Preoperative Computer-Assisted Laparoscopy Planning for the Minimally Invasive Surgical Repair of Hiatal Hernia
Autor: | Ștefan Pătrașcu, Ștefan Castravete, Andreea Șoimu Iacob, Konstantinos Sapalidis, Lucian Gheorghe Gruionu, Gabriel Gruionu, Valeriu Șurlin, Silviu Daniel Preda, Catalin Ciobirca |
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Rok vydání: | 2020 |
Předmět: |
Laparoscopic surgery
medicine.medical_specialty Future studies medicine.medical_treatment Clinical Biochemistry laparoscopy Surgical planning Xiphoid process Article surgical planning Hiatal hernia 03 medical and health sciences 0302 clinical medicine medicine Laparoscopy Surgical repair lcsh:R5-920 training medicine.diagnostic_test business.industry medicine.disease Surgery medicine.anatomical_structure 030220 oncology & carcinogenesis Surgical instrument 030211 gastroenterology & hepatology lcsh:Medicine (General) business hiatal hernia |
Zdroj: | Diagnostics, Vol 10, Iss 621, p 621 (2020) Diagnostics Volume 10 Issue 9 |
ISSN: | 2075-4418 |
Popis: | Minimal invasive surgical procedures such as laparoscopy are preferred over open surgery due to faster postoperative recovery, less trauma and inflammatory response, and less scarring. Laparoscopic repairs of hiatal hernias require pre-procedure planning to ensure appropriate exposure and positioning of the surgical ports for triangulation, ergonomics, instrument length and operational angles to avoid the fulcrum effect of the long and rigid instruments. We developed a novel surgical planning and navigation software, iMTECH to determine the optimal location of the skin incision and surgical instrument placement depth and angles during laparoscopic surgery. We tested the software on five cases of human hiatal hernia to assess the feasibility of the stereotactic reconstruction of anatomy and surgical planning. A whole-body CT investigation was performed for each patient, and abdominal 3D virtual models were reconstructed from the CT scans. The optical trocar access point was placed on the xipho-umbilical line. The distance on the skin between the insertion point of the optical trocar and the xiphoid process was 159.6, 155.7, 143.1, 158.3, and 149.1 mm, respectively, at a 40° elevation angle. Following the pre-procedure planning, all patients underwent successful surgical laparoscopic procedures. The user feedback was that planning software significantly improved the ergonomics, was easy to use, and particularly useful in obese patients with large hiatal defects where the insertion points could not be placed in the traditional positions. Future studies will assess the benefits of the planning system over the conventional, empirical trocar positioning method in more patients with other surgical challenges. |
Databáze: | OpenAIRE |
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