidly and promises to play an increasingly larger role in the field of urology. Herein, we review the current urological applications of 3D printing and discuss the potential impact of 3D‐printing technology on the future of urological practice.     

Pelvic‐floor imaging using three‐dimensional ultrasonography and magnetic resonance imaging in the long term follow‐up of the bladder‐exstrophy‐epispadias complex

Study Type – Therapy (case control)
Level of Evidence 3b

OBJECTIVE

To investigate whether established pelvic floor variables can be used to predict the risk of uterine prolapse after surgery and to compare two different operative strategies, pelvic adaptation with functional reconstruction and an open pelvis with urinary diversion, as a congenital bony pelvis and pelvic floor defect predisposes females with bladder‐exstrophy‐epispadias complex (BEEC) to uterine prolapse.

PATIENTS, SUBJECTS AND METHODS

We conducted a cross‐sectional study using perineal three‐dimensional ultrasonography (3D‐US) and magnetic resonance imaging (MRI) to describe pelvic floor anatomy in 19 women with BEEC (mean age 27.3 years) and five controls, with the outcome evaluated by a semi‐structured interview. The analysis of 3D‐US and MRI was conducted by two independent investigators.

RESULTS

Of the 19 women with BEEC, 13 initially had a functional bladder reconstruction, six a urinary diversion with removal of the exstrophic bladder, and 12 women had closure of the pelvis either by traction bandage or osteotomy, and in the other seven the symphysis was not approximated. Four patients had a complete and one a mild uterine prolapse. After a mean follow‐up of 24 years, the mean symphyseal diastasis was 4.5 cm after symphyseal approximation, 9.0 cm without symphyseal approximation in BEEC and 0.49 cm in controls. The mean levator hiatus was 4.9 cm on 3D‐US and 4.1 cm on MRI after symphyseal approximation, 5.9 and 7.6 cm without symphyseal approximation and 4.2 and 3.2 cm in controls, respectively. The respective mean levator angle was 86.6° and 87.3° after symphyseal approximation, 104.1° and 101.3° without and 71.3° and 45.5 in controls. Prolapse was statistically significantly more common in patients with no symphyseal approximation.

CONCLUSION

This is the first study showing that perineal 3D‐US is useful for pelvic floor imaging in BEEC. Established pelvic floor variables might be useful for predicting the risk of pelvic organ prolapse in BEEC.     

Criteria for three‐dimensional anorectal ultrasound assessment of response to chemoradiotherapy in rectal cancer patients

Aim The aim of this study was to identify criteria for three‐dimensional anorectal ultrasonography (3D‐AUS) to assess the response of rectal cancer to chemoradiotherapy; the 3D‐AUS results were compared with the histopathological findings of the resected specimen. Method Thirty‐five patients underwent 3D‐AUS and were grouped according to the presence (GI; n = 19) or absence (GII; n = 16) of anal canal invasion. All patients received chemoradiotherapy, then underwent a second 3D‐AUS. The response (complete, partial or insignificant and lymph node metastasis) was evaluated. Tumour length (cm) and volume (cm³), length and volume regression percentage (%), distal length regression, and distance between the distal tumour edge and the proximal border of the internal anal sphincter were measured before and after chemoradiotherapy. All patients underwent surgery, and the 3D‐AUS image was compared with the histopathological findings. Results Before chemoradiotherapy, the average tumour length was similar in G1 and GII, but the volume differed significantly (P = 0.0408). The response was insignificant in seven (37%) patients, partial in 10 (53%) patients and complete in two (10%) patients in GI. The corresponding figures for GII were one (6%) patient, 12 (75%) patients and three (19%) patients (P = 0.0318). The agreement between pathological and post‐chemoratherapy 3D‐AUS findings was almost identical for the identification of residual tumour or complete response (κ = 1.0) and substantial for lymph node metastases (κ = 0.74). The mean distance to the internal anal sphincter was greater in GII. A sphincter‐saving resection was performed in 2/19 patients in GI and in 14/16 patients in GII (P < 0.0001). The histopathological examination revealed a free distal margin. Conclusion 3D‐AUS was shown to evaluate accurately the response to chemoradiotherapy, helping in the selection of patients for a sphincter‐saving resection. The distance between the tumour and the internal anal sphincter was the most important parameter in this respect.     

