The world's first! Guangzhou doctor team puts 3D technology out of the box to apply to "heart"

The 3D virtual heart navigates over the field (referring to the range of vision during surgery).

The 3D printed heart is brought into the operating room.

3D printing technology, virtual reality technology, mixed reality technology, three kinds of 3D technology combined with medicine, black technology "can fight"?

The Guangdong Provincial People's Hospital informed the media that the dean of the Zhuang Jian team had applied mixed reality technology to nearly 10 complicated congenital heart disease operations, and “flowers and flowers” ​​in the heart-like shrubs to find narrow “small targets”. This is the world's first clinical breakthrough, and it is even more proud that all three 3D technologies and equipment originate from China.

3D intraoperative navigation "shifting flowers"

The 2 month old baby Xiaoan (a pseudonym), when he was born, showed signs of gradual lung failure, poor breathing, small face purple, newborns should be "windward long", birth weight reached the standard Xiaoan 2 months only 3 The weight is kilograms. He was sent to the Department of Cardiology of the People's Hospital of Guangdong Province, confirming that he suffered from a serious and complicated congenital heart disease, pulmonary atresia.

On March 27th, Xiao An became the first child in the world to receive “heart surgery” with the help of mixed reality technology.

Using the black technology MR technology, the doctors reconstructed the virtual three-dimensional Xiaoan heart image based on CT before surgery, and projected it onto the operating table. After opening the chest, the virtual heart was placed in the small chest, coincident with the actual heart, and then according to the image. Guide, strips to find bush-like collateral vessels, and then "shift the flowers" to where they are. The operation took only 4 hours and was shortened by more than 6 hours.

Immediately after Xiao An, the 4-year-old male baby Lele (a pseudonym) was also saved. Lele is also pulmonary atresia, as well as large ventricular septal defect, patent ductus arteriosus, collateral branch of the main lung, long-term complexion, white and purple, short and prolonged breathing, and multiple pneumonia. Lele's parents said that they have turned to a number of hospitals and said that their children's heart and lung function is too bad, and they are still dying. It is recommended to give up. The provincial medical team has become the last hope of the Lele family.

Also with the aid of mixed reality technology, Lele's pulmonary "stem" and "twig" were repaired, the ventricular septum was replenished, and the catheter was closed. Later, he will grow very close to normal children.

Decrypt

MR technology solves the problem of finding side branch vessels

Wen Shusheng, deputy director of the provincial medical pediatric ward and deputy director of the Provincial Children's Heart Center, said that in the past, the pulmonary atresia was relieved, which was considered a super-surgical operation - it was necessary to open an incision in the left and right chests, and a messy "bush" collateral vessel Find, separate, and then open an incision in the middle of the chest, splicing them one by one to the unlocked pulmonary artery, a surgery for at least 10 hours.

"Get in the morning at 8 or 9 in the morning and do it at 8:00 in the evening." Wen Shusheng said that the most time-consuming and difficult thing is to find the side branch vessels. It is not to find it. It is to find the origin, direction and free environment of each root.

Hybrid MR technology is the most critical aid to solve this problem.

Pre-operative "walking in" 3D heart hit "target"

Xiao Bing (a pseudonym), a 5-year-old girl, is also a child with complicated congenital heart disease. She had undergone heart surgery 2 years ago. Recently, she developed myocardial bundle hypertrophy and narrowing the intracardiac blood flow channel, which led to her small activities. Severe shortness of breath, growth and development are also significantly slow, and may even lead to sudden death. After the diagnosis, the child needs surgery for the first time.

The doctor team firstly printed 3D of the virtual three-dimensional small ice heart reconstructed according to CT data, which confirmed the left ventricular outflow obstruction, which was caused by hypertrophic muscle bundle; the anastomosis of the pulmonary artery and right ventricular outflow channel was also narrow.

On March 29, during the operation, the team projected Xiaobing's virtual 3D heart image onto the operating table. After opening the chest, the virtual heart was placed in the chest of Xiaobing, which coincided with the actual heart. The surgeon, Professor Jian Zhengzheng, also put on Head-mounted display (VR glasses), "walking into" the inside of Xiaobing's virtual heart, along the blood vessels, find a deformed stenosis, "touch" the small meat ring that grows out of the vascular obstruction.

With the help of three kinds of 3D technology, the team visually and intuitively found out the anatomical structure of the hypertrophic muscle bundle and stenosis, accurately found the lesion, accurately removed the hypertrophic muscle bundle, and widened the stenosis with the preoperatively planned patch. Xiao Bing was saved.

Decrypt

3D printed heart modeling to explore virtual heart precision "navigation"

Yan Jianzheng, director of the Provincial Out-of-Medical Comprehensive Disease Area, said that the biggest problem with secondary surgery like Xiao Bing is that after the surgery, the chest tissue, which has been clearly layered, has been stuck together, causing difficulty in finding the lesion, surrounding structure. There are many “minefields” such as how much to cut and how much material to use, and the risk of surgery is extremely high.

