LiverAIz

Prediction model for graft failure after liver transplantation-chatGPT coded program for Windows

jsrrules@gmail.com — Mon, 03 Feb 2025 13:25:25 +0000

Abstract This study was designed to build models predicting early graft failure after liver transplantation. Cox regression model for predicting early graft failure after liver transplantation using posttransplantation aspartate aminotransferase, total bilirubin, and international normalized ratio of prothrombin time was constructed based on data from both living donor (n = 1153) and deceased donor (n = 359) liver transplantation performed during 2004 to 2018. The model was compared with Model for Early Allograft Function Scoring (MEAF) and early allograft dysfunction (EAD) with their C-index and time-dependent area-under-curve (AUC). The C-index of the model for living donor (0.73, CI = 0.67–0.79) was significantly higher compared to those of both MEAF (0.69, P = 0.03) and EAD (0.66, P = 0.001) while C-index for deceased donor (0.74, CI = 0.65–0.83) was only significantly higher compared to C-index of EAD. (0.66, P = 0.002) Time-dependent AUC at 2 weeks of living donor (0.96, CI = 0.91–1.00) and deceased donor (0.98, CI = 0.96–1.00) were significantly higher compared to those of EAD. (both 0.83, P < 0.001 for living donor and deceased donor) Time-dependent AUC at 4 weeks of living donor (0.93, CI = 0.86–0.99) was significantly higher compared to those of both MEAF (0.87, P = 0.02) and EAD. (0.84, P = 0.02) Time-dependent AUC at 4 weeks of deceased donor (0.94, CI = 0.89– 1.00) was significantly higher compared to both MEAF (0.82, P = 0.02) and EAD. (0.81, P < 0.001). The prediction model for early graft failure after liver transplantation showed high predictability and validity with higher predictability compared to traditional models for both living donor and deceased donor liver transplantation. This program was coded by chatGPT implementing the graft survival prediction model developed by the article. ABC model stands for AST, Bilirubin, Coagulation factor. You can put maximum AST level during 0-7 days post-LT, maximum Total bilirubin level during 3-7 days, maximum INR level during 3-7 days. The day after LT is for calculating the probability of survival after LT. It shows you the exact number as well as the survival curve. Use it freely and when writing a paper, please make a citation on the article.

Impact of virtual reality education on disease-specific knowledge and anxiety for hepatocellular carcinoma patient scheduled fo

jsrrules — Sun, 12 Jan 2025 04:51:55 +0000

Abstract Purpose: Hepatocellular carcinoma (HCC) is a significant health concern, and the complexity of liver anatomy poses challenges in conveying radiologic findings and surgical plans to patients. This study aimed to evaluate the impact of a virtual reality (VR) education program on anxiety and knowledge in HCC patients undergoing hepatic resection. Method: From 1 January 2022 to 28 February 2023, 88 patients were enrolled in a randomized controlled trial, divided into the VR group ( n =44) and the control group ( n =44). The VR group received patient-specific 3D liver model education through a VR platform, while the control group underwent conventional explanation processes. Both groups completed preintervention and postintervention questionnaires assessing anxiety (using STAI-X-1, STAI-X-2, and VAS) and knowledge about liver resection. Comparison of the questionnaires were performed between the two groups. Multivariable logistic regression was performed to analyze factor related to decrease in anxiety. Result: While there was no significant difference in preintervention anxiety and knowledge scores between the two groups, the VR group exhibited significant reduction in STAI-X-1 scores (-4.14±7.5) compared to the control group (-0.84±5.7, P =0.023), as well as knowledge scores (17.20±2.6) compared to the control group (13.42±3.3, P <0.001). In the multivariable logistic regression model, VR education showed significant impact on decrease in STAI-X-1 score, postintervention. (OR=2.902, CI=1.097-7.674, P =0.032). Conclusion: The VR education program significantly improved knowledge and reduced anxiety among HCC patients compared to conventional methods. This study suggests that VR can be a valuable tool in patient education, enhancing comprehension and alleviating presurgical anxiety. 목적: 간세포암(HCC)은 중요한 건강 문제로, 간의 해부학적 복잡성 때문에 환자에게 방사선 소견과 수술 계획을 설명하는 데 어려움이 있다. 본 연구는 간 절제술을 앞둔 HCC 환자를 대상으로 가상현실(VR) 교육 프로그램이 불안과 지식에 미치는 영향을 평가하는 것을 목적으로 하였다. 방법: 2022년 1월 1일부터 2023년 2월 28일까지 무작위 대조군 연구에 88명의 환자가 참여하였으며, VR 그룹(n=44)과 대조군(n=44)으로 나누었다. VR 그룹은 VR 플랫폼을 통해 환자 맞춤형 3D 간 모델 교육을 받았고, 대조군은 기존의 설명 방식을 따랐다. 두 그룹 모두 불안(STAI-X-1, STAI-X-2, VAS)과 간 절제술에 대한 지식을 평가하는 사전 및 사후 설문지를 작성하였다. 두 그룹 간의 설문 결과를 비교하였고, 불안 감소와 관련된 요인을 다변량 로지스틱 회귀분석을 통해 분석하였다. 결과: 두 그룹 간 사전 불안과 지식 점수에는 유의미한 차이가 없었으나, VR 그룹은 STAI-X-1 점수에서 유의미한 감소(-4.14±7.5)를 보였으며, 대조군(-0.84±5.7)과 비교하여 통계적으로 유의미한 차이를 나타냈다(P=0.023). 또한 지식 점수에서도 VR 그룹(17.20±2.6)이 대조군(13.42±3.3)보다 유의미하게 높았다(P<0.001). 다변량 로지스틱 회귀분석에서 VR 교육은 STAI-X-1 점수 감소에 유의미한 영향을 미쳤다(OR=2.902, CI=1.097-7.674, P=0.032). 결론: VR 교육 프로그램은 기존 방식보다 환자의 지식을 향상시키고 불안을 감소시키는 데 효과적이었다. 본 연구는 VR이 환자 교육 도구로서 이해도를 높이고 수술 전 불안을 완화하는 데 유용할 수 있음을 시사한다. Yang J, Rhu J, Lim S, Kang D, Lee H, Choi GS, Kim JM, Joh JW. Impact of virtual reality education on disease-specific knowledge and anxiety for hepatocellular carcinoma patient scheduled for liver resection: a randomized controlled study. Int J Surg. 2024 May 1;110(5):2810-2817. doi: 10.1097/JS9.0000000000001197. PMID: 38377058; PMCID: PMC11093422.

