{"title":"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。","authors":"Suphalerk Lohasammakul, Mandy Flor, Clarissa Hoye, Kongkrit Chaiyasate, Jesse C Selber","doi":"10.1097/GOX.0000000000006872","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6872"},"PeriodicalIF":1.5000,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165664/pdf/","citationCount":"0","resultStr":"{\"title\":\"Surgical Theater, a Novel Technology, Enhances 3-dimensional Mapping for Robotic-assisted Deep Inferior Epigastric Perforator Free Flap.\",\"authors\":\"Suphalerk Lohasammakul, Mandy Flor, Clarissa Hoye, Kongkrit Chaiyasate, Jesse C Selber\",\"doi\":\"10.1097/GOX.0000000000006872\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":20149,\"journal\":{\"name\":\"Plastic and Reconstructive Surgery Global Open\",\"volume\":\"13 6\",\"pages\":\"e6872\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-06-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165664/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Plastic and Reconstructive Surgery Global Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/GOX.0000000000006872\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Plastic and Reconstructive Surgery Global Open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/GOX.0000000000006872","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
Surgical Theater, a Novel Technology, Enhances 3-dimensional Mapping for Robotic-assisted Deep Inferior Epigastric Perforator Free Flap.
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.
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.
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