Procedure-Specific Arthroscopic Simulation Using 3-Dimensional Printing.
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ABSTRACT:
SUBMITTER: Biggs A
PROVIDER: S-EPMC7823098 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Organ phantoms are widely used for evaluating medical technologies, training clinical practitioners, as well as surgical planning. In the context of cardiovascular disease, a patient-specific cardiac phantom can play an important role for interventional cardiology procedures. However, phantoms with complicated structures are difficult to fabricate by conventional manufacturing methods. The emergence of three-dimensional (3D) printing with soft materials provides the opportunity to produce phantoms with complex geometries and realistic properties. In this work, the aim was to explore the use of a direct 3D printing technique to produce multimodal imaging cardiac phantoms and to test the physical properties of the new materials used, namely the Poro-Lay series and TangoPlus. The cardiac phantoms were first modeled using real data segmented from a patient chest computer tomography (CT) scan and then printed with the novel materials. They were then tested quantitatively in terms of stiffness and ultrasound (US) acoustic values and qualitatively with US, CT, and magnetic resonance imaging systems. From the stiffness measurements, Lay-fomm 40 had the closest Young's modulus to real myocardium with an error of 29-54%, while TangoPlus had the largest difference. From the US acoustics measurements, Lay-fomm 40 also demonstrated the closest soft tissue-mimicking properties with both the smallest attenuation and impedance differences. Furthermore, the imaging results show that the phantoms are compatible with multiple imaging modalities and thus have potential to be used for interventional procedure simulation and testing of novel interventional devices. In conclusion, direct 3D printing with Poro-Lay and TangoPlus is a promising method for manufacture of multimodal imaging phantoms with complicated structures, especially for soft patient-specific phantoms.
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Project description:The primary function of an airway stent is to reestablish patency, impeding restenosis, supporting the tracheobronchial wall, or occluding fistulas. But stent-related complications are prevalent and can have devastating consequences. For this reason, stents are considered a last resort when there are no alternatives in treatment. Additionally, commercially available airway stents often poorly fit patients with complex airways, and they can cause various complications. At the end of the 20th century, three-dimensional (3D) printing technology was created. It has been transformative in healthcare and has been used in several applications. One of its first utilizations was the anatomical modeling of body structures that helps preoperative planning. In respiratory medicine, this technology has been essentially used in central airway diseases to produce 3D airway models and to create airway splints and prostheses. In the last decade, it has led to a transformation and allowed progress in personalized medicine, making patient-specific stents for individuals with complex airway problems. A patient-specific stent using 3D printing may minimize complications, improve quality of life, and reduce the need for repeated procedures. This review describes the recent advances in 3D printing technology, its use for developing airway prostheses to treat complex airway diseases, and the current evidence that supports its use.
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Project description:The Latarjet procedure is a method used for the treatment of shoulder instability in the presence of bone loss. A decade after the first description of the fully arthroscopic Latarjet procedure, modifications to the technique were reported to decrease the risk of complications and improve the position of the bone block. A recent trend toward the use of buttons to fix the coracoid has been reported. The technique described here is an arthroscopic Latarjet procedure that uses 2 pairs of round buttons as an alternative to screw fixation or the use of a single button, and the technique aims to combine the original procedure with safe and stable fixation.
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Project description:Arthroscopic Latarjet procedure is an efficient and reliable approach for the treatment of shoulder instability. Nevertheless, the screws fixing the bone block may sometimes be responsible for pain and uncomfortable snapping in the shoulder that is triggered during active external rotation. We propose an all-arthroscopic technique for screw removal in cases of complications involving the screws from a Latarjet procedure. The all-arthroscopic screw removal is reliable and efficient. This procedure is indicated in more cases than thought because of the bone block resorption. It permits a revision of the glenohumeral joint in case of persisting pain.