3D auto-segmentation of biliary structure of living liver donors using magnetic resonance cholangiopancreatography for enhanced

jsrrules — Fri, 13 Dec 2024 15:37:27 +0000

Background: This study aimed to develop an automated segmentation system for biliary structures using a deep learning model, based on data from magnetic resonance cholangiopancreatography (MRCP). Materials and methods: Living liver donors who underwent MRCP using the gradient and spin echo technique followed by three-dimensional modeling were eligible for this study. A three-dimensional residual U-Net model was implemented for the deep learning process. Data were divided into training and test sets at a 9:1 ratio. Performance was assessed using the dice similarity coefficient to compare the model’s segmentation with the manually labeled ground truth. Results: The study incorporated 250 cases. There was no difference in the baseline characteristics between the train set (n =225) and test set (n=25). The overall mean Dice Similarity Coefficient was 0.80 ± 0.20 between the ground truth and inference result. The qualitative assessment of the model showed relatively high accuracy especially for the common bile duct (88%), common hepatic duct (92%), hilum (96%), right hepatic duct (100%), and left hepatic duct (96%), while the third-order branch of the right hepatic duct (18.2%) showed low accuracy. Conclusion: The developed automated segmentation model for biliary structures, utilizing MRCP data and deep learning techniques, demonstrated robust performance and holds potential for further advancements in automation 배경: 본 연구는 자기공명 담췌관조영술(MRCP) 데이터를 기반으로 심층 학습 모델을 활용하여 담도 구조를 자동으로 분할하는 시스템을 개발하는 것을 목표로 하였습니다. 재료 및 방법: Gradient 및 Spin Echo 기법을 사용하여 MRCP를 시행한 후 3D 모델링을 수행한 생체 간 기증자가 본 연구에 포함되었습니다. 심층 학습 과정에서는 3D 잔여 U-Net(Residual U-Net) 모델을 구현하였으며, 데이터를 9:1 비율로 학습 세트와 테스트 세트로 나누어 분석하였습니다. 모델의 분할 성능은 수동으로 라벨링된 기준 데이터(ground truth)와 비교하여 Dice 유사도 계수를 사용해 평가하였습니다. 결과: 연구에는 총 250건의 사례가 포함되었으며, 학습 세트(n=225)와 테스트 세트(n=25) 간에 기초 특성의 차이는 없었습니다. 기준 데이터와 모델 추론 결과 간의 평균 Dice 유사도 계수는 0.80 ± 0.20이었습니다. 모델의 질적 평가는 비교적 높은 정확도를 보였으며, 특히 총담관(88%), 총간관(92%), 간문부(96%), 우간관(100%), 좌간관(96%)에서 높은 정확도를 나타냈습니다. 반면, 우간관 3차 분지(18.2%)에서는 낮은 정확도를 보였습니다. 결론: MRCP 데이터와 심층 학습 기술을 활용하여 개발된 담도 구조 자동 분할 모델은 강력한 성능을 입증하였으며, 자동화 기술의 발전 가능성을 보여주었습니다.

Comprehensive deep learning-based assessment of living liver donor CT angiography: from vascular segmentation to volumetric ana

