Prediction of complexity and complications of laparoscopic liver surgery: The comparison of the Halls‐score to the IWATE‐score in 100 consecutive laparoscopic liver resections

BACKGROUND The development of laparoscopic liver surgery is slower than in other disciplines. Two different scoring systems have been proposed to estimate difficulty of laparoscopic liver resections (LLR) preoperatively. The aim of this analysis was to compare these two scores in an independent patient cohort regarding the predictability of morbidity. METHODS All LLRs performed between 01/2011 until 01/2019 were identified from our prospective institutional database. Patient characteristics as well as intra- and postoperative data were analyzed. Postoperative complications were graded according to Dindo-Clavien classification. Difficulty of LLR was classified using IWATE- and Halls-score. R…

Chirurgische Ausbildung im digitalen Zeitalter – Virtual Reality, Augmented Reality und Robotik im Medizinstudium

The digital transformation of healthcare is changing the medical profession. Augmented/Virtual Reality (AR/VR) and robotics are being increasingly used in different clinical contexts and require supporting education and training, which must begin within the medical school. There is currently a large discrepancy between the high demand and the number of scientifically proven concepts. The aim of this thesis was the conceptual design and structured evaluation of a newly developed learning/teaching concept for the digital transformation of medicine, with a special focus on the influence of surgical teaching.Thirty-five students participated in three courses of the blended learning curriculum "…

Virtuelle 3-D-Laparoskopie-Simulation in der chirurgischen Aus- und Weiterbildung – Ergebnisse einer Pilotstudie

Hintergrund: Dem technischen Fortschritt folgend, werden im Operationssaal Module zur 3-dimensionalen Darstellung in der Laparoskopie eingesetzt. Erste Untersuchungen an Box-Trainern haben diskrepante Ergebnisse gezeigt. Fur die Virtual-Reality-Laparoskopie (VRL) fehlen Daten zur 3-dimensionalen Simulation. Material und Methoden: 5 Facharzte fur Chirurgie, 10 chirurgisch tatige Arzte in Weiterbildung und 29 Medizinstudenten fuhrten abstrakte und prozedurale Ubungen am VRL-Simulator im 2-D- und 3-D-Modus durch. Die Reihenfolge der Durchfuhrung (2-D/3-D) wurde randomisiert. Ergebnisse: Fur Arzte und Studenten zeigten sich keine signifikanten Leistungsunterschiede fur Ubungen im 2-D- und 3-D-D…

Umfrage zum Training laparoskopischer Fertigkeiten in Deutschland

Hintergrund: Das Training fur Laparoskopie an Simulationsmoglichkeiten wie Box-, POP- oder Virtual-Reality-Trainern verbessert nachweislich die intraoperativen Leistungen. In Deutschland ist dieses Training nicht verpflichtend in die Facharztweiterbildung integriert, muss jedoch bspw. in zertifizierten Zentren fur minimalinvasive Chirurgie bereitgestellt werden. Simulatoren sind in Deutschland von Weiterbildern und Weiterzubildenden erwunscht, jedoch laut fruheren Umfragen nicht ausreichend verfugbar. Ziel des Projekts war die strukturierte Erfassung der Moglichkeiten fur Laparoskopietraining in Deutschland sowie deren Nutzung und Finanzierung. Methoden: Es wurde eine Onlineumfrage unter Mi…

Leberresektionen können bei vorsichtiger Patientenselektion auch in Zirrhose sicher durchgeführt werden

Zusammenfassung Hintergrund Das hepatozelluläre Karzinom (HCC) ist der häufigste maligne Lebertumor in einer Leberzirrhose. Neben der Lebertransplantation stellt die Leberresektion in kompensierter Zirrhose eine kurative Therapieoption dar, die jedoch mit einer höheren postoperativen Morbidität und Mortalität einhergeht. Patienten Es wurden 108 Patienten identifiziert, die mit einer Leberzirrhose im Zeitraum von Januar 2008 bis Dezember 2019 an der Universitätsmedizin Mainz eine Leberresektion erhalten haben. Im gleichen Zeitraum wurden 185 Resektionen wegen eines HCC in nicht zirrhotischer Leber durchgeführt. Als weitere Kontrollgruppe dienten 167 Resektionen wegen kolorektaler Lebermetast…

Virtual reality and 3D printing improve preoperative visualization of 3D liver reconstructions-results from a preclinical comparison of presentation modalities and user's preference.