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Project description:A survey of 67 experienced orthopedic surgeons indicated that precise portal placement was the most important skill in arthroscopic surgery. However, none of the currently available virtual reality simulators include simulation / training in portal placement, including haptic feedback of the necessary puncture force. This study aimed to: (1) measure the in vivo force and stiffness during a portal placement procedure in an actual operating room and (2) implement active haptic simulation of a portal placement procedure using the measured in vivo data. We measured the force required for port placement and the stiffness of the joint capsule during portal placement procedures performed by an experienced arthroscopic surgeon. Based on the acquired mechanical property values, we developed a cable-driven active haptic simulator designed to train the portal placement skill and evaluated the validity of the simulated haptics. Ten patients diagnosed with rotator cuff tears were enrolled in this experiment. The maximum peak force and joint capsule stiffness during posterior portal placement procedures were 66.46 (±10.76N) and 2560.82(±252.92) N/m, respectively. We then designed an active haptic simulator using the acquired data. Our cable-driven mechanism structure had a friction force of 3.763 ± 0.341 N, less than 6% of the mean puncture force. Simulator performance was evaluated by comparing the target stiffness and force with the stiffness and force reproduced by the device. R-squared values were 0.998 for puncture force replication and 0.902 for stiffness replication, indicating that the in vivo data can be used to implement a realistic haptic simulator.
| S-EPMC5833274 | biostudies-literature
Project description:PurposeTo demonstrate the use of anatomic MRI-visible three-dimensional (3D)-printed phantoms and to assess process accuracy and material MR signal properties.MethodsA cervical spine model was generated from computed tomography (CT) data and 3D-printed using an MR signal-generating material. Printed phantom accuracy and signal characteristics were assessed using 120 kVp CT and 3 Tesla (T) MR imaging. The MR relaxation rates and diffusion coefficient of the fabricated phantom were measured and 1 H spectra were acquired to provide insight into the nature of the proton signal. Finally, T2 -weighted imaging was performed during cryoablation of the model.ResultsThe printed model produced a CT signal of 102 ± 8 Hounsfield unit, and an MR signal roughly 1/3rd that of saline in short echo time/short repetition time GRE MRI (456 ± 36 versus 1526 ± 121 arbitrary signal units). Compared with the model designed from the in vivo CT scan, the printed model differed by 0.13 ± 0.11 mm in CT, and 0.62 ± 0.28 mm in MR. The printed material had T2 ∼32 ms, T2*∼7 ms, T1 ∼193 ms, and a very small diffusion coefficient less than olive oil. MRI monitoring of the cryoablation demonstrated iceball formation similar to an in vivo procedure.ConclusionCurrent 3D printing technology can be used to print anatomically accurate phantoms that can be imaged by both CT and MRI. Such models can be used to simulate MRI-guided interventions such as cryosurgeries. Future development of the proposed technique can potentially lead to printed models that depict different tissues and anatomical structures with different MR signal characteristics. Magn Reson Med 77:613-622, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
| S-EPMC5108690 | biostudies-literature
Project description:The arthroscopic Latarjet procedure is challenging because it can be difficult to place 2 screws parallel to the glenoid surface and a medial portal (dangerous for the brachial plexus) is mandatory. In addition, precise positioning of the coracoid bone block flush with the joint line and in a subequatorial position as recommended is troublesome without the use of a guiding system because of the arthroscopic lens distortion. To improve the reproducibility of the arthroscopic Latarjet procedure and to minimize the risk of nerve complications, we developed a guiding system to optimize the positioning of the coracoid bone block and 2 cortical buttons to facilitate its fixation. Four portals are used: a posterior standard portal and 3 anterior portals, all lateral to the conjoint tendon. The anterior rim of the glenoid and the coracoid process are prepared. Two holes are drilled in the glenoid and in the coracoid process with 2 specific guides. The subscapularis is then split, and 2 cortical buttons are passed from posterior to anterior through the tunnels with a shuttle relay. The coracoid process undergoes osteotomy and is guided through the split in the subscapularis to the anteroinferior rim of the glenoid by pulling on the cortical buttons.
