Purpose
Performing a transrectal ultrasound (TRUS) prostate biopsy is at the heart of the current prostate cancer detection procedure. With today's two‐dimensional (2D) live ultrasound (US) imaging ...equipment, this task remains complex due to the poor visibility of cancerous tissue on TRUS images and the limited anatomical context available in the 2D TRUS plane. This paper presents a rigid 2D/3DUS registration method for navigated prostate biopsy. This allows continuous localization of the biopsy trajectory during the procedure.
Methods
We proposed an organ‐based approach to achieve real‐time rigid registration without the need for any probe localization device. The registration method combines image similarity and geometric proximity of detected features. Additions to our previous work include a multi‐level approach and the use of a rejection rate favouring the best matches. Their aim is to increase the accuracy and time performances. These modifications and their in‐depth evaluation on real clinical cases and comparison to this previous work are described. We performed static and dynamic evaluations along biopsy trajectories on a very large amount of data acquired under uncontrolled routine conditions. The computed transforms are compared to a ground truth obtained either from corresponding manually detected fiducials or from an already evaluated registration method.
Results
All results show that the current method outperforms its previous version, both in terms of accuracy (the average error reported here is 12 to 17% smaller depending on the experiment) and processing time (from 20 to 60 times faster compared to the previous implementation). The dynamic registration experiment demonstrates that the method can be successfully used for continuous tracking of the biopsy location w.r.t the prostate at a rate that varies between 5 and 15 Hz.
Conclusions
This work shows that on the fly 2D/3DUS registration can be performed very efficiently on biopsy trajectories. This allows us to plan further improvements in prostate navigation and a clinical transfer.
Background
For many abdominal surgical interventions, laparotomy has gradually been replaced by laparoscopy, with numerous benefits for the patient in terms of post-operative recovery. However, ...during laparoscopy, the endoscope only provides a single viewpoint to the surgeon, leaving numerous blind spots and opening the way to peri-operative adverse events. Alternative camera systems have been proposed, but many lack the requisite resolution/robustness for use during surgery or cannot provide real-time images. Here, we present the added value of the Enhanced Laparoscopic Vision System (ELViS) which overcomes these limitations and provides a broad view of the surgical field in addition to the usual high-resolution endoscope.
Methods
Experienced laparoscopy surgeons performed several typical procedure steps on a live pig model. The time-to-completion for surgical exercises performed by conventional endoscopy and ELViS-assisted surgery was measured. A debriefing interview following each operating session was conducted by an ergonomist, and a System Usability Scale (SUS) score was determined.
Results
Proof of concept of ELVIS was achieved in an animal model with seven expert surgeons without peroperative adverse events related to the surgical device. No differences were found in time-to-completion. Mean SUS score was 74.7, classifying the usability of the ELViS as “good”. During the debriefing interview, surgeons highlighted several situations where the ELViS provided a real advantage (such as during instrument insertion, exploration of the abdominal cavity or for orientation during close work) and also suggested avenues for improvement of the system.
Conclusions
This first test of the ELViS prototype on a live animal model demonstrated its usability and provided promising and useful feedback for further development.
Multi-view vision system for laparoscopy surgery Tamadazte, Brahim; Agustinos, Anthony; Cinquin, Philippe ...
International journal for computer assisted radiology and surgery,
02/2015, Letnik:
10, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Purpose
A global endoscopic view of the surgical field could help avoid complications such as perforation of occluded organs and may reduce the endoscope displacements and also the usual time of ...laparoscopic procedure using a conventional endoscopy system. An augmented laparoscopy system was developed by increasing the field of view of a traditional endoscope. This system was implemented and tested in vitro using a testbench.
Method
High-definition miniature cameras were integrated into a traditional endoscope to obtain a panoramic vision device with a large field of view of the abdominal cavity. The additional cameras are mounted around the endoscopy body as a pair of
glasses
providing a global view of the abdominal cavity completing the traditional endoscopic view. Each camera can reach a frame rate of 30 images/second with a resolution of 1,600
×
1,200 pixels. To be able to fix the cameras to the endoscope, a deployment, fixation and rapid extraction system of the proposed device through the trocar was designed and validated in preclinical experiments (testbench and human cadaver). The preclinical experiments compared the time required to perform a pick-and-place task with the traditional endoscope alone and with the proposed system alone.
Results
A statistically significant reduction in procedure time was found using an augmented video endoscopy system for a pick-and-place task.
Conclusion
An augmented laparoscopy system with increased field of view is feasible and may be advantageous compared with a traditional endoscope. In vivo testing of the system should be done to establish the clinical utility of this innovation.
Purpose
Evaluation of surgical technical abilities is a major issue in minimally invasive surgery. Devices such as training benches offer specific scores to evaluate surgeons but cannot transfer in ...the operating room (OR). A contrario, several scores measure performance in the OR, but have not been evaluated on training benches. Our aim was to demonstrate that the GOALS score, which can effectively grade in the OR the abilities involved in laparoscopy, can be used for evaluation on a laparoscopic testbench (MISTELS). This could lead to training systems that can identify more precisely the skills that have been acquired or must still be worked on.