jsrrules — Fri, 13 Dec 2024 15:31:38 +0000

Background: Precise preoperative assessment of liver vasculature and volume in living donor liver transplantation is essential for donor safety and recipient surgery. Traditional manual segmentation methods are being supplemented by deep learning (DL) models, which may offer more consistent and efficient volumetric evaluations. Methods: This study analyzed living liver donors from Samsung Medical Center using preoperative CT angiography data between April 2022 and February 2023. A DL-based 3D residual U-Net model was developed and trained on segmented CT images to calculate the liver volume and segment vasculature, with its performance compared to traditional manual segmentation by surgeons and actual graft weight. Results: The DL model achieved high concordance with manual methods, exhibiting Dice Similarity Coefficients of 0.94 ± 0.01 for the right lobe and 0.91 ± 0.02 for the left lobe. The liver volume estimates by DL model closely matched those of surgeons, with a mean discrepancy of 9.18 ml, and correlated more strongly with actual graft weights (R-squared value of 0.76 compared to 0.68 for surgeons). Conclusion: The DL model demonstrates potential as a reliable tool for enhancing preoperative planning in liver transplantation, offering consistency and efficiency in volumetric assessment. Further validation is required to establish its generalizability across various clinical settings and imaging protocols. 배경: 생체 간이식에서 기증자의 안전과 수혜자의 수술을 위해 간 혈관과 용적에 대한 정확한 수술 전 평가가 필수적입니다. 기존의 수작업 분할 방법은 심층 학습(Deep Learning, DL) 모델에 의해 보완되고 있으며, 이는 보다 일관되고 효율적인 용적 평가를 제공할 수 있습니다. 방법: 본 연구는 2022년 4월부터 2023년 2월까지 삼성서울병원에서 생체 간 기증자를 대상으로 한 수술 전 CT 혈관조영 데이터를 분석하였습니다. 3D 잔여 U-Net(Residual U-Net) 기반의 DL 모델을 개발하여 간의 용적과 혈관을 분할 및 계산하였으며, 해당 성능은 외과의가 수행한 기존 수작업 분할 및 실제 이식 간 중량과 비교되었습니다. 결과: DL 모델은 수작업 방법과 높은 일치도를 보였으며, 우엽의 Dice 유사도 계수(Dice Similarity Coefficient)는 0.94 ± 0.01, 좌엽은 0.91 ± 0.02로 나타났습니다. DL 모델이 추정한 간 용적은 외과의의 결과와 평균 9.18ml의 차이를 보였으며, 실제 이식 간 중량과 더 높은 상관관계(R²=0.76, 외과의 R²=0.68)를 나타냈습니다. 결론: DL 모델은 간이식 수술 전 계획을 향상시키는 신뢰할 수 있는 도구로서 잠재력을 보여주었으며, 용적 평가의 일관성과 효율성을 제공합니다. 다양한 임상 환경과 영상 프로토콜에서의 일반화 가능성을 입증하기 위해 추가적인 검증이 필요합니다.

Automated 3D liver segmentation from hepatobiliary phase MRI for enhanced preoperative planning

jsrrules — Fri, 13 Dec 2024 15:28:21 +0000

Recent advancements in deep learning have facilitated significant progress in medical image analysis. However, there is lack of studies specifically addressing the needs of surgeons in terms of practicality and precision for surgical planning. Accurate understanding of anatomical structures, such as the liver and its intrahepatic structures, is crucial for preoperative planning from a surgeon’s standpoint. This study proposes a deep learning model for automatic segmentation of liver parenchyma, vascular and biliary structures, and tumor mass in hepatobiliary phase liver MRI to improve preoperative planning and enhance patient outcomes. A total of 120 adult patients who underwent liver resection due to hepatic mass and had preoperative gadoxetic acid-enhanced MRI were included in the study. A 3D residual U-Net model was developed for automatic segmentation of liver parenchyma, tumor mass, hepatic vein (HV), portal vein (PV), and bile duct (BD). The model’s performance was assessed using Dice similarity coefficient (DSC) by comparing the results with manually delineated structures. The model achieved high accuracy in segmenting liver parenchyma (DSC 0.92 ± 0.03), tumor mass (DSC 0.77 ± 0.21), hepatic vein (DSC 0.70 ± 0.05), portal vein (DSC 0.61 ± 0.03), and bile duct (DSC 0.58 ± 0.15). The study demonstrated the potential of the 3D residual U-Net model to provide a comprehensive understanding of liver anatomy and tumors for preoperative planning, potentially leading to improved surgical outcomes and increased patient safety. 심층 학습의 최근 발전은 의료 영상 분석에서 상당한 진전을 가능하게 했습니다. 그러나 수술 계획의 실용성과 정확성 측면에서 외과의의 요구를 구체적으로 다룬 연구는 부족한 실정입니다. 외과의의 관점에서 간 및 간내 구조와 같은 해부학적 구조를 정확히 이해하는 것은 수술 전 계획에 매우 중요합니다. 본 연구는 간담췌 단계 간 MRI에서 간 실질, 혈관 및 담도 구조, 종양 덩어리를 자동으로 분할하기 위한 심층 학습 모델을 제안하여 수술 전 계획을 개선하고 환자 결과를 향상시키는 것을 목표로 합니다. 총 120명의 성인을 대상으로 연구를 진행했으며, 이들은 간 종양으로 인해 간 절제술을 받았고, 수술 전 가독세트산 강화 MRI를 시행하였습니다. 간 실질, 종양, 간 정맥(HV), 문맥(PV), 담도(BD)를 자동으로 분할하기 위해 3D 잔여 U-Net(Residual U-Net) 모델을 개발하였고, 수작업으로 표시된 구조와 비교하여 Dice 유사도 계수(DSC)를 사용해 모델의 성능을 평가하였습니다. 모델은 간 실질(DSC 0.92 ± 0.03), 종양 (DSC 0.77 ± 0.21), 간 정맥(DSC 0.70 ± 0.05), 문맥(DSC 0.61 ± 0.03), 담도(DSC 0.58 ± 0.15)의 분할에서 높은 정확도를 달성했습니다. 본 연구는 3D 잔여 U-Net 모델이 간 해부학 및 종양에 대한 포괄적인 이해를 제공하여 수술 전 계획을 개선하고, 궁극적으로 수술 결과를 향상시키며 환자 안전성을 높이는 데 기여할 가능성을 입증하였습니다.

