“…The physician was able to identify the structures in the ultrasound and CT images that were needed for computer-assisted resection. Detailed explanations of the experiment can be found in the publication by Müller et al [16] . Fig.…”
Section: Resultsmentioning
confidence: 99%
“…To evaluate the resection properties, the phantom was used in the course of a study on computer-assisted endoscopic resection of intraparenchymal tumors starting from the pancreatic duct [16] . The experimental technique of transduodenal-transpapillary endopancreatic surgery makes use of a hybrid NOTES approach in which a rigid endoscope is inserted into the pancreatic duct via a duodenal incision to perform a resection.…”
Section: Methodsmentioning
confidence: 99%
“…Prior to each case, CT images of the phantom were acquired, and the structures segmented using a commercially available software (Myrian, Intrasense, Montpellier, France). To obtain computer-assisted resection guidance, the user performed a matching of landmarks acquired using a tracked ultrasound probe with the respective landmarks in the image data [16] .…”
Section: Methodsmentioning
confidence: 99%
“…To obtain computerassisted resection guidance, the user performed a matching of landmarks acquired using a tracked ultrasound probe with the respective landmarks in the image data. [16] 2) Needle insertion To evaluate the suitability for interventional training, a study was conducted in which computer-assisted needle placements were performed. This study made use of a simplistic, polymerbased version of the phantom with an aorta and a tumor encompassing the celiac artery.…”
Training of surgical residents and the establishment of innovative surgical techniques require training phantoms that realistically mimic human anatomy. Because animal models have their limitations due to ethical aspects, costs, and the required efforts to set up such training, artificial phantoms are a promising alternative. In the field of image-guided surgery, the challenge lies in developing phantoms that are accurate both anatomically and in terms of imaging properties, while taking the cost factor into account. With respect to the pancreas, animal models are less suitable because their anatomy differs significantly from human anatomy and tissue properties rapidly degrade in the case of ex vivo models. Nevertheless, progress with artificial phantoms has been sparse, although the need for innovative, minimally invasive therapies that require adequate training is steadily increasing. Methods: In the course of this project, an artificial pancreas phantom that is compatible with basic electrosurgical techniques was developed with realistic anatomic and haptic properties, computed tomography, and ultrasound imaging capabilities. This article contains step-by-step instructions for the fabrication of a low-cost pancreatic phantom. The molds are also available for download in a 3D file format. Results: The phantom was successfully validated with regard to its computed tomography and ultrasound properties. As a result, the phantom could be used in combination with a state-of-the-art computer-assisted navigation system. The resection capabilities were positively evaluated in a preclinical study evaluating endoscopic resections using the navigation system. Finally, the durability of the phantom material was tested in a study with multiple needle insertions. Conclusion: The developed phantom represents an open-access and low-cost durable alternative to conventional animal models in the continuous process of surgical training and development of new techniques.