In the past, for such surgery, whether it is to confirm cardiovascular abnormality, tissue identification, or specific details of surgery, we can only wait for the repeated exploration after the chest is opened, and the surgeon must always worry about "not enough." clear". "This kind of surgery, I used to be in the heart catheter room, I can't stay away from it," said Huang Meiping, director of the provincial medical catheter room. Now with pre-operative 3D printing, AR "into the heart", MR virtual heart and the actual heart "fit", all-round navigation surgery, Huang Meiping finally put down the burden of "off-site navigation."

Interview team:

"Black technology" bravely does not increase the patient's penny

Guangzhou Daily: "Black Technology" is admitted to the doctor, do patients need to pay the bill?

Zhuang Jian: Three kinds of virtual technologies are applied to the clinic, which greatly improves the safety and fineness of the operation and shortens the operation time by more than 1/3. At present, the operation cost is calculated by time, and the patient is undoubtedly saving money and safety. In addition to the cost of machinery and materials for 3D printing, VR equipment is about 20,000 yuan/set, and MR equipment is about 30,000 yuan/set, all of which add up to less than 100,000 yuan. This kind of investment will not be passed on to the new technology application. On the patient.

What's more worth mentioning is that the operation time is greatly reduced, the operating room rotation speed is increased, and more patients get faster treatment opportunities.

Guangzhou Daily: There is a saying in the industry that “technology is practiced on patients”. Can 3D “black technology” change this situation?

Zhuang Jian: In the complex congenital field, the anatomy of the lesion is particularly complicated, and the surgical treatment needs to be extremely precise. In the past, young doctors normally needed 8 to 10 years of repeated specimen simulation and training to be able to practice. The specimens of heart disease were abnormally lacking; even if the organic platform was on the stage, the surgery relied heavily on B-ultrasound, CT, MR, and angiography. Its two-dimensional, fault structure, etc., test the doctor's anatomy and spatial position. Before surgery, you can look at the 3D reconstruction map in the computer, but after 10 hours of surgery, the memory of the person is not reliable.

Now with 3D printed virtual heart, AR virtual heart image, MR mixed reality imaging technology, the heart anatomy is presented in front of the surgeon, the lesion size, position, and neighbor relationship, etc., clear, do not rely on experience and feel . It can be said that as long as the young doctor is diligent enough to practice on the specimen, there is no problem at all.

What new advances can be expected in the next step?

Zhuang Jian: First of all, the virtual technology will be enhanced in terms of fineness. Now it is the virtual and physical cardiovascular basics. The next step is to expand the source of image data, instead of relying solely on CT data for 3D reconstruction, but also ultrasound image data. Integration into.

The second is to establish a case specimen library. Usually, complex congenital entity specimens are rare. Cases are the key. At present, more than 20,000 cases of provincial doctors are stored in the European database. In the future, they will strive to build their own databases to achieve faster and more effective clinician training. teaching.

In addition, 3D virtual technology is currently being applied in cardiac, neurosurgery, orthopedics, and pulmonary applications, and the next step is expected to be applied to more structural lesions.

Clinical breakthrough in the world's first 3D combination technology made in China

Zhuang Jian, chairman of the Chinese Medical Association's Thoracic Heart Branch and dean of the Guangdong Provincial People's Hospital, said that virtual technology is used in medical clinics. In January this year, it was reported that in December last year, international peers applied AR technology in a simple congenital treatment. The first 3D printing, AR "into the heart", MR virtual heart and the actual heart "fit" three virtual technologies combined attack, and has applied close to 10 complex congenital treatment, which is the world's first leading clinical breakthrough.

What makes Zhuang Jian proud is that such a global initiative, whether it is technology or equipment, all of China has completely independent intellectual property rights.

According to reports, the earliest application of the virtual technology to the clinic is 3D printing technology. The laboratory jointly established by the provincial doctor and Zhuhai has printed more than 70 virtual hearts, and realized pre-operative and intraoperative navigation after modeling. "The blood vessels are covered by tissues. In the past, half of the surgery was often found. The anatomical structure in memory could not be matched. The blood vessels could not be found. I had to ask for help outside the court." Zhuang Jian said that there is now a virtual heart navigation. Don't worry about half-way withdrawal and extracorporeal circulation, which greatly improves the safety of surgery.

VR virtual reality technology is a collaboration with Xi'an University of Electronic Science and Technology, allowing doctors to directly enter the virtual heart "heart", look for internal complex deformities, and no longer need to open the chest as before. "Cut a bit here, cut a bite there" In-situ exploration, "complex heart, most of them are intracardiac malformations." Zhuang Jian said that it is very important for patients to have less heart damage.

MR mixed reality technology is a cooperative application between a provincial doctor and a company in Heilongjiang. On the basis of augmented reality, the patient's heart image can be placed above the surgery field, and even the virtual heart and the physical heart coincide, even if it is fine. The blood vessels of the lateral branch do not need to separate the tissues everywhere, and the positioning is very precise. (Guangzhou Daily)

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