Multivariable linear model for predicting graft weight based on 3-dimensional volumetry in regards to body weight change of liv

jsrrules — Sun, 08 Dec 2024 20:57:57 +0000

Purpose: The purpose of this study is to build a prediction model for estimating graft weight about different graft volumetry methods combined with other variables. Methods: Donors who underwent living-donor right hepatectomy from March 2021 to March 2023 were included. Estimated graft volume measured by conventional method and 3-dimensional (3D) software were collected as well as the actual graft weight. Linear regression was used to build a prediction model. Donor groups were divided according to the 3D volumetry of <700 cm3, 700–899 cm3, and ≥900 cm3 to compare the performance of different models. Results: A total of 119 donors were included. Conventional volumetry showed R2 of 0.656 (P < 0.001) while 3D software showed R2 of 0.776 (P < 0.001). The R2 of the multivariable model was 0.842 (P < 0.001) including for 3D volume (β = 0.623, P < 0.001), body mass index (β = 7.648, P < 0.001), and amount of weight loss (β = –7.252, P < 0.001). The median errors between different models and actual graft weight did not differ in donor groups (<700 and 700–899 cm3), while the median error of univariable linear model using 3D software (122.5; interquartile range [IQR], 61.5–179.8) was significantly higher than multivariable-adjusted linear model (41.5; IQR, 24.8–69.8; P = 0.003) in donors with estimated graft weight ≥900 cm3. Conclusion: The univariable 3D volumetry model showed an acceptable outcome for donors with an estimated graft volume <900 cm3. For donors with an estimated graft volume ≥900 cm3, the multivariable-adjusted linear model showed higher accuracy. [Ann Surg Treat Res 2024;107(2):91-99] English: 3D modeling enhances surgical precision by: Providing detailed anatomical insights for preoperative planning. Reducing human errors in volumetric assessments. Supporting personalized, data-driven surgical strategies, especially in challenging cases like large-volume liver grafts. Korean: 3D 모델링은 수술 계획을 다음과 같이 개선합니다: 수술 전 계획을 위한 세밀한 해부학적 정보를 제공합니다. 용적 평가에서 인간 오류를 줄입니다. 특히 대용량 간 이식과 같은 복잡한 사례에서 맞춤형 데이터 기반 수술 전략을 지원합니다.

Risk Factors Associated With Surgical Morbidities of Laparoscopic Living Liver Donors