New three‐dimensional head‐mounted display system,TMDU‐S‐3D system,for minimally invasive surgery application: Procedures for gasless single‐port radical nephrectomy

We present an application of a new three‐dimensional head‐mounted display system that combines a high‐definition three‐dimensional organic electroluminescent head‐mounted display with a high‐definition three‐dimensional endoscope to minimally invasive surgery, using gasless single‐port radical nephrectomy procedures as a model. This system presents the surgeon with a higher quality of magnified three‐dimensional imagery in front of the eyes regardless of head position, and simultaneously allows direct vision by moving the angle of sight downward. It is also significantly less expensive than the current robotic surgery system. While carrying out gasless single‐port radical nephrectomy, the system provided the surgeon with excellent three‐dimensional imagery of the operative field, direct vision of the outside and inside of the patient, and depth perception and tactile feedback through the devices. All four nephrectomies were safely completed within the operative time, blood loss was within usual limits and there were no complications. The display was light enough to comfortably be worn for a long operative time. Our experiences show that the three‐dimensional head‐mounted display system might facilitate maneuverability and safety in minimally invasive procedures, without prohibitive cost, and thus might mitigate the drawbacks of other three‐dimensional vision systems. Because of the potential benefits that this system offers, it deserves further refinements of its role in various minimally invasive surgeries.     

Robot‐assisted fracture reduction using three‐dimensional intraoperative fracture visualization: An experimental study on human cadaver femora

Closed fracture reduction can be a challenging task. Robot‐assisted reduction of the femur is a newly developed technique that could minimize potential complications and pitfalls associated with fracture reduction and fixation. We conducted an experimental study using 11 human cadaver femora with intact soft tissues. We compared robot‐assisted fracture reduction using 3D visualization with manual reduction, using 2D fluoroscopy. The main outcome measure was the accuracy of reduction. The manual reductions were done by an experienced orthopedic trauma surgeon, whereas the robot‐assisted reductions were done by surgeons of different experience. The robot‐assisted group showed significantly less postreduction malalignment (p < 0.05) for internal/external rotation (2.9° vs. 8.4°) and for varus/valgus alignment (1.1° vs. 2.5°). However, the reduction time was significantly (p < 0.01) longer (6:14 min vs. 2:16 min). The higher precision associated with robot‐assisted fracture reduction makes this technique attractive and further research and development worthwhile. In particular, less experienced surgeons may benefit from this new technique. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1240–1244, 2010     

Pilot study to evaluate a novel three‐dimensional wound measurement device

As the burden of diabetes continues to grow and treatment standards require careful tracking of wound progress, clinicians increasingly need to rely on technological improvements in wound measurement technologies to track the progress of their treatments. This study aims to determine the accuracy of a new three‐dimensional wound measurement (3DWM) device against laser‐assisted wound measurement (LAWM) devices and traditional methods of wound measurement. Using several wound models, we demonstrate that the 3DWM device measures wound area, depth and volume similarly to the other methods tested. This is especially apparent when changes in wound measurements were compared between the two devices. Differences between the two technologies were apparent when analysing wound measurement time and measurement repeatability. There was a significantly lower incidence of error in measurements between the 3DWM device and the LAWM device. Finally, the measurement time was significantly faster with the 3DWM device compared to the LAWM device. Together, these data demonstrate that the 3DWM device provides an accurate and reproducible method for measuring changes in wound healing similar to other available technologies. Further, the use of the 3DWM device provides a faster and more consistent measurement, which is critical for clinical application and use.     