“…The physician was able to identify the structures in the ultrasound and CT images that were needed for computer-assisted resection. Detailed explanations of the experiment can be found in the publication by Müller et al [16] . Fig.…”
Section: Resultsmentioning
confidence: 99%
“…To evaluate the resection properties, the phantom was used in the course of a study on computer-assisted endoscopic resection of intraparenchymal tumors starting from the pancreatic duct [16] . The experimental technique of transduodenal-transpapillary endopancreatic surgery makes use of a hybrid NOTES approach in which a rigid endoscope is inserted into the pancreatic duct via a duodenal incision to perform a resection.…”
Section: Methodsmentioning
confidence: 99%
“…Prior to each case, CT images of the phantom were acquired, and the structures segmented using a commercially available software (Myrian, Intrasense, Montpellier, France). To obtain computer-assisted resection guidance, the user performed a matching of landmarks acquired using a tracked ultrasound probe with the respective landmarks in the image data [16] .…”
Section: Methodsmentioning
confidence: 99%
“…To obtain computerassisted resection guidance, the user performed a matching of landmarks acquired using a tracked ultrasound probe with the respective landmarks in the image data. [16] 2) Needle insertion To evaluate the suitability for interventional training, a study was conducted in which computer-assisted needle placements were performed. This study made use of a simplistic, polymerbased version of the phantom with an aorta and a tumor encompassing the celiac artery.…”
Training of surgical residents and the establishment of innovative surgical techniques require training phantoms that realistically mimic human anatomy. Because animal models have their limitations due to ethical aspects, costs, and the required efforts to set up such training, artificial phantoms are a promising alternative. In the field of image-guided surgery, the challenge lies in developing phantoms that are accurate both anatomically and in terms of imaging properties, while taking the cost factor into account. With respect to the pancreas, animal models are less suitable because their anatomy differs significantly from human anatomy and tissue properties rapidly degrade in the case of ex vivo models. Nevertheless, progress with artificial phantoms has been sparse, although the need for innovative, minimally invasive therapies that require adequate training is steadily increasing. Methods: In the course of this project, an artificial pancreas phantom that is compatible with basic electrosurgical techniques was developed with realistic anatomic and haptic properties, computed tomography, and ultrasound imaging capabilities. This article contains step-by-step instructions for the fabrication of a low-cost pancreatic phantom. The molds are also available for download in a 3D file format. Results: The phantom was successfully validated with regard to its computed tomography and ultrasound properties. As a result, the phantom could be used in combination with a state-of-the-art computer-assisted navigation system. The resection capabilities were positively evaluated in a preclinical study evaluating endoscopic resections using the navigation system. Finally, the durability of the phantom material was tested in a study with multiple needle insertions. Conclusion: The developed phantom represents an open-access and low-cost durable alternative to conventional animal models in the continuous process of surgical training and development of new techniques.
“…2). [57][58][59] A critical component of image guidance is the accuracy of the fusion of preoperative images with the patient's anatomy. The retroperitoneal localization of the pancreas makes the organ less prone to deformation and therefore more suitable for navigation as compared to the liver.…”
Surgery plays a central role in the treatment of benign and malignant pancreatic diseases. Artificial intelligence (AI) is an important upcoming technology to support surgeons in pre-, intra-, and postoperative diagnosis, decision-making and training toward an optimized patient care. Current AI applications show a promising role in the evaluation of preoperative images for prediction of malignancy and resectability, intraoperative decision support, surgical training as well as a postoperative risk stratification to personalize the management of complications. This scoping review summarizes the most up to date developments of AI in pancreatic surgery with the highest available level of evidence.
Background
Surgical process model (SPM) analysis is a great means to predict the surgical steps in a procedure as well as to predict the potential impact of new technologies. Especially in complicated and high-volume treatments, such as parenchyma sparing laparoscopic liver resection (LLR), profound process knowledge is essential for enabling improving surgical quality and efficiency.
Methods
Videos of thirteen parenchyma sparing LLR were analyzed to extract the duration and sequence of surgical steps according to the process model. The videos were categorized into three groups, based on the tumor locations. Next, a detailed discrete events simulation model (DESM) of LLR was built, based on the process model and the process data obtained from the endoscopic videos. Furthermore, the impact of using a navigation platform on the total duration of the LLR was studied with the simulation model by assessing three different scenarios: (i) no navigation platform, (ii) conservative positive effect, and (iii) optimistic positive effect.
Results
The possible variations of sequences of surgical steps in performing parenchyma sparing depending on the tumor locations were established. The statistically most probable chain of surgical steps was predicted, which could be used to improve parenchyma sparing surgeries. In all three categories (i–iii) the treatment phase covered the major part (~ 40%) of the total procedure duration (bottleneck). The simulation results predict that a navigation platform could decrease the total surgery duration by up to 30%.
Conclusion
This study showed a DESM based on the analysis of steps during surgical procedures can be used to predict the impact of new technology. SPMs can be used to detect, e.g., the most probable workflow paths which enables predicting next surgical steps, improving surgical training systems, and analyzing surgical performance. Moreover, it provides insight into the points for improvement and bottlenecks in the surgical process.
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