BACKGROUND: Preoperative three-dimensional (3D) reconstructions for liver surgery planning have been shown to be effective in reduction of blood loss and operation time. However, the role of the ‘presentation modality’ is not well investigated. We present the first study to compare 3D PDFs, 3D printed models (PR) and virtual reality (VR) 3D models with regard to anatomical orientation and personal preferences in a high volume liver surgery center. METHODS: Thirty participants, 10 medical students, 10 residents, 5 fellows and 5 hepatopancreatobiliary (HPB) experts, assigned the tumor-bearing segments of 20 different patient’s individual liver reconstructions. Liver models were presented in a…

In Virtual Reality durch die Pandemie: Digitale Lehre mit modernster Technologie in der Leberchirurgie

Inclusive B ¯ → X s ℓ + ℓ − $$ \overline{B}\to {X}_s{\ell}^{+}{\ell}^{-} $$ : complete angular analysis and a thorough study of collinear photons

We investigate logarithmically enhanced electromagnetic corrections of all angular observables in inclusive $$ \overline{B}\to {X}_s{\ell}^{+}{\ell}^{-} $$ . We present analytical results, which are supplemented by a dedicated Monte Carlo study on the treatment of collinear photons in order to determine the size of the electromagnetic logarithms. We then give the Standard Model predictions of all observables, considering all available NNLO QCD, NLO QED and power corrections, and investigate their sensitivity to New Physics. Since the structure of the double differential decay rate is modified in the presence of QED corrections, we also propose new observables which vanish if only QCD correc…

Erweiterte Hemihepatektomie rechts mit Hepatikusgabelresektion und Rekonstruktion der Pfortadergabel und der linken Lebervene bei cholangiozellulärem Karzinom

ZusammenfassungDie vollständige Resektion gilt bei Patienten mit cholangiozellulärem Karzinom als Therapie der Wahl. Aufgrund der Tumorausdehnung sind hierbei Resektion und Rekonstruktion vaskulärer Strukturen häufig erforderlich. Dreidimensionale Rekonstruktionen der Schnittbildgebung können in diesen Fällen hilfreich für die Resektionsplanung sein. Das vorliegende Video zeigt eine erweiterte Hemihepatektomie rechts mit Hepatikusgabelresektion mit Resektion und Rekonstruktion der Pfortadergabel und einer von 2 linken Lebervenen bei einem intrahepatischen cholangiozellulären Karzinom.

An Interactive Demonstration of Collaborative VR for Laparoscopic Liver Surgery Training

We introduce a collaborative virtual reality (VR) system for planning and simulation in laparoscopic liver surgery training. Patient image data is used for surgical model visualization and simulation. We developed two modes for training in laparoscopic procedures: exploration and surgery mode. Surgical joysticks are used in surgery mode to provide training for psychomotor skills and cooperation between a camera assistant and an experienced surgeon. Continuous feedback from our clinical partner comprised an important part of the development. Our evaluation showed that surgeons were positive about the usability and usefulness of the developed system. For further details, please refer to our f…

Collaborative VR for Liver Surgery Planning using Wearable Data Gloves: An Interactive Demonstration

Preoperative planning for liver surgery is a critical procedure to assess a potential resection and it supports surgeons to define the affected vessels and resection volume. Traditional surgical planning systems are widely used to support the planning with the usage of desktop-based 3D and 2D visualizations. However, desktop-based systems offer limited interactions and visualizations compared to virtual reality (VR) [3]. A suitable technique to support collaboration among surgeons is required. Our previous works [1], [2] illustrate that using collaborative VR is essential to enhance communication, teamwork, and over-distance collaboration. In this work, we present a collaborative VR prototy…

A collaborative virtual reality environment for liver surgery planning

Abstract Surgical planning software is a key component in the treatment of tumor diseases. However, desktop-based systems provide only limited visualization and interaction opportunities. Moreover, collaborative planning among members of a surgical team is only possible to a limited extent. In this work, a collaborative virtual reality (VR) environment to assist liver surgeons in tumor surgery planning is presented. Our aim is to improve virtual resection planning between surgeons in a remote or co-located environment. The system allows surgeons to define and adjust virtual resections on patient-specific organ 3D surfaces and 2D image slices. Changes on both modalities are synchronized, whi…

3D-Druck, Virtual Reality oder regulärer Monitor? Vergleich unterschiedlicher Darstellungsmöglichkeiten dreidimensionaler Leberrekonstruktionen

Educational Team Time Out in der onkologischen Viszeralchirurgie: Ein Konzept zur Optimierung der Weiterbildung

Quality-based assessment of camera navigation skills for laparoscopic fundoplication.