Methods
32 volunteers (surgeons, residents and medical students) performed the 5 tasks of the MISTELS training bench and were simultaneously video-recorded. Their performance was evaluated with the MISTELS score and with the GOALS score based on the review of the recording by two experienced, blinded laparoscopic surgeons. The concurrent validity of the GOALS score was assessed using Pearson and Spearman correlation coefficients with the MISTELS score. The construct validity of the GOALS score was assessed with
k
-means clustering and accuracy rates. Lastly, abilities explored by each MISTELS task were identified with multiple linear regression.
Results
GOALS and MISTELS scores are strongly correlated (Pearson correlation coefficient = 0.85 and Spearman correlation coefficient = 0.82 for the overall score). The GOALS score proves to be valid for construction for the tasks of the training bench, with a better accuracy rate between groups of level after k-means clustering, when compared to the original MISTELS score (accuracy rates, respectively, 0.75 and 0.56).
Conclusion
GOALS score is well suited for the evaluation of the performance of surgeons of different levels during the completion of the tasks of the MISTELS training bench.
Introduction and hypothesis
The aim of our study was to evaluate the efficiency and safety of synthetic mid-urethral slings (sMUS) for the treatment of stress urinary incontinence (SUI) in women with ...neurogenic lower urinary tract dysfunction (NLUTD).
Methods
A systematic review was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MEDLINE, Embase and Cochrane controlled trials databases were systematically searched from January 1995 to April 2021. Studies including adult women with NLUTD who had a sMUS for SUI were considered for inclusion. Primary outcome was success of the surgery according to study criteria. Secondary outcomes were complications, especially de novo urgency, urinary retention, tape exposure and revision for complications.
Results
A total of 752 abstracts were screened and 9 studies were included, representing 298 patients. The mean age was 52 years and median follow-up was 41.3 months. sMUS insertion was successful in 237 patients (79.5%). The median rate of de novo urgency was 15.7% (range 8.3–30%). In patients with spontaneous voiding, the median rate of retention was 19.3% (range 0–46.7%) and 21 out of 26 patients required intermittent self-catheterisation. Four cases of tape exposure were reported, and 8 patients underwent a revision for complications.
Conclusions
This review suggests that sMUS might offer interesting success rates and acceptable morbidity and could be considered for the treatment of SUI in women with NLUTD. Further studies are required to define which patients would be more likely to benefit from this intervention, as well as its place among the other surgical treatments for SUI.
Outcomes after kidney transplantation are largely driven by the development of
donor-specific antibodies (dnDSA), which may be triggered by blood transfusion. In this single-center study, we ...investigated the link between early blood transfusion and dnDSA development in a mainly anti-thymocyte globulin (ATG)-induced kidney-transplant cohort. We retrospectively included all recipients of a kidney transplant performed between 2004 and 2015, provided they had >3 months graft survival. DSA screening was evaluated with a Luminex assay (Immucor). Early blood transfusion (EBT) was defined as the transfusion of at least one red blood-cell unit over the first 3 months post-transplantation, with an exhaustive report of transfusion. Patients received either anti-thymocyte globulins (ATG) or basiliximab induction, plus tacrolimus and mycophenolic acid maintenance immunosuppression. A total of 1088 patients received a transplant between 2004 and 2015 in our center, of which 981 satisfied our inclusion criteria. EBT was required for 292 patients (29.7%). Most patients received ATG induction (86.1%); the others received basiliximab induction (13.4%). dnDSA-free graft survival (dnDSA-GS) at 1-year post-transplantation was similar between EBT+ (2.4%) and EBT- (3.0%) patients (chi-squared p=0.73). There was no significant association between EBT and dnDSA-GS (univariate Cox's regression, HR=0.88, p=0.556). In multivariate Cox's regression, adjusting for potential confounders (showing a univariate association with dnDSA development), early transfusion remained not associated with dnDSA-GS (HR 0.76, p=0.449). However, dnDSA-GS was associated with pretransplantation HLA sensitization (HR=2.25, p=0.004), hemoglobin >10 g/dL (HR=0.39, p=0.029) and the number of HLA mismatches (HR=1.26, p=0.05). Recipient's age, tacrolimus and mycophenolic-acid exposures, and graft rank were not associated with dnDSA-GS. Early blood transfusion did not induce dnDSAs in our cohort of ATG-induced patients, but low hemoglobin level was associated with dnDSAs-GS. This suggests a protective effect of ATG induction therapy on preventing dnDSA development at an initial stage post-transplantation.