Dry box training with three‐dimensional vision for the assistant surgeon in robot‐assisted urological surgery

We analyzed whether three‐dimensional vision, practice or previous laparoscopic experience improves the surgical performance of the bedside assistant during robot‐assisted surgery. Six experienced laparoscopic surgeons and 15 novices carried out three skills drills imitating an assistant's maneuvers in robot‐assisted surgery, and times for completing the tasks were recorded. Both the novice and experienced groups showed significantly shorter manipulation times for each drill with three‐dimensional vision compared with two‐dimensional or glassless three‐dimensional vision. The experienced group showed significantly shorter manipulation times than the novice group for all types of vision. A significant improvement was observed 14 out of 18 times in the novice group, but only one out of 18 times in the experienced group. We can conclude that the use of three‐dimensional visualization facilitates the performance of the assistant surgeon, especially if a novice, during robot‐assisted surgery. Laparoscopic experience also improves the performance, whereas training is beneficial for novice assistant surgeons before carrying out actual operations.     

Three‐dimensional printing in orthopaedic surgery: review of current and future applications

Three‐dimensional (3D) printing is a rapidly evolving technology with the potential for significant contributions to surgical practice. There are many current applications for 3D printing technology with future applications being explored. This technology has applications in preoperative planning, education, custom manufacturing (implants, prosthetics and surgical guides) and exciting potential for biological applications. This article reviews the current and future applications of 3D technology in orthopaedic surgery.     

Rotating three‐dimensional dynamic culture of adult human bone marrow‐derived cells for tissue engineering of hyaline cartilage

The method of constructing cartilage tissue from bone marrow‐derived cells in vitro is considered a valuable technique for hyaline cartilage regenerative medicine. Using a rotating wall vessel (RWV) bioreactor developed in a NASA space experiment, we attempted to efficiently construct hyaline cartilage tissue from human bone marrow‐derived cells without using a scaffold. Bone marrow aspirates were obtained from the iliac crest of nine patients during orthopedic operation. After their proliferation in monolayer culture, the adherent cells were cultured in the RWV bioreactor with chondrogenic medium for 2 weeks. Cells from the same source were cultured in pellet culture as controls. Histological and immunohistological evaluations (collagen type I and II) and quantification of glycosaminoglycan were performed on formed tissues and compared. The engineered constructs obtained using the RWV bioreactor showed strong features of hyaline cartilage in terms of their morphology as determined by histological and immunohistological evaluations. The glycosaminoglycan contents per µg DNA of the tissues were 10.01 ± 3.49 µg/µg DNA in the case of the RWV bioreactor and 6.27 ± 3.41 µg/µg DNA in the case of the pellet culture, and their difference was significant. The RWV bioreactor could provide an excellent environment for three‐dimensional cartilage tissue architecture that can promote the chondrogenic differentiation of adult human bone marrow‐derived cells. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 517–521, 2009     

Neuroanatomy of the male pelvis in respect to radical prostatectomy including three‐dimensional visualization

The neuroanatomical structures of the radical prostatectomy (RP) are extensively discussed for their existence, localization and function. Especially structures, e.g. the so‐called neurovascular bundle (NVB) that are points of debate in numerous anatomical studies. We review the literature and present our observations in cadaveric specimens, to reconstruct neuroanatomical structures in three dimensions (3D) with the use of appropriate computer applications and produce images of operative fields. We used an internet PubMed survey ( http://www.ncbi.nlm.nih.gov ) to review recent publications and included back copies of historical neuroanatomical studies from our own library. Our own experimental cadaveric (specimens preserved in Thiel’s solution) studies of the autonomic nerve supply of the lower urinary tract were also reviewed. Visualization of the pelvic anatomy and neuroanatomy was done using computer‐based software packages. No unified terminology for the structures of the NVBs can be presented to date. The innervation of the smooth muscular structures of the urethra and the complex morphology of urethral sphincter remain unclear. Our cadaveric studies showed that nerves are located on the lateral aspect of the prostate in addition to the NVBs described at the dorsolateral side of the prostate. The neuroanatomical investigations of the male pelvis and visualization of the structures in 3D enable the presentation of operative sites as seen intraoperatively. Moreover, dynamic depiction of the pelvic floor is also possible.