jsrrules — Sun, 08 Dec 2024 20:41:50 +0000

Objective: This study analyzed the incidence and risk factors for surgical morbidities of laparoscopic living donors. Background: Although laparoscopic living donor programs have been established safely in leading centers, donor morbidities have not been discussed sufficiently. Methods: Laparoscopic living donors operated on from May 2013 to June 2022 were reviewed. Donor complications were reviewed, and factors related to bile leakage and biliary stricture were analyzed using the multivariable logistic regression method. Results: A total of 636 donors underwent laparoscopic living donor hepatectomy. The open conversion rate was 1.6%, and the 30-day complication rate was 16.8% (n=107). Grade IIIa and IIIb complications occurred in 4.4% (n=28) and 1.9% (n=12) of patients, respectively. The most common complication was bleeding (n=38, 6.0%). Fourteen donors (2.2%) required reoperation. Portal vein stricture, bile leakage, and biliary stricture occurred in 0.6% (n=4), 3.3% (n=21), and 1.6% (n=10) of cases, respectively. The readmission rate and reoperation rate were 5.2% (n=33) and 2.2% (n=14), respectively. Risk factors related to bile leakage were 2 hepatic arteries in the liver graft (OR=13.836, CI=4.092–46.789, P<0.001), division-free margin<5 mm from the main duct (OR=2.624, CI=1.030–6.686, P=0.043), and estimated blood loss during operation (OR=1.002, CI=1.001–1.003, P=0.008), while the Pringle maneuver (OR=0.300, CI=0.110–0.817, P=0.018) was protective against leakage. Regarding biliary stricture, bile leakage was the only significant factor (OR=11.902, CI=2.773–51.083, P=0.001). Conclusions: Laparoscopic living donor surgery showed excellent safety for the majority of donors, and critical complications were resolved with proper management. To minimize bile leakage, cautious surgical manipulation is needed for donors with complex hilar anatomy. This study analyzed risk factors and incidence rates of surgical morbidities in laparoscopic living donor hepatectomy (LLDH) performed over a 9-year period, focusing on complications like bile leakage, biliary stricture, and portal vein stricture. Key Findings: Patient Cohort: Total donors: 636. Open conversion rate: 1.6%. Overall complication rate: 16.8%. Severe complications (Clavien-Dindo grade ≥III): 6.3%. Portal vein stricture: 0.6%, all resolved with intervention. Bile leakage: 3.3%, often associated with complex bile duct and hepatic artery anatomy. Biliary stricture: 1.6%, all managed successfully. Risk Factors: Bile Leakage: Two hepatic arteries in the graft (OR: 13.836; P < 0.001). Division-free margin <5 mm from the main duct (OR: 2.624; P = 0.043). Higher estimated blood loss (OR: 1.002; P = 0.008). Use of the Pringle maneuver was protective (OR: 0.300; P = 0.018). Biliary Stricture: Strongly linked to prior bile leakage (OR: 11.902; P = 0.001). Key Outcomes: Comprehensive complication index median: 0. Most complications were successfully resolved with minimal long-term morbidity. Conclusion: LLDH demonstrates excellent safety when performed by experienced teams. Detailed preoperative imaging and cautious surgical planning are critical to minimizing donor risks, particularly for cases with complex hilar anatomy. 3D modeling and imaging technologies are critical for ensuring safe laparoscopic donor hepatectomy: Enhanced Preoperative Planning: Visualizing vascular and bile duct anatomy minimizes risks of complications. Precision in Complex Cases: Detailed anatomical insights are essential for handling variations in hepatic arteries and bile ducts. Improved Donor Outcomes: Structured imaging reduces intraoperative risks, particularly for bile leakage and biliary stricture. 9년간 시행된 **복강경 생체 간 공여자 절제술(LLDH)**에서 발생한 수술 합병증의 발생률과 위험 요인을 분석하였습니다. 주요 합병증으로는 담즙 누출, 담관 협착, 문맥 협착 등이 포함되었습니다. 주요 결과: 환자군: 총 공여자: 636명. 개복 전환율: 1.6%. 전체 합병증 발생률: 16.8%. 중증 합병증(Clavien-Dindo 등급 ≥III): 6.3%. 문맥 협착: 0.6%, 모두 중재술로 해결. 담즙 누출: 3.3%, 복잡한 담관 및 간동맥 해부학과 연관. 담관 협착: 1.6%, 모두 성공적으로 관리. 위험 요인: 담즙 누출: 간동맥 2개가 포함된 이식편(OR: 13.836; P < 0.001). 주간관에서 5 mm 미만의 여유 분리 거리(OR: 2.624; P = 0.043). 수술 중 출혈량 증가(OR: 1.002; P = 0.008). Pringle 수기 사용은 보호적 역할(OR: 0.300; P = 0.018). 담관 협착: 이전 담즙 누출과 강한 연관성(OR: 11.902; P = 0.001). 주요 결과: 합병증 지수 중앙값: 0. 대부분의 합병증이 장기적 영향을 최소화하며 성공적으로 해결됨. 결론: LLDH는 경험이 풍부한 팀이 시행할 경우 우수한 안전성을 보입니다. 복잡한 간문부 해부학을 가진 경우, 세밀한 수술 계획과 철저한 사전 영상 검토가 공여자 위험을 최소화하는 데 중요합니다. 3D 모델링 및 영상 기술은 복강경 공여자 절제술의 안전성을 보장하는 데 필수적입니다: 수술 전 계획 강화: 혈관 및 담관 해부학을 시각화하여 합병증 위험을 최소화합니다. 복잡한 경우 정밀성: 간동맥 및 담관 변이를 처리하는 데 세부 해부학적 통찰이 필수적입니다. 공여자 결과 개선: 구조화된 영상은 특히 담즙 누출 및 담관 협착과 관련된 수술 중 위험을 줄여줍니다.

Laparoscopic Living Donor Right Hepatectomy Regarding the Anatomical Variation of the Portal Vein: A Propensity Score–Matched A

