The effect of three-dimensional computed tomography reconstructions on preoperative planning of tibial plateau fractures: a case–control series

Abstract Aims Increased complexity in cardiac surgery over the last decades necessitates more precise preoperative planning to minimize operating time, to limit the risk of complications during surgery and to aim for the best possible patient outcome. Novel, more realistic, and more immersive techniques, such as three-dimensional (3D) virtual reality (VR) could potentially contribute to the preoperative planning phase. This study shows our initial experience on the implementation of immersive VR technology as a complementary research-based imaging tool for preoperative planning in cardiothoracic surgery. In addition, essentials to set up and implement a VR platform are described. Methods Six patients who underwent cardiac surgery at the Erasmus Medical Center, Rotterdam, The Netherlands, between March 2020 and August 2020, were included, based on request by the surgeon and availability of computed tomography images. After 3D VR rendering and 3D segmentation of specific structures, the reconstruction was analysed via a head mount display. All participating surgeons (n = 5) filled out a questionnaire to evaluate the use of VR as preoperative planning tool for surgery. Conclusion Our study demonstrates that immersive 3D VR visualization of anatomy might be beneficial as a supplementary preoperative planning tool for cardiothoracic surgery, and further research on this topic may be considered to implement this innovative tool in daily clinical practice. Lay summary Over the past decades, surgery on the heart and vessels is becoming more and more complex, necessitating more precise and accurate preoperative planning. Nowadays, operative planning is feasible on flat, two-dimensional computer screens, however, requiring a lot of spatial and three-dimensional (3D) thinking of the surgeon. Since immersive 3D virtual reality (VR) is an upcoming imaging technique with promising results in other fields of surgery, we aimed in this study to explore the additional value of this technique in heart surgery. Our surgeons planned six different heart operations by visualizing computed tomography scans with a dedicated VR headset, enabling them to visualize the patient’s anatomy in an immersive and 3D environment. The outcomes of this preliminary study are positive, with a much more reality-like simulation for the surgeon. In such, VR could potentially be beneficial as a preoperative planning tool for complex heart surgery.

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Three-Dimensional Reconstructed Computed Tomography-Magnetic Resonance Fusion Image-Based Preoperative Planning for Surgical Procedures for Spinal Lipoma or Tethered Spinal Cord After Myelomeningocele Repair

Neurologia medico-chirurgica ◽

10.2176/nmc.51.397 ◽

2011 ◽

Vol 51 (5) ◽

pp. 397-402 ◽

Cited By ~ 9

Author(s):

Yohei BAMBA ◽

Masahiro NONAKA ◽

Shin NAKAJIMA ◽

Mami YAMASAKI

Keyword(s):

Computed Tomography ◽

Spinal Cord ◽

Magnetic Resonance ◽

Surgical Procedures ◽

Preoperative Planning ◽

Three Dimensional ◽

Tethered Spinal Cord ◽

Spinal Lipoma ◽

Fusion Image ◽

Myelomeningocele Repair

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The Impact of Computed Tomography on Decision Making in Tibial Plateau Fractures

The Journal of Knee Surgery ◽

10.1055/s-0038-1627464 ◽

2018 ◽

Vol 31 (10) ◽

pp. 1007-1014 ◽

Cited By ~ 4

Author(s):

Marcello Castiglia ◽

Marcello Nogueira-Barbosa ◽

Andre Messias ◽

Rodrigo Salim ◽

Fabricio Fogagnolo ◽

...

Keyword(s):

Computed Tomography ◽

Decision Making ◽

Surgical Approach ◽

Tibial Plateau ◽

Classification Systems ◽

Tibial Plateau Fractures ◽

Surgical Approaches ◽

Plain Radiographs ◽

Schatzker Classification ◽

The Impact

AbstractSchatzker introduced one of the most used classification systems for tibial plateau fractures, based on plain radiographs. Computed tomography brought to attention the importance of coronal plane-oriented fractures. The goal of our study was to determine if the addition of computed tomography would affect the decision making of surgeons who usually use the Schatzker classification to assess tibial plateau fractures. Image studies of 70 patients who sustained tibial plateau fractures were uploaded to a dedicated homepage. Every patient was linked to a folder which contained two radiographic projections (anteroposterior and lateral), three interactive videos of computed tomography (axial, sagittal, and coronal), and eight pictures depicting tridimensional reconstructions of the tibial plateau. Ten attending orthopaedic surgeons, who were blinded to the cases, were granted access to the homepage and assessed each set of images in two different rounds, separated to each other by an interval of 2 weeks. Each case was evaluated in three steps, where surgeons had access, respectively to radiographs, two-dimensional videos of computed tomography, and three-dimensional reconstruction images. After every step, surgeons were asked to present how would they classify the case using the Schatzker system and which surgical approaches would be appropriate. We evaluated the inter- and intraobserver reliability of the Schatzker classification using the Kappa concordance coefficient, as well as the impact of computed tomography in the decision making regarding the surgical approach for each case, by using the chi-square test and likelihood ratio. The interobserver concordance kappa coefficients after each assessment step were, respectively, 0.58, 0.62, and 0.64. For the intraobserver analysis, the coefficients were, respectively, 0.76, 0.75, and 0.78. Computed tomography changed the surgical approach selection for the types II, V, and VI of Schatzker (p < 0.01). The addition of computed tomography scans to plain radiographs improved the interobserver reliability of Schatzker classification. Computed tomography had a statistically significant impact in the selection of surgical approaches for the lateral tibial plateau.

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