The Applications of 3D Imaging and Indocyanine Green Dye Fluorescence in Laparoscopic Liver Surgery

Laparoscopic liver resections have gained widespread popularity among hepatobiliary surgeons and is nowadays performed for both standard and more complex hepatectomies. Given the increased technical challenges, preoperative planning and intraoperative guidance is pivotal in laparoscopic surgery to safely carry out complex and oncologically safe hepatectomies. Modern tools can help both preoperatively and intraoperatively and allow surgeons to perform more precise hepatectomies. Preoperative 3D reconstructions and printing as well as augmented reality can increase the knowledge of the specific anatomy of the case and therefore plan the surgery accordingly and tailor the procedure on the patient. Furthermore, the indocyanine green retention dye is an increasingly used tool that can nowadays improve the precision during laparoscopic hepatectomies, especially when considering anatomical resection. The use of preoperative modern imaging and intraoperative indocyanine green dye are key to successfully perform complex hepatectomies such as laparoscopic parenchymal sparing liver resections. In this narrative review, we discuss the aspects of preoperative and intraoperative tools that are nowadays increasingly used in experienced hepatobiliary centers.

Intraoperative Guidance Using Hyperspectral Imaging: A Review for Surgeons

Hyperspectral imaging (HSI) is a novel optical imaging modality, which has recently found diverse applications in the medical field. HSI is a hybrid imaging modality, combining a digital photographic camera with a spectrographic unit, and it allows for a contactless and non-destructive biochemical analysis of living tissue. HSI provides quantitative and qualitative information of the tissue composition at molecular level in a contrast-free manner, hence making it possible to objectively discriminate between different tissue types and between healthy and pathological tissue. Over the last two decades, HSI has been increasingly used in the medical field, and only recently it has found an application in the operating room. In the last few years, several research groups have used this imaging modality as an intraoperative guidance tool within different surgical disciplines. Despite its great potential, HSI still remains far from being routinely used in the daily surgical practice, since it is still largely unknown to most of the surgical community. The aim of this study is to provide clinical surgeons with an overview of the capabilities, current limitations, and future directions of HSI for intraoperative guidance.

AI in Healthcare: medical and socio-economic benefits and challenges

The objective of this research was to investigate benefits and challenges of AI in healthcare. Wedivided the benefits into two subcategories: benefits related to the medical domain, and the benefitsrelated to economic and social lives domain. The findings are: 1) Smart data inclusion contributessignificantly and help to improve decision-making quality. 2) Surgical robots have improved theprecision and predictability of the surgery. 3) Intraoperative guidance via video pictures andcommunication systems has proven to be beneficial, particularly in situations when there is a pooraccess to clinics, travel limitations, or pandemic. 4) Sentiment analysis analyzes, interprets, andresponds to verbal expressions of human emotions. 6)Data scientists have been able to create algorithmsthat can comprehend human feeling from written textwith unique combination of NLP and sentimentanalysis. 7) AI could re-balance a clinician's workload,providing them more time to connect with patientsand thereby improve care quality. The majorchallenges are: 1) the data reflects sometimesinherent biases and disparities in the healthcare system. 2) The demand for huge datasets incentivizesdevelopers to acquire data from a large number of patients. Some patients may be worried that thisdata collection would infringe on their confidentiality. 3) AI systems may occasionally be incorrect,resulting in patient damage or other health-care issues. It is not assumed that a new technology willalways be good; it has the potential to be detrimental. There are some improvements that benefit andthere are some challenges that may harm, and these challenges must be responded by futureresearch.

Real-Time Monitoring and Step-by-Step Guidance for Transapical Mitral Valve Edge-to-Edge Repair Using Transesophageal Echocardiography

MitraClip edge-to-edge (E2E) repair system is the only transcatheter device recommended in the current guidelines for treating mitral regurgitation (MR). The percutaneous femoral venous transseptal access of MitraClip requires a complex steerable delivery system and may thus be technically complex to optimally position and deploy the clip onto the mitral valve. A transapical approach for E2E repair has been devised to treat MR for the ease of operation (ValveClamp system, Hanyu Medical Technology, Shanghai). The first-in-human study of ValveClamp has demonstrated its early feasibility and effectiveness for the treatment of patients with degenerative MR. Transesophageal echocardiography (TEE) is the only imaging modality required for intraoperative guidance of ValveClamp implantation. Successful implantation depends on accurate localization and orientation of the clamp and efficient intraoperative communication between the echocardiographer and the intervention team. Thus, the focus of this review is on elaborating how two-dimensional (2D) and three-dimensional (3D) TEE are used in clinical practice to guide ValveClamp implantation and it may facilitate the understanding of simplicity and safety of this novel procedure. We also describe the implementation of several novel advancements in 3D TEE imaging, which improve the confidence of image interpretation for intraoperative guidance and expedite implantation times.