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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_585_Библиотеки_им_академика_М_И_Перельмана.pdf
11 Digital Surgical Diagnosis andManagement ofExtrahepatic Cholelithiasis
e
227
f
Fig. 11.3 (continued)
228
Y. Tang et al.
g
h
Fig. 11.3 (continued)
11 Digital Surgical Diagnosis andManagement ofExtrahepatic Cholelithiasis
ab
cd
229
Fig. 11.4 3D reconstruction effect. (a) Reconstructed arterial system; (b) Reconstructed portal vein system; (c) Reconstructed hepatic veins; (d)
Reconstructed biliary tract system; (e) Calculi were visible when the transparency of reconstructed hepatobiliary and bile ducts was 0.25
230
e
Fig. 11.4 (continued)
Y. Tang et al.
Fig. 11.5 Reconstructed
hepatobiliary, pancreatic, and
spleen model
11 Digital Surgical Diagnosis andManagement ofExtrahepatic Cholelithiasis
Fig. 11.6 The transparency
of the liver is 0.5, showing the
tubular structure inside the
liver
231
Fig. 11.7 Calculi are
revealed when hepatobiliary
transparency is 0.5
232
Fig. 11.8 When biliary tract
transparency is 0.5 and liver
transparency is 1, the calculi
in the lower segment of the
common bile duct are
revealed
Y. Tang et al.
Fig. 11.9 Activation of
biliary tract system,
introduction of virtual scalpel,
and cutting the common bile
duct
11 Digital Surgical Diagnosis andManagement ofExtrahepatic Cholelithiasis
233
a
b
Fig. 11.10 3D visualized simulation surgery—simulation of stone removal process. (a) Introduce the lithotomy forceps to carry out the stone
removal; (b) stone removal process; (c) remove the stone
234
Y. Tang et al.
c
Fig. 11.10 (continued)
• Step 4 Introduce the T-tube and insert the needle into the
lower end of the common bile duct (Fig.11.11a, b, c).
• Step 5 Introduce the needle, suture, and knot and perform
the suturing process of the common bile duct incision and
T-tube indwelling (Fig.11.12a, b, c).
The STL format of the liver, bile, pancreas, and spleen
model of choledocholithiasis was imported into the FreeForm
Modeling System. The model can be magnied, reduced,
and rotated in all directions. It can be seen that the internal
structure of the model is faithful to the original twodimensional image. Different systems were rendered in different colors: the liver was reddish-brown, the bile duct was
green, the bile duct stone was black, the artery was red, the
portal vein was purple, the hepatic vein was blue, the pancreas was yellow, and the spleen was purplish-red. The 3D
model is more stereoscopic and realistic. The internal duct
structure and the location of stones can be displayed by setting different transparency (Figs.11.5, 11.6, 11.7, and 11.8).
The secondary virtual surgical instrument T-tube is similar to
the real one. The manipulation force feedback device
(PHANTOM) can be used to perform visual simulation surgery for choledocholithotomy and T-tube drainage
(Figs.11.9, 11.10, 11.11, and 11.12).
11.3.2 Signicance of3D Visualization
intheManagement
ofCholedocholithiasis
With the continuous progress of imaging techniques such as
MSCT and MRI, people’s understanding of internal structure
changes of the hepatobiliary system caused by hepatobiliary
diseases has deepened. In recent years, the development of
computer technology and image processing technology has
promoted research on the visualization of liver and gallbladder. However, there is still a long way to go with clinic
requirements. At present, there are many studies on the
whole digitized virtual human dataset at home and abroad as
well as the use of perfused liver specimens to study the structure of liver internal pipeline or to use medical imaging
equipment such as CT, MRI, 3DCT, and workstations
brought in by the instruments to reconstruct the viscera, but
there are some shortcomings. The 64-slice spiral CT scanning data of intrahepatic and extrahepatic bile duct stones
provides clear submillimeter data, which can be used for 3D
visualization stereo imaging assisted by a computer.
Computer-aided surgery (CAS) is a new technology
based on the high-speed processing and controlling of
data. It can provide technical support for surgeons through
11 Digital Surgical Diagnosis andManagement ofExtrahepatic Cholelithiasis
235
a
b
Fig. 11.11 3D visualized simulation surgery—simulating the indwelling of T tube. (a) Introduce t-tube; (b) indwell the T-tube; (c) bile duct
transparency is 0.5, showing the position of the T-tube
236
Y. Tang et al.
c
Fig. 11.11 (continued)
a virtual environment to make the operation safer and
more accurate. In recent years, with the development of
diagnostic imaging instruments such as CT and MRI, the
application of computer virtual reality technology in medicine has rapidly developed. Virtual surgery is an emerging discipline that uses a variety of medical image data to
create a simulated environment in a computer using virtual reality technology. Doctors use the information from
the virtual environment for surgical planning, training,
and guiding the surgeon during the actual operation
process.
After the establishment of a virtual surgical system for
biliary calculi, the automatic image segmentation and 3D
reconstruction were carried out through the MIPS system
(using the CT image information obtained preoperatively
on the patients with cholelithiasis); enabling rapid building of the 3D model. In the virtual environment established
by the computer, the operation process, position, and angle
of the incision were well-designed, thus improving the
success rate of the operation. Moreover, surgical training
is crucial because 80% of the errors in surgical teaching
and training are caused by human factors. Young doctors
can observe the expert’s surgical procedure on the system
and repeat the exercise. Virtual surgery has greatly shortened the time required for surgical training while reducing
the need for expensive subjects. Since the virtual surgery
system can provide the operator with a realistic and immersive training environment, Force feedback rendering algorithms can create a good sense of presence, so the training
process is almost identical to the real situation, especially
the hand feeling of the actual operation. This technique has
opened up a new model of medical teaching that helps
solve the difculties of clinical medical training and
education.