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TECHNOLOGY IN SURGERY

Technology is rapidly changing the way surgeons operate in the 21st century. The impact of this is dependent upon the specific challenges related to particular specialties. Much of the innovation in surgery over the past few decades has centered around performing increasingly complex procedures through smaller incisions often with improvement in patient outcomes, occasionally offset by surgical difficulty. Although transition to a minimally invasive approach required adaptation of operative view, given the lack of three-dimensional (3D) viewing, the magnification of the view through the camera compensated somewhat for this deficit, especially as the camera improved. In addition, the minimally invasive instruments required new technical skills specific to working with nonarticulating instruments. Initially less complicated procedures were transitioned to minimally invasive approaches. However, advances in technology have led to continued transition to less invasive approaches. Innovations in surgical technology have been paralleled by similar progress in medical imaging. Improved resolution and quality of imaging, coupled with modern computer processing power, has rendered advanced imaging as an additional high-powered valuable tool that can be used for complex preoperative planning as well as for intraoperative use for guided navigation and feedback.

USE OF ADVANCED IMAGING FOR SURGICAL PLANNING

The development of computed tomography (CT) imaging revolutionized medical imaging from plain film x-rays by providing multiple cross-sectional images of the area being studied. With digital imaging and advances in software, imaging reconstruction is routinely performed to generate high-quality imaging assessment in three spatial planes (axial, coronal, and sagittal views). Imaging reconstruction in this way provides additional points of reference and measurement that both improve diagnostic yield and serve as an invaluable tool for surgeons and surgical planning. The amount of data and resolution of structures contained within a CT scan is directly related to the image slice thickness, or the width of spacing between each cross-sectional image performed in the series of images. Slice thickness determines the spatial resolution of the scan in the same way that pixel size determines the resolution of an image on a computer or TV screen. Thicker slices yield lower resolution, whereas thinner slices increase the level of detail of the area being studied. The degree of slice thickness and resolution needed is largely dependent on the tissue being studied and the reason for evaluation. High-resolution CT is the use of thin-section CT images (≤ 1.5-mm slice thickness) with a high spatial frequency reconstruction algorithm to detect and characterize diseases that affect, for example, the pulmonary parenchyma and small airways.

Three-Dimensional Imaging

High-resolution digital imaging in three spatial planes naturally led to interest in the clinical utility of reconstructing the entire volume of data into a digital 3D structure. Three-dimensional reconstruction requires a high level of computer processing and advanced software packages but is becoming increasingly utilized in some areas of diagnostic imaging. Examples include situations when it is difficult to assess ...

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