PUBBLICAZIONI

Conductive Gel Phantoms for Training in Electrosurgery

Considering the increasing demand for personalized surgical care, as well as current healthcare resources limitations, the use of anatomical accurate 3D physical phantoms is becoming increasingly important for the training of surgeons and the test of surgical instruments. A lack of physical models is nowadays denoted regarding the training in electrosurgery, despite its wide diffusion in medical practice. This work reports an extensive characterization of electrosurgical physical phantoms fabricated with tissue-mimicking ionogels and hydrogels. A careful design of the conductive gels allow the fine tuning of their mechanical and electrical properties, in order to match those of biological tissues. The manufacturing of a novel multi-material skin stratification bench-top pad is reported together with its use for training in both cold and electrical surgery. Furthermore, a feasibility study is reported, showing the use of conductive ionogels for simulating the coagulation of cortical vessels during brain surgery. 📌L. Migliorini, G. Valaperta, F. Acocella, T. Santaniello, N. Castelli, A. Perin, F. Cavaliere, M. Vertemati, G. V. Zuccotti, P. Milani, Conductive Gel Phantoms for Training in Electrosurgery. Adv. Mater. Interfaces 2024, 11, 2400246. https://doi.org/10.1002/admi.202400246

Virtual Reality Head-Mounted Display (HMD) and Preoperative Patient-Specific Simulation: Impact on Decision-Making in Pediatric Urology: Preliminary Data

To assess how virtual reality (VR) patient-specific simulations can support decision-making processes and improve care in pediatric urology, ultimately improving patient outcomes. Virtual Reality patient-specific simulations represent an empowering tool in pediatric urology. By leveraging the immersive capabilities of VR technology, preoperative planning and intraoperative navigation can greatly impact surgical decision-making. As we continue to advance in medical simulation, VR holds promise in educational programs to include even surgical treatment of more complex urogenital malformations.  📌 Lanfranchi G, Costanzo S, Selvaggio GGO, Gallotta C, Milani P, Rizzetto F, Musitelli A, Vertemati M, Santaniello T, Campari A, Paraboschi I, Camporesi A, Marinaro M, Calcaterra V, Pierucci UM, Pelizzo G.  Virtual Reality Head-Mounted Display (HMD) and Preoperative Patient-Specific Simulation: Impact on Decision-Making in Pediatric Urology: Preliminary Data. Diagnostics (Basel). 2024 Jul 30;14(15):1647. doi: 10.3390/diagnostics14151647. PMID: 39125523; PMCID: PMC11311633.   

Laparoscopic Microwave Ablation: Which Technologies Improve the Results

Laparoscopic ablation of hepatic tumors is a demanding procedure. In this article, Authors show the new technologies which permitted to perform this procedure safely and obtaining good oncological results. In the preoperative period, 3D reconstruction of radiological imaging permits to evaluate exactly the position of the lesions. Intraoperatively, it is possible to guide the treatment using ICG-fluorescence imaging and the intraoperative ultrasound. All these technologies are very useful tools to permit the surgeon to obtain the best results after laparoscopic ablative treatments.   📌Santambrogio R, Vertemati M, Barabino M, Zappa MA.Laparoscopic Microwave Ablation: Which Technologies Improve the Results. Cancers (Basel). 2023 Mar 17;15(6):1814. doi: 10.3390/cancers15061814. PMID: 36980701; PMCID: PMC10046461.  

Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children.

Exploration of the common bile duct in children differs from that of the adult population and combines echo-endoscopy and ERCP (endoscopic retrograde cholangiopancreatography). The integrated use of minimally invasive surgery in the pediatric area is necessary for the whole management perspective in complex malformations and small patients. The introduction in the clinical practice of a preoperative study with Virtual Reality allows a better survey of the malformation and a tailored treatment.  📌 Destro F, Salerno R, Calcaterra V, Ardizzone S, Meroni M, Roveri M, Pierucci UM, Zaja A, Rizzetto F, Campari A, Vertemati M, Milani P, Pelizzo G. Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children. Children (Basel). 2023 Apr 21;10(4):760. doi: 10.3390/children10040760. PMID: 37190009; PMCID: PMC10137240   

Planning the treatment: preoperative 3D reconstruction

Computed tomography and/or magnetic resonance imaging are commonly used for definite diagnosis of liver tumors, but they furnish only two-dimensional data to the surgeon, which in many cases is difficult to use during surgical treatments because the surgeon must evaluate the three-dimensional (3D) aspect of the lesion to be removed or ablated and understand patients’ hepatic features and vascular structures. 3D reconstruction view and 3D printing technologies can clearly demonstrate the precise spatial anatomy of a nodule and can help the surgeons improve their surgical preparations, which can be used for either liver resection or thermoablation. The use of 3D-printed models or holograms in the operative room during the operation increases the surgical accuracy. This article describes all the phases of the hepatic 3D modeling and printing procedure, convenient for improving our preoperative surgical preparation for personalized surgery.