Summary Laparoscopic fundoplication is considered the gold standard surgical procedure for the treatment of symptomatic hiatus hernia. Studies on surgical performance in minimally invasive hiatus hernia repair have neglected the role of the camera assistant so far. The current study was designed to assess the applicability of the structured assessment of laparoscopic assistance skills (SALAS) score to laparoscopic fundoplication as an advanced and commonly performed laparoscopic upper GI procedure. Randomly selected laparoscopic fundoplications (n = 20) at a single institute were evaluated. Four trained reviewers independently assigned SALAS scoring based on synchronized video and voice rec…

Collaborative Virtual Reality for Laparoscopic Liver Surgery Training

Virtual reality (VR) has been used in many medical training systems for surgical procedures. However, the current systems are limited due to inadequate interactions, restricted possibilities of patient data visualization, and collaboration. We propose a collaborative VR system for laparoscopic liver surgical planning and simulation. Medical image data is used for model visualization and manipulation. Additionally, laparoscopic surgical joysticks are used to provide an opportunity for a camera assistant to cooperate with an experienced surgeon in VR. Continuous clinical feedback led us to optimize the visualization, synchronization, and interactions of the system. Laparoscopic surgeons were …

Technik der Mesohepatektomie

Bei Patienten mit einer primar oder sekundar malignen zentralen Leberraumforderung stellt die Resektion im Sinne einer erweiterten Hemihepatektomie rechts bzw. links das Standardverfahren dar. Unter Berucksichtigung der erhohten Morbiditat und Mortalitat bei erweiterten Resektionen und dem Aspekt des hohen Verlusts an gesundem Lebergewebe stellt die zentrale Leberresektion oder Mesohepatektomie (Resektion der Segmente 4a/4b, 5 und 8) mit oder ohne Resektion des Segments 1 eine technisch anspruchsvolle und weiterhin selten genutzte Alternative dar. Die Resektionsgrenzen liegen rechtsseitig des Lig. falciforme und auf der oft schwierig zu identifizierenden Grenze zwischen den Segmenten 5/6 so…

Head-Mounted Mixed-Reality Technology During Robotic-Assisted Transanal Total Mesorectal Excision

INTRODUCTION Head-mounted mixed-reality technologies may enable advanced intraoperative visualization during visceral surgery. In this technical note, we describe an innovative use of real-time mixed reality during robotic-assisted transanal total mesorectal excision. TECHNIQUE Video signals from the robotic console and video endoscopic transanal approach were displayed on a virtual monitor using a head-up display. The surgeon, assistant, and a surgical trainee used this technique during abdominal and transanal robotic-assisted total mesorectal excision. We evaluated the feasibility and usability of this approach with the use of validated scales. RESULTS The technical feasibility of the rea…

Chirurgische Lehre in Zeiten von Covid-19 - Aus notwendigen Kompromissen werden Chancen für die Zukunft

Zusammenfassung Hintergrund Chirurgische Lehre im Rahmen des klinischen Studienabschnitts beruht sowohl auf der Wissensvermittlung von Krankheitsbildern und deren Behandlung als auch auf der Weitergabe von psychomotorischen Fähigkeiten wie z. B. dem chirurgischen Nähen. Im gesamten klinischen Studienabschnitt werden kommunikative Fertigkeiten und der professionelle Umgang mit Patienten geschult. Die Kontaktbeschränkungen im Rahmen der COVID-19-Pandemie stellten seit dem Sommersemester (SoSe) 2020 die chirurgische Lehre vor neue, kurzfristig umzusetzende Herausforderungen. Hierzu gehörten die zügige Implementierung digitaler Lerninhalte sowie die Ausarbeitung neuer Hygienekonzepte für Lehre …

Laparoscopic assistance by operating room nurses: Results of a virtual-reality study

Abstract Background Laparoscopic assistance is often entrusted to a less experienced resident, medical student, or operating room nurse. Data regarding laparoscopic training for operating room nurses are not available. Objectives The aim of the study was to analyse the initial performance level and learning curves of operating room nurses in basic laparoscopic surgery compared with medical students and surgical residents to determine their ability to assist with this type of procedure. Design The study was designed to compare the initial virtual reality performance level and learning curves of user groups to analyse competence in laparoscopic assistance. Participants The study subjects were…

A VR/AR Environment for Multi-User Liver Anatomy Education

We present a Virtual and Augmented Reality multi-user prototype of a learning environment for liver anatomy education. Our system supports various training scenarios ranging from small learning groups to classroom-size education, where students and teachers can participate in virtual reality, augmented reality, or via desktop PCs. In an iterative development process with surgeons and teachers, a virtual organ library was created. Nineteen liver data sets were used comprising 3D surface models, 2D image data, pathology information, diagnosis and treatment decisions. These data sets can interactively be sorted and investigated individually regarding their volumetric and meta information. The …

