Surgical Theater, a Novel Technology, Enhances 3-dimensional Mapping for Robotic-assisted Deep Inferior Epigastric Perforator Free Flap.

IF 1.5 Q3 SURGERY

Plastic and Reconstructive Surgery Global Open Pub Date : 2025-06-13 eCollection Date: 2025-06-01 DOI:10.1097/GOX.0000000000006872

Suphalerk Lohasammakul, Mandy Flor, Clarissa Hoye, Kongkrit Chaiyasate, Jesse C Selber

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引用次数: 0

Abstract

Background: Computed tomography angiography (CTA) is useful in deep inferior epigastric perforator (DIEP) flap planning. Limitations include that 2-dimensional analysis can be difficult to interpret and the resolution of 3-dimensional (3D) images can be too low. Merging with Surgical Theater software provides high-resolution 3D visualization of the vasculature, which may improve preoperative planning.

Methods: Surgical Theater and conventional CTA were combined for preoperative DIEP flap planning. Technical rendering details are explained, receiver operating characteristic curves are identified, and use in robotic-assisted DIEP flap planning is described.

Results: Seven patients were presented. The mean times of 3D mapping and intraoperative perforator identification and selection were 30.8 ± 4.7 and 36 ± 8.2 minutes, respectively. One dominant perforator was identified that was not visible on CTA and was concordant with intraoperative findings. Receiver operating characteristics metrics include sensitivity of 95%, specificity of 93%, positive predictive value of 91%, and negative predictive value of 96%. The rotational capabilities of 3D images allow easier interpretation of intramuscular course and branching patterns.

Conclusions: Combining Surgical Theater with conventional CTA in DIEP flap breast reconstruction provides advantages over CTA alone, including high-fidelity visualization of the course of the DIEP vasculature from multiple views with image rotation in space, which may enhance perforator identification. This technology is particularly helpful in identifying candidates for robotic-assisted DIEP flaps, which is particularly dependent on preoperative imaging. The learning curve is shorter than that for interpreting 2-dimensional imaging, and building 3D images is quick, making adoption straightforward. The potential use of multiple surgical services makes the capital expense cost-effective.

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外科剧院，一种新技术，增强了机器人辅助下腹壁深穿支自由皮瓣的三维定位。

背景：计算机断层血管造影（CTA）在腹下深穿支（DIEP）皮瓣规划中是有用的。限制包括二维分析可能难以解释，三维（3D）图像的分辨率可能太低。与Surgical Theater软件合并可提供脉管系统的高分辨率3D可视化，可改善术前计划。方法：采用外科手术室与常规CTA相结合的方法进行DIEP皮瓣术前规划。解释了技术渲染细节，确定了接收器的工作特性曲线，并描述了在机器人辅助DIEP皮瓣规划中的应用。结果：共7例患者。三维定位和术中穿支识别选择的平均时间分别为30.8±4.7分钟和36±8.2分钟。一个显性穿支在CTA上不可见，与术中发现一致。受试者工作特征指标包括敏感性95%，特异性93%，阳性预测值91%，阴性预测值96%。3D图像的旋转功能可以更容易地解释肌肉内的过程和分支模式。结论：将外科手术室与传统CTA联合应用于DIEP皮瓣乳房重建中，其优势优于单独使用CTA，包括从多个角度高保真地显示DIEP血管的过程，图像在空间旋转，可以增强穿支识别。这项技术特别有助于识别机器人辅助DIEP皮瓣的候选者，这特别依赖于术前成像。学习曲线比解释二维图像要短，构建三维图像也很快，采用起来很简单。多种手术服务的潜在使用使得资本费用具有成本效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and Reconstructive Surgery Global Open SURGERY-

CiteScore

2.20

自引率

13.30%

发文量

1584

审稿时长

10 weeks

期刊介绍： Plastic and Reconstructive Surgery—Global Open is an open access, peer reviewed, international journal focusing on global plastic and reconstructive surgery.Plastic and Reconstructive Surgery—Global Open publishes on all areas of plastic and reconstructive surgery, including basic science/experimental studies pertinent to the field and also clinical articles on such topics as: breast reconstruction, head and neck surgery, pediatric and craniofacial surgery, hand and microsurgery, wound healing, and cosmetic and aesthetic surgery. Clinical studies, experimental articles, ideas and innovations, and techniques and case reports are all welcome article types. Manuscript submission is open to all surgeons, researchers, and other health care providers world-wide who wish to communicate their research results on topics related to plastic and reconstructive surgery. Furthermore, Plastic and Reconstructive Surgery—Global Open, a complimentary journal to Plastic and Reconstructive Surgery, provides an open access venue for the publication of those research studies sponsored by private and public funding agencies that require open access publication of study results. Its mission is to disseminate high quality, peer reviewed research in plastic and reconstructive surgery to the widest possible global audience, through an open access platform. As an open access journal, Plastic and Reconstructive Surgery—Global Open offers its content for free to any viewer. Authors of articles retain their copyright to the materials published. Additionally, Plastic and Reconstructive Surgery—Global Open provides rapid review and publication of accepted papers.