jsrrules — Sun, 08 Dec 2024 20:29:09 +0000

This study is designed to analyze the feasibility of laparoscopic living donor right hemihepatectomy in living donors with portal vein variation. Living donor liver transplantation cases using a right liver graft during the period of January 2014 to September 2019 were included. Computed tomographic angiographies of the donor were 3-dimensionally reconstructed, and the anatomical variation of the portal vein was classified. To reduce selection bias, a 1:1 ratio propensity score–matched analysis between the laparoscopy group and the open group was performed. Surgical and recovery-related outcomes as well as portal vein complication-free survival, graft survival, and overall survival rates were analyzed. After matching, 171 cases in each group from 444 original cases were compared. The laparoscopy group had a shorter operation time (P < 0.001), a smaller number of additional opioids required by the donor (P < 0.001), and a shorter hospital stay (P < 0.001). There were no differences in the portal vein complication-free survival (P = 0.16), graft survival (P = 0.26), or overall survival rates (P = 0.53). Although portal vein complication-free survival was inferior in portal veins other than type I (P = 0.01), the laparoscopy group showed similar portal vein complication-free survival regardless of the anatomical variation of portal vein (P = 0.35 in type I and P = 0.30 in other types). Laparoscopic living donor right hemihepatectomy can be performed as safely as open surgery regardless of the anatomical variation of the portal vein. Study Focus: The study evaluates the feasibility and safety of laparoscopic living donor right hepatectomy (LLDRH) in cases with portal vein (PV) anatomical variations, using propensity score (PS)–matched analysis to compare laparoscopic and open surgery approaches. Key Findings: - Portal Vein Variations: PV variations (types II and III) were associated with more grafts having two PV openings, but laparoscopic surgery managed these safely with outcomes comparable to open surgery. Complication rates were similar between laparoscopy and open surgery regardless of PV type. - Safety and Efficiency: Laparoscopic surgery had shorter operation times, less blood loss, shorter hospital stays, and reduced opioid requirements compared to open surgery. Postoperative PV complication rates requiring intervention were lower in the laparoscopy group (1.8% vs. 7.0%, P = 0.03). - 3D Modeling: Preoperative 3D reconstructions of donor PV anatomy aided in surgical planning, especially for complex PV types, improving precision and safety. Conclusion: LLDRH is a safe and effective alternative to open surgery, even in cases with challenging PV variations, provided the surgical team has sufficient expertise. 3D modeling in laparoscopic liver surgery is pivotal for visualizing complex PV anatomy, improving preoperative planning, and enhancing surgical safety and precision. By reducing complications and streamlining procedures, 3D modeling facilitates the broader adoption of minimally invasive techniques in liver transplantation. 연구 초점: 이 연구는 문맥(portal vein, PV) 해부학적 변이를 가진 생체 공여자 간 우엽 절제술에서 복강경 수술의 안전성과 타당성을 평가하기 위해 성향 점수(PS) 매칭 분석을 사용하여 복강경 수술과 개복 수술을 비교했습니다. 주요 결과: - 문맥 변이: PV 변이(II형 및 III형)는 두 개의 문맥 개구부를 가지는 경우가 더 많았지만, 복강경 수술에서도 안전하게 관리되어 개복 수술과 유사한 결과를 보였습니다. PV 변이 유형에 관계없이 복강경과 개복 수술 간 합병증 비율은 유사했습니다. - 안전성과 효율성: 복강경 수술은 개복 수술에 비해 수술 시간 단축, 출혈량 감소, 입원 기간 단축, 진통제 요구량 감소 등의 장점을 보였습니다. 수술 후 문맥 합병증 발생률은 복강경 그룹에서 더 낮았습니다(1.8% vs. 7.0%, P = 0.03). - 3D 모델링: 공여자의 PV 해부학적 구조를 3D 재구성하여 복잡한 PV 유형에서도 수술 계획을 개선하고 정밀도와 안전성을 높였습니다. 결론: 충분한 경험을 가진 외과 팀이 수행한다면, 복강경 생체 공여자 간 우엽 절제술은 어려운 PV 변이를 가진 경우에도 안전하고 효과적인 대안으로 자리 잡을 수 있습니다. 복강경 간 수술에서 3D 모델링은 복잡한 문맥 해부학을 시각화하고, 수술 전 계획을 개선하며, 수술 안전성과 정밀성을 높이는 데 중요한 역할을 합니다. 합병증을 줄이고 절차를 간소화함으로써, 3D 모델링은 간 이식에서 최소 침습 기술의 광범위한 채택을 촉진합니다.

A Novel Technique for Bile Duct Division During Laparoscopic Living Donor Hepatectomy to Overcome Biliary Complications in Live

jsrrules — Sun, 08 Dec 2024 20:12:12 +0000

Background. This study was designed to analyze the clinical impact of a new bile duct division technique during laparoscopic living donor hepatectomy. Methods. Laparoscopic donor right hepatectomies performed by a single surgeon between December 2016 and August 2019 were included. Magnetic resonance cholangiopancreatography of the donors was reconstructed, and the length of the common channel of the dividing intrahepatic duct was measured. Patients were divided into 2 groups based on the bile duct division techniques of “clip and cut” versus “cut and clip.” Outcome of bile duct division was categorized based on the graft and bile duct type and number of bile duct openings. Results. A total of 147 transplantations were included. Outcomes in the “cut and clip” group were better than those in the “clip and cut” group with regard to obtaining an adequate division point (94.2% versus 78.8%; P = 0.019). The “cut and clip” showed superior biliary stricture-free survival than the “clip and cut” group (hazard ratio [HR], 0.456; confidence interval [CI], 0.217-0.957; P = 0.038) whereas recipients with hepaticojejunostomy (HR, 3.358; CI, 1.090-10.350; P = 0.035) and bile duct type other than type I (HR, 2.214; CI, 1.143-4.289; P = 0.018) showed increased risk for biliary stricture-free survival. Better outcome in terms of obtaining a single opening was also obtained in the “cut and clip” group (68.2% versus 84.6%; P = 0.040), and this difference was significant especially with a common channel shorter than 10 mm (45.5% versus 81.2%; P = 0.043). Conclusions. The “cut and clip” technique showed superior outcomes to the “clip and cut” technique in terms of fewer bile duct openings and biliary stricture-free survival of the recipients. This study introduces a novel bile duct division technique, “cut and clip,” for laparoscopic living donor hepatectomy (LLDH) and evaluates its effectiveness using 3D modeling for preoperative planning. The study analyzed outcomes from 144 cases performed between 2016 and 2019, comparing the “cut and clip” technique to the traditional “clip and cut” approach. Key Findings: - Improved Outcomes: The “cut and clip” technique resulted in fewer bile duct openings (15.4% vs. 31.8%) and significantly reduced biliary stricture rates in recipients. - Efficiency: Operation times were shorter in the “cut and clip” group (225.9 vs. 258.8 minutes, p < 0.001). - Enhanced Planning: 3D modeling based on MRCP enabled precise visualization of biliary structures and optimized division points. - Safety: The technique maintained donor safety while improving recipient outcomes. - Conclusion: The integration of 3D modeling and the “cut and clip” technique enhances surgical precision, reduces complications, and improves outcomes in LLDH, making it a safer and more efficient approach. 3D modeling technology is transforming surgical planning by providing detailed, patient-specific visualizations of complex anatomical structures. In LLDH, it enhances the precision of bile duct division, reduces complications, and optimizes surgical outcomes. As 3D modeling becomes more accessible, it is poised to set new standards in minimally invasive surgeries. 이 연구는 복강경 생체 간 기증자 간 절제술(LLDH)을 위한 새로운 담관 절단 기술인 “절단 후 클립(cut and clip)”을 도입하고, 수술 전 계획을 위한 3D 모델링을 활용하여 그 효과를 평가하였습니다. 2016년부터 2019년까지 수행된 144건의 사례를 분석하여 기존의 “클립 후 절단(clip and cut)” 방식과 비교하였습니다. 주요 결과: - 개선된 결과: “절단 후 클립” 기법은 담관 개구 수를 줄였고(15.4% vs. 31.8%), 수혜자의 담관 협착 비율을 유의미하게 감소시켰습니다. - 효율성: 수술 시간이 단축되었습니다(225.9분 vs. 258.8분, p < 0.001). - 계획 강화: MRCP를 기반으로 한 3D 모델링이 담관 구조를 정확하게 시각화하고 최적의 절단 지점을 결정하는 데 도움을 주었습니다. - 안전성: 기증자의 안전성을 유지하면서 수혜자 결과를 개선했습니다. 결론: 3D 모델링과 “절단 후 클립” 기술의 통합은 수술의 정밀도를 높이고 합병증을 줄이며 LLDH에서 더 안전하고 효율적인 접근 방식을 제공합니다. 3D 모델링 기술은 복잡한 해부학적 구조를 상세히 시각화하여 수술 계획을 혁신하고 있습니다. LLDH에서 담관 절단의 정밀도를 높이고 합병증을 줄이며 수술 결과를 최적화합니다. 3D 모델링의 접근성이 증가함에 따라 최소 침습 수술의 새로운 기준을 제시할 가능성이 큽니다.

