Computer-aided surgical simulation and student's training progressed significantly in the last decade. At the same time, the development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. Careful planning is of great importance in order to limit the damage to healthy tissue during surgery. In particular, accurate modelling of the mechanical behavior of the tissues is required. To achieve accurate representation of various organs and or anatomical districts, various techniques were proposed in order to reconstruct the morphological properties of such elements. Currently, many surgical procedures on human patients are not simulated yet can be relevant in minimally invasive surgeries to protect human health and to save human lives, particularly for surgeries with high accuracy requirements. An accurate 3D anatomical reconstruction necessarily starts from MRI or CT acquired details of the patients, through imaging segmentation and proper stacking and smoothing of adjacent slices. More particularly, to gain accurate models suitable for computer-aided surgical tools, many problems must be faced. In particular: a) free form surface modelling starting from MRI or CT scans; b) tissue constitutive material. In this research we aim to investigate these topics to enhance physical description of organs subjected to surgical operations. Therefore, this project would provide an analysis of different modeling techniques. The results will be valuated from multidisciplinary unit, namely the bioengineers and surgeons involved in the research.
Medical students can perform `hands on¿ procedures but in a safe and controlled setting. They are able to make mistakes ¿ and learn from them but in an environment where there is no risk to the patient. They interact with a virtual patient and as a result of this, learn skills which they can then apply in the real world. This proposal is the natural prosecution of a research cooperation aimed to develop Computer Aided Tools for colorectal surgery suitable for planning, verifying and teaching surgical operations. It has been started in the recent past, after the proposal of Dr. Laura Lorenzon, involving the researchers of the Department of Mechanical and Aerospace Engineering (DIMA) in different fields of interest, bioengineers (Franco Marinozzi, Fabiano Bini, ING-IND/34, PhD Andrada Pica, Post- doc Simone Novelli), mechanical engineers expert in CAD (Computer Aided Design) techniques and virtual prototyping (PhD Robinson Guachi) and surgeons (Renzo Pretagostini, MED/18).
In particular, we can explore the feasibility of virtual reconstruction applied to Transanal total mesorectal excision (taTME)Technique. taTME is a novel operative approach of the radical surgery for rectal cancer, and has been a hot topic in colorectal surgery for years. TaTME aims to solve some problems from previous TME, such as exposure of peripheral mid-lower rectal space, judge of distal cutting margin, and to carry out completely minimal invasive operation.
To our knowledge, no three dimensional representation was proposed relative to a virtual reality taTME ambient.
In the recent past many works have been focused on the shape reconstruction of real images acquired by MRI and CT scans. In this work their adoption will be studied in terms of final accuracy of the FEA simulation just to understand how they can support a better understand of the surgical practice, thanks to the strict cooperation with the surgeon involved in the work. To the best of our knowledge, this is the first study based on 3D imaging in colorectal surgery settled in our Country. Although few data are emerging in relation to MRI segmentation and implementation of diagnosis (for CRM assessing and the prediction value of variation of volumetry), literature in this field is promising but very scant. Indeed, optimizing the selection criteria for patients requiring neo-adjuvant (chemo)radiation treatments (neoCHT-RT) could impact and implement surgical and multidisciplinary management of rectal cancer patients, avoiding e.g. unnecessary treatment with a consequent reduction of side-effects and cost. On the same extent, the prediction of response to neo-adjuvant treatments using variation in volumetry could aid in defining and in predicting complete pathologic responses which could benefit e.g. of a more conservative treatment if un-fit for extended resections.
Finally, the result of this research project, together with the investigation about tool-path simulation and planning, that is being provided by other activities of the proponents, will define the core for an educational platform, as reported in the Guidelines for Evaluation of Credentials of Individuals for the Purpose of Awarding Surgical Privileges in New Technologies, published by the American College of Surgeons, that state of The surgeon must be a member in good standing of the department or service from which privileges are to be recommended. A defined educational program in the technology, including didactic and practical elements, must be completed and documented either as a post-residency course of instruction, or as a component of an approved residency program. The surgeon must be qualified, experienced and knowledgeable in the management of the diseases for which the technology is applied.¿
In future, the educational platform, could be also developed and tested by means of an experimental set-up that will be designed and sensor-equipped by the proponents and finally provided by means of rapid prototyping solutions. Rapid prototyping will also used for reverse engineering reconstructions of organs starting from image acquisition, reproducing soft tissue compliance via topological optimization.