| S-EPMC5981180 | biostudies-literature
Project description:Background:To evaluate the feasibility of using a single device to close multiple atrial septal defects (ASDs) under the guidance of transthoracic echocardiography (TTE) and with the aid of three-dimensional (3D) printing models. Methods:Sixty-two patients with multiple ASDs were retrospectively analyzed. Thirty of these patients underwent TTE-guided closure (3D printing and TTE group) after a simulation of occlusion in 3D printing models. The remaining 32 patients underwent ASD closure under fluoroscopic guidance (conventional group). Closure status was assessed immediately and at 6 months after device closure. Results:Successful transcatheter closure with a single device was achieved in 26 patients in the 3D printing and TTE group and 27 patients in the conventional group. Gender, age [18.8?±?15.9 (3-51) years in the 3D printing and TTE group; 14.0?±?11.6 (3-50) years in the conventional group], mean maximum distance between defects, prevalence of 3 atrial defects and large defect distance (defined as distance ?7?mm), and occluder size used were similarly distributed between groups. However, the 3D printing and TTE group had lower frequency of occluder replacement (3.8% vs 59.3%, p < 0.0001), prevalence of mild residual shunts (defined as <5?mm) immediately (19.2% vs 44.4%, p < 0.05) and at 6 months (7.7% vs 29.6%, p < 0.05) after the procedure, and cost (32960.8?±?2018.7 CNY vs 41019.9?±?13758.2 CNY, p < 0.01). Conclusion:The combination of the 3D printing technology and ultrasound-guided interventional procedure provides a reliable new therapeutic approach for multiple ASDs, especially for challenging cases with large defect distance.
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Project description:We present a novel all-arthroscopic technique of posterior shoulder stabilization that uses suture anchors for both bone block fixation and capsulolabral repair. The bone graft, introduced inside the glenohumeral joint through a cannula, is fixed with 2 suture anchors. The associated posteroinferior capsulolabral repair places the bone block in an extra-articular position. In this article we present the detailed arthroscopic technique performed in a consecutive series of 15 patients and report the early results. We also report the positioning, healing, and remodeling of the bone block using postoperative 3-dimensional computed tomography. The benefits of this new technique are as follows: (1) it is all arthroscopic, preserving the posterior deltoid and posterior rotator cuff muscles; (2) it is accurate, resulting in appropriate bone block positioning; (3) it is efficient, allowing for consistent bone graft healing; (4) it is anatomic, both restoring the glenoid bone stock and repairing the injured posterior labrum; and (5) it is safe, limiting hardware-related complications and eliminating the risk of injury to vital structures associated with drilling or screw insertion from posterior to anterior. We believe that this technique is advantageous because it does not use screws for fixation and may be safer for the patient.
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Project description:The Trillat procedure is a surgical treatment for recurrent anterior shoulder instability in the setting of significant or irreparable rotator cuff tears in elderly patients. The procedure comprises an inferior closing wedge partial osteotomy of the coracoid process with fixation to the glenoid neck. This results in a lowered and medialized coracoid process that acts as a bone block and the conjoint tendon is brought closer to the glenohumeral joint, thus closing the subcoracoid space, which blocks humeral dislocation. We describe an arthroscopic step-by-step guided Trillat technique that is simple, efficient, and reproducible, while minimizing risk in the extra-articular subcoracoid space. Our technique does not require the release of the pectoralis minor tendon from the coracoid process, which reduces the risk of damaging the brachial plexus. We use a tight-rope fixation construct that allows progressive transfer of the coracoid process, limiting fracture risk and the risk of overtightening of the subscapularis muscle. Because there is a trend for more complex procedures being performed arthroscopically, it is important to develop and simplify operative techniques, aiding surgeons in achieving reproducible and reliable patient outcomes.
| S-EPMC7189268 | biostudies-literature