Management of Bleeding Complications in Virtual Reality Laparoscopy

The aim of this study was to compare the impact of induced bleeding complication training with regular training on a virtual reality laparoscopic (VRL) simulator. Although bleeding complications occur rarely during laparoscopic surgery, they usually arise without warning and may have severe consequences for the patient because complication management training is not currently widespread. Third-year medical students (n = 41) were randomly selected for 2 curricular courses on how to perform a bimanual task on a VRL simulator. Both the regular training group (RTG) and the induced bleeding complication training (ICT) group performed 2 regular training sessions and 9 training sessions. For the I…

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition) 1

Contains fulltext : 232759.pdf (Publisher’s version ) (Closed access) In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to…

Liver Resection for Intrahepatic Cholangiocarcinoma—Single-Center Experience with 286 Patients Undergoing Surgical Exploration over a Thirteen Year Period

Background: Intrahepatic cholangiocarcinoma (iCCA) accounts for about 10% of primary liver cancer. Surgery is the only potentially curative treatment. We report on our current series of 229 consecutive hepatic resections for iCCA, which is one of the largest Western single-center series published so far. Methods: Between January 2008 to December 2020, a total of 286 patients underwent 307 surgical explorations for intended liver resection of iCCA at our department. Data were analyzed with regard to (1) preoperative treatment of tumor, (2) operative details, (3) perioperative morbidity and mortality, (4) histopathology, (5) outcome measured by tumor recurrence, treatment of recurrence and su…

Erweiterte Hemihepatektomie links mit Rekonstruktion der rechten Lebervene bei intrahepatischem cholangiozellulärem Karzinom

Die erweiterte Hemihepatektomie links mit der Resektion der Lebersegmente 1, 2, 3, 4 a/b, 5 und 8 ist eine auch weiterhin sehr herausfordernde Leberresektion, deren Indikation bei gut selektionierten Patienten die Chance auf eine kurative Resektion bei primaren oder sekundaren Lebertumoren mit komplizierter Lage bieten kann. Die Morbiditat und Mortalitat ist gegenuber den nicht erweiterten Leberresektionen erhoht. Eine prazise Bildgebung und genaue Operationsplanung unter Berucksichtigung des verbleibenden Lebervolumens sowie von Einflussfaktoren wie Vorschadigungen des Leberparenchyms durch Chemotherapie oder eine Fibrose/Zirrhose ist hierbei unabdingbar. Notwendig wird dieses operative Vo…

Virtual and Augmented Reality in Liver Surgery.

The Belle II Physics Book

cd. autorów: L. Cao48,‡, G. Caria145,‡, G. Casarosa57,‡, C. Cecchi56,‡,D. Cˇ ervenkov10,‡,M.-C. Chang22,‡, P. Chang92,‡, R. Cheaib146,‡, V. Chekelian83,‡, Y. Chen154,‡, B. G. Cheon28,‡, K. Chilikin77,‡, K. Cho70,‡, J. Choi14,‡, S.-K. Choi27,‡, S. Choudhury35,‡, D. Cinabro170,‡, L. M. Cremaldi146,‡, D. Cuesta47,‡, S. Cunliffe16,‡, N. Dash33,‡, E. de la Cruz Burelo9,‡, E. de Lucia52,‡, G. De Nardo54,‡, †Editor. ‡Belle II Collaborator. §Theory or external contributing author. M. De Nuccio16,‡, G. De Pietro59,‡, A. De Yta Hernandez9,‡, B. Deschamps129,‡, M. Destefanis60,‡, S. Dey116,‡, F.Di Capua54,‡, S.Di Carlo75,‡, J. Dingfelder129,‡, Z. Doležal10,‡, I. Domínguez Jiménez125,‡, T.V. Dong30,26,…

Artificial Versus Video-Based Immersive Virtual Surroundings: Analysis of Performance and User's Preference.

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 …

Voluntary distance running prevents TNF-mediated liver injury in mice through alterations of the intrahepatic immune milieu

AbstractPhysical activity confers a broad spectrum of health benefits. Beyond the obvious role in metabolically driven diseases, the role of physical activity in acute liver injury is poorly explored. To study the role of physical activity in acute liver injury, a novel model of voluntary distance running in mice was developed and mice were subjected to acute liver injury induced by N-galactosamine (GalN) and lipopolysaccharide (LPS). Analyses included histological stains, immunoblotting, qRT-PCR and FACS analysis. Voluntary distance running increased to an average of 10.3 km/day after a learning curve. Running lead to a decrease in the absolute numbers of intrahepatic CD4+ T and B lymphocy…