Radiological Society of North America (RSNA) 3D Printing Special Interest Group (SIG) clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: Abdominal, hepatobiliary, and gastrointestinal conditions

BACKGROUND: Medical 3D printing has demonstrated value in anatomic models for abdominal, hepatobiliary, and gastrointestinal conditions. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness criteria for abdominal, hepatobiliary, and gastrointestinal 3D printing indications. METHODS: A literature search was conducted to identify all relevant articles using 3D printing technology associated with a number of abdominal pathologic processes. Each included study was graded according to published guidelines. RESULTS: Evidence-based appropriateness guidelines are provided for the following areas: intra-hepatic masses, hilar cholangiocarcinoma, biliary stenosis, biliary stones, gallbladder pathology, pancreatic cancer, pancreatitis, splenic disease, gastric pathology, small bowel pathology, colorectal cancer, perianal fistula, visceral trauma, hernia, abdominal sarcoma, abdominal wall masses, and intra-abdominal fluid collections. CONCLUSION: This document provides initial appropriate use criteria for medical 3D printing in abdominal, hepatobiliary, and gastrointestinal conditions

Start to finish:Biomechanics of abdominal wall hernia prevention & long-term outcomes of repair

Biomechanical insights into incisional hernia prevention. Literature and clinical studies on the outcomes of ventral abdominal wall hernia repair surgery

Start to finish:Biomechanics of abdominal wall hernia prevention & long-term outcomes of repair

Biomechanical insights into incisional hernia prevention. Literature and clinical studies on the outcomes of ventral abdominal wall hernia repair surgery

25th International Congress of the European Association for Endoscopic Surgery (EAES) Frankfurt, Germany, 14-17 June 2017 : Oral Presentations

Introduction: Ouyang has recently proposed hiatal surface area (HSA) calculation by multiplanar multislice computer tomography (MDCT) scan as a useful tool for planning treatment of hiatus defects with hiatal hernia (HH), with or without gastroesophageal reflux (MRGE). Preoperative upper endoscopy or barium swallow cannot predict the HSA and pillars conditions. Aim to asses the efficacy of MDCT’s calculation of HSA for planning the best approach for the hiatal defects treatment. Methods: We retrospectively analyzed 25 patients, candidates to laparoscopic antireflux surgery as primary surgery or hiatus repair concomitant with or after bariatric surgery. Patients were analyzed preoperatively and after one-year follow-up by MDCT scan measurement of esophageal hiatus surface. Five normal patients were enrolled as control group. The HSA’s intraoperative calculation was performed after complete dissection of the area considered a triangle. Postoperative CT-scan was done after 12 months or any time reflux symptoms appeared. Results: (1) Mean HSA in control patients with no HH, no MRGE was cm2 and similar in non-complicated patients with previous LSG and cruroplasty. (2) Mean HSA in patients candidates to cruroplasty was 7.40 cm2. (3) Mean HSA in patients candidates to redo cruroplasty for recurrence was 10.11 cm2. Discussion. MDCT scan offer the possibility to obtain an objective measurement of the HSA and the correlation with endoscopic findings and symptoms. The preoperative information allow to discuss with patients the proper technique when a HSA[5 cm2 is detected. During the follow-up a correlation between symptoms and failure of cruroplasty can be assessed. Conclusions: MDCT scan seems to be an effective non-invasive method to plan hiatal defect treatment and to check during the follow-up the potential recurrence. Future research should correlate in larger series imaging data with intraoperative findings

Mechanical Characterization of Synthetic Mesh for Pelvic Organ Prolapse Repair

Pelvic organ prolapse (POP) is characterized by the abnormal descent of the pelvic organs into the vaginal canal. POP is associated with urinary, defacatory, and sexual dysfunction, in addition to psychological disorders including depression. Prolapse is quite common, with ~50% of women over the age of 50 exhibiting some degree of prolapse, and over 200,000 surgical repairs in the United States annually. During surgical repair, a graft is used to restore support to the vagina, re-approximating the normal anatomy. Given the high failure rate of native tissue repair, use of polypropylene mesh has become widespread. Despite the prevalence of synthetic mesh, complication rates are ~20%, with little known about its behavior following implantation. Therefore, this dissertation aims to rigorously characterize the mechanical behavior of synthetic mesh, with the goal of optimizing device design for use in the pelvic floor. First, micro- and macro-level deformation of mesh was assessed in response to mechanical loads using uniaxial testing and 3D reconstruction. Upon loading, mesh pores significantly deformed, yielding textile dimensions that are known to heighten the foreign body response. In addition, point loads significantly wrinkled the mesh surface, further reducing mesh dimensions and producing configurations consistent with those found clinically. Next, a finite element model for synthetic mesh was developed, using a novel method to allow for textile properties to be measured in-silico. This model was validated using a custom testing apparatus to simultaneously load and image transvaginal mesh products. Evaluation of mesh deformation found experimental and computational results to be similar, demonstrating the predictive capabilities of this model. The validated model was then used to examine the sensitivity of mesh behavior to variable loading conditions. Here the magnitude and orientation of tensile forces were found to significantly predict undesired deformations. Finally, computational mesh models were combined with MRI reconstructions of patient specific anatomy to simulate the development of prolapse and mesh repair. Again, mesh pores experienced significant deformation upon anatomical fixation, corresponding with clinical sites of exposure and pain. In total, this dissertation provides a tool for the evaluation and optimization of synthetic mesh devices prior to implantation and pre-surgical evaluation of mesh procedures

XXII International Conference on Mechanics in Medicine and Biology - Abstracts Book

This book contain the abstracts presented the XXII ICMMB, held in Bologna in September 2022. The abstracts are divided following the sessions scheduled during the conference

Recent Advances in Minimally Invasive Surgery

Minimally invasive surgery has become a common term in visceral as well as gynecologic surgery. It has almost evolved into its own surgical speciality over the past 20 years. Today, being firmly established in every subspeciality of visceral surgery, it is now no longer a distinct skillset, but a fixed part of the armamentarium of surgical options available. In every indication, the advantages of a minimally invasive approach include reduced intraoperative blood loss, less postoperative pain, and shorter rehabilitation times, as well as a marked reduction of overall and surgical postoperative morbidity. In the advent of modern oncologic treatment algorithms, these effects not only lower the immediate impact that an operation has on the patient, but also become important key steps in reducing the side-effects of surgery. Thus, they enable surgery to become a module in modern multi-disciplinary cancer treatment, which blends into multimodular treatment options at different times and prolongs and widens the possibilities available to cancer patients. In this quickly changing environment, the requirement to learn and refine not only open surgical but also different minimally invasive techniques on high levels deeply impact modern surgical training pathways. The use of modern elearning tools and new and praxis-based surgical training possibilities have been readily integrated into modern surgical education,which persists throughout the whole surgical career of modern gynecologic and visceral surgery specialists