ObjectivesTo systematically review the clinical efficacy of three-dimensional (3D) visualization vs. two-dimensional (2D) imaging technique in hepatectomy.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect clinical trials which compared 3D visualization with conventional 2D imaging technique for hepatectomy from inception to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 studies involving 953 patients were included. The results of meta-analysis showed that: compared to 2D imaging technique, 3D visualization technique could improve R0 resection rate (OR=2.91, 95%CI 1.31 to 6.43, P=0.009), had lower incidence of postoperative complication (OR=0.55, 95%CI 0.38 to 0.80, P=0.002), less amount of blood transfusion in operation (MD=–96.05, 95%CI –126.78 to –65.31, P<0.000 01), lower discrepancy range between the volume of the predicted liver resection and actual resection volume (MD=–94.38, 95%CI –185.46 to –3.30,P=0.04), shorter operation time (MD=–33.58, 95%CI –60.09 to –7.08, P=0.01), and lower intraoperative blood loss (MD=–79.70, 95%CI –139.86 to –19.53, P=0.009), the differences were statistically significant. There were no statistical differences between two groups in postoperative hospital stay time (MD=–0.75, 95%CI –2.45 to 0.95, P=0.39).ConclusionsThe current evidence shows that application of 3D visualization technique in hepatectomy can predict the liver resection volume more accurately, improve the R0 resection rate, shorten operation time, decrease intraoperative blood transfusion volume and the amount of bleeding, and reduce the incidence of postoperative complications. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusion.
ObjectiveTo investigate the role of 3D visualization technology in the laparoscopic precise hepatectomy. MethodsTo retrieve the literatures about the application of 3D visualization technology in laparoscopic precise hepatectomy, and summarize and analyzed them. ResultsThe application of 3D visualization in laparoscopic precise hepatectomy could effectively reduce the operative time, blood loss, blood transfusion rate, and total complication rate. The application of 3D visualization in preoperative evaluation of the resection surface and residual liver volume had been relatively mature. Although many organizations try to use 3D visualization in laparoscopic hepatectomy, such as laser registration and real-time intraoperative navigation, it had not been widely used in clinic because of technical limitations. ConclusionsExisting research results show that, the application of 3D visualization technology in laparoscopic precise hepatectomy can improve the resectability of lesions, increase perioperative safety, but intraoperative navigation is still need to be further developed before it is expected to be widely used in clinical practice. Existing evidence of increased benefit from laparoscopic precise hepatectomy with 3D reconstruction remains limited, and more rigorous randomized controlled trials of large cases are needed to confirm this.
Three-dimensional (3D) visualization technology can well characterize lung nodules, accurately locate lung nodules, accurately identify lung anatomical structures, shorten operation time, reduce intraoperative and postoperative complications, and make thoracoscopic precise lung resection safer and more efficient. However, the mastery of 3D reconstruction technology in some hospitals still needs to be improved. Due to the time and economic cost of 3D printing, the development of this technology is restricted. With the application and improvement of 3D visualization technology in more centers in the future, the development of precise lung resection will be more extensive. This article reviewed the progress on 3D visualization technology in thoracoscopic precise lung resection.
Objective To compare the reduction qualities of three-dimensional visible technique without fluoroscopy and two-dimensional fluoroscopy for unstable pelvic fractures during operations. Methods The clinical data of 40 patients with unstable pelvic fractures, who met the selection criteria in three clinical centers between June 2021 and September 2022, were retrospectively analyzed. According to the reduction methods, the patients were divided into two groups. Twenty patients in trial group were treated with unlocking closed reduction system combined with three-dimensional visible technique without fluoroscopy; 20 patients in control group with unlocking closed reduction system under two-dimensional fluoroscopy. There was no significant difference in the gender, age, injury mechanism, Tile type of fracture, Injury Severity Score (ISS), and the time between injury to operation between the two groups (P>0.05). The qualities of fracture reduction according to the Matta criteria, operative time, intraoperative blood loss, fracture reduction time, times of fluoroscopy, and System Usability Scale (SUS) score were recorded and compared. Results All operations were successfully completed in both groups. According to the Matta criteria, the qualities of fracture reduction were rated as excellent in 19 patients (95%) in trial group, which was better than that in the control group (13 cases, 65%), with a significant difference (χ2=3.906, P=0.048). The operative time and intraoperative blood loss had no significant differences between the two groups (P>0.05). The fracture reduction time and times of fluoroscopy were significantly less in trial group than in control group (P<0.05), and SUS score in trial group was significantly higher in trial group than in control group (P<0.05). ConclusionCompared to using unlocking closed reduction system under two-dimensional fluoroscopy, three-dimensional visible technique without fluoroscopy can significantly improve the reduction quality of unstable pelvic fractures without prolonging the operative time, and is valuable to reduce iatrogenic radiation exposure for patients and medical workers.
ObjectiveTo evaluate the application value of three-dimensional visualization (3DV) technique in the reconstruction of complex abdominal incisional hernia. MethodsThe clinical data of the patients with complex abdominal incisional hernia admitted to the West China Hospital of Sichuan University from September 2021 to September 2022 were collected. The area of abdominal wall defects was analyzed by Medraw software and reconstructed using 3DV technique, then the classifying and partition of abdominal wall defects were performed, the hernia sac/ intraabdominal volume ratio was calculated, patch size was estimated, and intraabdominal pressure values at 24 h and 48 h after surgery as well as operation time, complications were recorded. ResultsA total of 48 patients with complex abdominal incisional hernia were enrolled, including 30 cases of midline abdominal incisional hernia and 18 cases of other sites. There were 13 cases of moderate hernia, 19 cases of large hernia, and 16 cases of huge hernia. The abdominal wall defect area measured by 3DV technique for the 48 patients was (92.11±60.25) cm2, the hernia sac / intraabdominal volume ratio was (7.7±5.2)%, and the actual defect area measured intraoperatively was (89.20±57.38) cm2. Pearson correlation analysis showed a positive correlation between the preoperative 3DV measurement and intraoperative measurement (r=0.959, P<0.001). The operation time was (73.5±8.2) min, postoperative anal exhaust time (31.66±15.32) h, intraabdominal pressures at 24 h and 48 h postoperatively were (13.50±2.12) mmHg and (11.39±1.42) mmHg, respectively. The patient’s hospitalization time was (7.12±1.21) d. Among the 48 patients, 7 cases (14.58%) experienced complications after surgery, recovered smoothly after conservative treatment and no unplanned reoperation was required. All patients were followed up for 18–32 months with a median time of 26 months, and no long-term hernia recurrence was observed. ConclusionFrom the analysis results of this study, it can be seen that the application of 3DV technique to evaluate complex abdominal wall defects can assist hernia surgeons to make a correct choice and has a better safety and effect.