📌 Santambrogio R, Vertemati M, Picardi E, Zappa MA. Planning the treatment: preoperative 3D reconstruction. Laparosc Surg 2022;6:17 | https://dx.doi.org/10.21037/ls-22-.  

Developing Virtual Reality Head Mounted Display (HMD) Set-Up for Thoracoscopic Surgery of Complex Congenital Lung MalFormations in Children

Video assisted thoracoscopic surgery (VATS) has been adopted in pediatric age for the treatment of congenital lung malformations (CLM). The aim of this report is to introduce a virtual reality (VR) head mounted display (HMD) of organ models and HMD model in VATS procedure to improve the quality of care in children with CLM. VR HMD set-up for planning thoracoscopic surgery was performed in a series of pediatric patients with diagnosis of CLM. The preoperative VR HMD evaluation allowed a navigation into the malformation with the aim to explore, interact, and make the surgeon more confident and skilled to answer to the traps.  

📌Pelizzo G, Costanzo S, Roveri M, Lanfranchi G, Vertemati M, Milani P, Zuccotti G, Cassin S, Panfili S, Rizzetto F, Campari A, Camporesi A, Calcaterra V. Developing Virtual Reality Head Mounted Display (HMD) Set-Up for Thoracoscopic Surgery of Complex Congenital Lung MalFormations in Children. Children (Basel). 2022 Jan 3;9(1):50. doi: 10.3390/children9010050. PMID: 35053675; PMCID: PMC8774663. .

Hybrid Additive Fabrication of a Transparent Liver with Biosimilar Haptic Response for Preoperative Planning

Due to the complexity of liver surgery, the interest in 3D printing is constantly increasing among hepatobiliary surgeons. The aim of this study was to produce a patient-specific transparent life-sized liver model with tissue-like haptic properties by combining additive manufacturing and 3D moulding. A multistep pipeline was adopted to obtain accurate 3D printable models. Our 3D transparent model with haptic properties can help surgeons understand the spatial changes of intrahepatic structures during surgical manoeuvres, optimising preoperative surgical planning. 

📌 Aseni P, Santaniello T, Rizzetto F, Gentili L, Pezzotta F, Cavaliere F, Vertemati M, Milani P.  Hybrid Additive Fabrication of a Transparent Liver with Biosimilar Haptic Response for Preoperative Planning. Diagnostics (Basel). 2021 Sep 21;11(9):1734. doi: 10.3390/diagnostics11091734. PMID: 34574075; PMCID: PMC8471167.   

Immersive Virtual Reality in surgery and medical education: Diving into the future.

In recent years, the widespread adoption of Immersive Virtual Reality (IVR) has sparked interest in its applications in medical education and surgery. IVR creates an immersive virtual world through head-mounted displays and haptic devices, enabling the visualization of three-dimensional anatomical models, the execution of simulated procedures, and the recreation of surgical environments. This technology enhances anatomical understanding, increases knowledge retention, and allows the exploration of patient-specific anatomical variability. In the surgical field, it provides a realistic and controlled environment for learning techniques, reducing risks, and improving clinical outcomes. However, the high cognitive load and the need for greater realism remain challenges to address. While more studies are required to evaluate its effectiveness, technological advancements and early positive results suggest a growing role for IVR in the future of medicine.  📌Rizzetto F, Bernareggi A, Rantas S, Vanzulli A, Vertemati M.Immersive Virtual Reality in surgery and medical education: Diving into the future. Am J Surg. 2020 Oct;220(4):856-857. doi: 10.1016/j.amjsurg.2020.04.033. Epub 2020 Apr 30. PMID: 32386709.  

A Virtual Reality Environment to Visualize Three-Dimensional Patient-Specific Models by a Mobile Head-Mounted Display

With the availability of low-cost head-mounted displays (HMDs), virtual reality environments (VREs) are increasingly being used in medicine for teaching and clinical purposes. Our aim was to develop an interactive, user-friendly VRE for tridimensional visualization of patient-specific organs, establishing a workflow to transfer 3-dimensional (3D) models from imaging datasets to our immersive VRE. Our approach, based on open-source software and mobile hardware, proved to be a valid and well-appreciated system to visualize 3D patient-specific models, paving the way for a potential new tool for teaching and preoperative planning. 

📌Vertemati M, Cassin S, Rizzetto F, Vanzulli A, Elli M, Sampogna G, Gallieni M. A Virtual Reality Environment to Visualize Three-Dimensional Patient-Specific Models by a Mobile Head-Mounted Display. Surg Innov. 2019 Jun;26(3):359-370. doi: 10.1177/1553350618822860. Epub 2019 Jan 11. PMID: 30632462.Â