Objective
Annual countrywide data are scarce when comparing surgical approaches in terms of hospital stay outcomes and costs for radical prostatectomy (RP). We aimed to assess the impact of surgical ...approach on post-operative outcomes and costs after RP by comparing open (ORP), laparoscopic (LRP), and robot-assisted (RARP) RP in the French healthcare system.
Patients and methods
Data from all patients undergoing RP in France in 2020 were extracted from the central database of the national healthcare system. Primary endpoints were length of hospital stay (LOS including intensive care unit (ICU) stay if present), complications (estimated by severity index), hospital readmission rates (at 30 and 90 days), and direct costs of initial stay.
Results and limitations
A total of 19,018 RPs were performed consisting in ORP in 21.1%, LRP in 27.6%, and RARP in 51.3% of cases. RARP was associated with higher center volume (
p
< 0.001), lower complication rates (
p
< 0.001), shorter LOS (
p
< 0.001), and lower readmission rates (
p
= 0.004). RARP was associated with reduced direct stay costs (2286 euros) compared with ORP (4298 euros) and LRP (3101 euros). The main cost driver was length of stay. The main limitations were the lack of mid-term data, readmission details, and cost variations due to surgery system.
Conclusions
This nationwide analysis demonstrates the benefits of RARP in terms of post-operative short-term outcomes. Higher costs related to the robotic system appear to be balanced by patient care improvements and reduced direct costs due to shorter LOS.
Clear cell renal cell carcinoma (ccRCC) is the third type of urologic cancer. At time of diagnosis, 30% of cases are metastatic with no effect of chemotherapy or radiotherapy. Current targeted ...therapies lead to a high rate of relapse and resistance after a short-term response. Thus, a major hurdle in the development and use of new treatments for ccRCC is the lack of good pre-clinical models that can accurately predict the efficacy of new drugs and allow the stratification of patients into the correct treatment regime. Here, we describe different 3D cultures models of ccRCC, emphasizing the feasibility and the advantage of ex-vivo treatment of fresh, surgically resected human tumor slice cultures of ccRCC as a robust preclinical model for identifying patient response to specific therapeutics. Moreover, this model based on precision-cut tissue slices enables histopathology measurements as tumor architecture is retained, including the spatial relationship between the tumor and tumor-infiltrating lymphocytes and the stromal components. Our data suggest that acute treatment of tumor tissue slices could represent a benchmark of further exploration as a companion diagnostic tool in ccRCC treatment and a model to develop new therapeutic drugs.
Active surveillance (AS) in prostate cancer (PCa) represents a curative alternative for men with localised low-risk PCa. Continuous improvement of AS patient's selection and surveillance modalities ...aims at reducing misclassification, simplifying modalities of surveillance and decreasing need for invasive procedures such repeated biopsies. Biomarkers represent interesting tools to evaluate PCa diagnosis and prognosis, of which many are readily available or under evaluation. The aim of this review is to investigate the biomarker performance for AS selection and patient outcome prediction. Blood, urinary and tissue biomarkers were studied and a brief description of use was proposed along with a summary of major findings. Biomarkers represent promising tools which could be part of a more tailored risk AS strategy aiming to offer personalized medicine and to individualize the treatment and monitoring of each patient. The usefulness of biomarkers has mainly been suggested for AS selection, whereas few studies have investigated their role during the monitoring phase. Randomized prospective studies dealing with imaging are needed as well as larger prospective studies with long-term follow-up and strong oncologic endpoints.
Purpose The management of major renal trauma has shifted in the last decade in favor of a nonoperative approach. Our level 1 trauma center promotes this approach with the objective of renal function ...preservation. However, certain situations still require surgery. In this study we analyze predictors of surgery and long-term outcomes after conservative management. Materials and Methods From January 2004 to March 2015 we prospectively collected data from all patients admitted to our institution for high grade blunt renal trauma (grades IV and V). Nonoperative management was considered successful when patients did not undergo surgical exploration, regardless of angioembolization or endoscopic treatment. Results Of 306 patients with renal trauma 151 presented with major injuries, including 124 grade IV and 27 grade V. Nonoperative management was successful in 110 (89%) cases of grade IV and 14 (52%) cases of grade V lesions. Deceleration mechanism (p=0.03), associated lesions (p=0.001), percentage of devitalized parenchyma (p=0.012), angioembolization (p <0.001), hemodynamic instability (p <0.001) and low hemoglobin (p=0.001) were more frequent in patients treated surgically. On multivariate analysis grade (OR 7.36, p=0.01) and hemodynamic instability (OR 4.18, p=0.04) were the only independent predictors of surgical treatment. Long-term followup of preserved kidneys revealed a remaining 40% and 0% relative renal function after grade IV and V injuries, respectively. Only devascularized parenchyma greater than 25% predicted the decline of long-term renal function. Conclusions Nonoperative management can and should be performed safely in cases of grade IV injuries whenever possible, with valuable long-term renal function. It can also be initiated in grade V cases. However, surgeons should consider nephrectomy with the onset of any suspicious symptoms.
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