Image guidance using two-dimensional illustrations and threedimensional modeling of donor anatomy during living donor hepatecto

jsrrules — Sun, 08 Dec 2024 19:51:45 +0000

Abstract Background: For living donor liver transplantation, preoperative imaging is required for the safety of both the donor and the recipient. We previously initiated our image guidance program using two-dimensional illustrations and three-dimensional modeling in September 2018; herein, we analyzed the resultant changes in the clinical outcomes. Methods: Living donors and recipients who underwent liver transplantation between September 2017 and August 2019 were included. Cases with image guidance were compared to those without image guidance regarding the operative outcome, especially bile-duct opening in the graft as well as surgical complications. Results: Among 200 living donor transplantation, 90 transplantations were completed with image guidance. The image-guidance group had a higher rate of laparoscopy (80.9% vs. 97.8%; p < .001) as compared with the group without image guidance. Although there was no difference in the type of bile duct (p = .144), more grafts with single bile-duct openings were found in the image-guidance group (52.7% vs. 80.0%; p = .001). Consequently, achievements in bile-duct openings were superior in the image-guidance group (p = .022). There were no differences in bile leakage, graft failure, or number of deaths during the first month post-transplantation. Conclusion: As we initiated our image-guidance program for living donor liver transplantation, clinical outcomes, especially bile-duct division, were improved relative to before implementation. This study evaluates the impact of 2D illustrations and 3D modeling technology on living donor liver transplantation (LDLT) outcomes. A comparison was made between surgeries conducted before and after implementing an image-guidance program that utilized advanced 3D modeling techniques. Key Findings: - Improved Outcomes: The image-guidance group achieved superior bile-duct opening results (80.0% single openings vs. 52.7% in the non-image-guidance group, p = 0.001). - Efficiency Gains: Operation times were significantly reduced in the image-guidance group (240.3 ± 34.4 minutes vs. 259.8 ± 47.3 minutes, p = 0.002). - Enhanced Surgical Planning: 3D models provided detailed visualization of vascular and biliary structures, offering better guidance during donor hepatectomy. - Safety: There were no differences in post-operative complications or graft failure rates between the two groups. - Conclusion: The introduction of 3D modeling improved surgical precision, reduced operation times, and enhanced safety in laparoscopic donor liver transplantation. 3D modeling technology revolutionizes surgical planning and execution by offering precise, patient-specific visualizations of anatomical structures. In LDLT, it enhances safety, optimizes bile-duct division, and reduces operation times. This innovation represents a pivotal advancement in minimally invasive surgeries, supporting better outcomes and expanding the scope of laparoscopic procedures. 이 연구는 2D 일러스트레이션과 3D 모델링 기술이 생체 간 이식(LDLT) 결과에 미친 영향을 평가하였습니다. 첨단 3D 모델링 기술을 활용한 영상 유도 프로그램 도입 전후의 수술을 비교하였습니다. 주요 결과: - 결과 개선: 영상 유도 그룹에서 단일 담관 개구 비율이 더 높았음 (80.0% vs. 52.7%, p = 0.001). - 효율성 향상: 영상 유도 그룹의 수술 시간이 유의미하게 단축됨 (240.3 ± 34.4분 vs. 259.8 ± 47.3분, p = 0.002). - 수술 계획 강화: 3D 모델은 혈관 및 담관 구조를 상세히 시각화하여 수술 중 지침으로 작용. - 안전성 보장: 두 그룹 간 수술 후 합병증 및 이식 실패율에는 차이가 없었음. - 결론: 3D 모델링 기술 도입은 수술의 정밀도를 높이고 수술 시간을 단축하며 생체 간 이식의 안전성을 강화하였습니다. 3D 모델링 기술은 해부학적 구조를 정확하고 환자 맞춤형으로 시각화하여 수술 계획과 실행을 혁신합니다. 생체 간 이식에서 안전성을 높이고 담관 분리를 최적화하며 수술 시간을 단축합니다. 이러한 혁신은 최소 침습 수술의 결과를 개선하고 복강경 수술의 범위를 확장하는 중요한 진전을 나타냅니다.

