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Preoperative Computer-Assisted Laparoscopy Planning for the Minimally Invasive Surgical Repair of Hiatal Hernia

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 positionin...

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Autores principales: Preda, Silviu Daniel, Ciobîrcă, Cătălin, Gruionu, Gabriel, Iacob, Andreea Șoimu, Sapalidis, Konstantinos, Gruionu, Lucian Gheorghe, Castravete, Ștefan, Pătrașcu, Ștefan, Șurlin, Valeriu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554699/
https://www.ncbi.nlm.nih.gov/pubmed/32839375
http://dx.doi.org/10.3390/diagnostics10090621
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author Preda, Silviu Daniel
Ciobîrcă, Cătălin
Gruionu, Gabriel
Iacob, Andreea Șoimu
Sapalidis, Konstantinos
Gruionu, Lucian Gheorghe
Castravete, Ștefan
Pătrașcu, Ștefan
Șurlin, Valeriu
author_facet Preda, Silviu Daniel
Ciobîrcă, Cătălin
Gruionu, Gabriel
Iacob, Andreea Șoimu
Sapalidis, Konstantinos
Gruionu, Lucian Gheorghe
Castravete, Ștefan
Pătrașcu, Ștefan
Șurlin, Valeriu
author_sort Preda, Silviu Daniel
collection PubMed
description 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.
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spelling pubmed-75546992020-10-19 Preoperative Computer-Assisted Laparoscopy Planning for the Minimally Invasive Surgical Repair of Hiatal Hernia Preda, Silviu Daniel Ciobîrcă, Cătălin Gruionu, Gabriel Iacob, Andreea Șoimu Sapalidis, Konstantinos Gruionu, Lucian Gheorghe Castravete, Ștefan Pătrașcu, Ștefan Șurlin, Valeriu Diagnostics (Basel) Article 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. MDPI 2020-08-21 /pmc/articles/PMC7554699/ /pubmed/32839375 http://dx.doi.org/10.3390/diagnostics10090621 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Preda, Silviu Daniel
Ciobîrcă, Cătălin
Gruionu, Gabriel
Iacob, Andreea Șoimu
Sapalidis, Konstantinos
Gruionu, Lucian Gheorghe
Castravete, Ștefan
Pătrașcu, Ștefan
Șurlin, Valeriu
Preoperative Computer-Assisted Laparoscopy Planning for the Minimally Invasive Surgical Repair of Hiatal Hernia
title Preoperative Computer-Assisted Laparoscopy Planning for the Minimally Invasive Surgical Repair of Hiatal Hernia
title_full Preoperative Computer-Assisted Laparoscopy Planning for the Minimally Invasive Surgical Repair of Hiatal Hernia
title_fullStr Preoperative Computer-Assisted Laparoscopy Planning for the Minimally Invasive Surgical Repair of Hiatal Hernia
title_full_unstemmed Preoperative Computer-Assisted Laparoscopy Planning for the Minimally Invasive Surgical Repair of Hiatal Hernia
title_short Preoperative Computer-Assisted Laparoscopy Planning for the Minimally Invasive Surgical Repair of Hiatal Hernia
title_sort preoperative computer-assisted laparoscopy planning for the minimally invasive surgical repair of hiatal hernia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554699/
https://www.ncbi.nlm.nih.gov/pubmed/32839375
http://dx.doi.org/10.3390/diagnostics10090621
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