Improved graft survival by using three-dimensional printing of intra-abdominal cavity to prevent large-for-size syndrome in liv

jsrrules — Sun, 08 Dec 2024 18:53:30 +0000

Backgrounds/Aims: While large-for-size syndrome is uncommon in liver transplantation (LT), it can result in fatal outcome. To prevent such fatality, we manufactured 3D-printed intra-abdominal cavity replicas to provide intuitive understanding of the sizes of the graft and the patient’s abdomen in patients with small body size between July 2020 and February 2022. Methods: Clinical outcomes were compared between patients using our 3D model during LT, and patients who underwent LT without 3D model by using 1 : 5 ratio propensity score-matched analysis. Results: After matching, a total of 20 patients using 3D-printed abdominal cavity model and 100 patients of the control group were included in this study. There were no significant differences in 30-day postoperative complication (50.0% vs. 64.0%, p = 0.356) and the incidence of large-for-size syndrome (0% vs. 7%, p = 0.599). Overall survival of the 3D-printed group was similar to that of the control group (p = 0.665), but graft survival was significantly superior in the 3D-printed group, compared to the control group (p = 0.034). Conclusions: Since it showed better graft survival, as well as low cost and short production time, our 3D-printing protocol can be a feasible option for patients with small abdominal cavity to prevent large-for-size syndrome after LT. This study explores the use of 3D-printed abdominal cavity models in liver transplantation (LT) to address large-for-size syndrome, which can lead to fatal outcomes. A total of 20 patients underwent LT using 3D-printed models, and their outcomes were compared with a control group of 100 patients via propensity score matching. Key Findings: - Graft Survival: The 3D-printed group had significantly superior graft survival compared to the control group. - Cost and Time Efficiency: Manufacturing cost was approximately $1.25 per model, with a production time of about 6-7 hours, showcasing cost-effectiveness and practicality. - Applications: The models were particularly helpful for recipients with small abdominal cavities, aiding in selecting appropriate grafts and preventing complications. Conclusion: The integration of 3D-printed models into clinical practice improves surgical planning and outcomes while being cost-effective and efficient. 3D printing technology is redefining surgical approaches, providing personalized anatomical models for preoperative planning and intraoperative guidance. Its application in liver transplantation exemplifies its potential to improve graft selection, prevent complications, and enhance surgical outcomes. With advancements in cost and production time, 3D printing is becoming an accessible tool for precision medicine. 이 연구는 간 이식(LT) 중 과대 크기 증후군을 예방하기 위해 3D 프린팅 복강 모델을 활용한 사례를 다룹니다. 3D 프린팅 모델을 이용하여 간 이식을 받은 20명의 환자와 100명의 대조군 환자 결과를 성향 점수 매칭을 통해 비교했습니다. 주요 결과: - 이식 생존율: 3D 프린팅 모델을 사용한 그룹이 대조군에 비해 이식 생존율이 유의미하게 높았습니다. - 비용 및 시간 효율성: 모델 제작 비용은 약 $1.25, 제작 시간은 약 6~7시간으로 비용 효율성과 실용성을 보여주었습니다. - 적용 사례: 특히 작은 복강을 가진 수혜자들에게 적합한 간을 선택하고 합병증을 예방하는 데 유용했습니다. - 결론: 3D 프린팅 모델의 임상 적용은 수술 계획과 결과를 개선하며 비용 효율적이고 실용적인 방법임을 입증했습니다. 3D 프린팅 기술은 수술 접근 방식을 혁신하며, 수술 전 계획 및 수술 중 가이드를 위한 개인 맞춤형 해부학적 모델을 제공합니다. 간 이식 분야에서의 활용은 이식 간 선택을 개선하고 합병증을 예방하며 수술 결과를 향상시키는 잠재력을 보여줍니다. 비용 및 제작 시간의 발전으로 3D 프린팅은 정밀 의학의 도구로 점점 더 접근 가능해지고 있습니다.

3D Printing Model of Abdominal Cavity of Liver Transplantation Recipient to Prevent Large-for-Size Syndrome

jsrrules — Sun, 08 Dec 2024 18:52:41 +0000

Abstract: The application of three-dimensional (3D) printing has been increasing and we invented cost-effective and time-saving 3D printed model of intra-abdominal cavity which was utilized in liver transplantation (LT) to prevent large-for-size syndrome. 3D printings were performed on potential adult recipients with small cavity and pediatric patients scheduled for transplantation during July 2020 – September 2021. Based on the computed tomography of the recipient, the inner surface of the abdominal cavity was outlined. The line was marked with a distance of 1 – 3 cm. Then, the outlined data were reconstructed as a 3D model and printed by a fused deposition modeling type 3D printer with a thickness of 2 mm. Pillars and footings for holding the lines were printed and assembled altogether. During deceased donor organ procurement, the size of the graft was compared to that of the printed model. For living donor LT, preoperatively planned liver graft was printed and was physically placed into the 3D printed abdominal cavity. All the 16 cases with 3D printed abdominal cavity showed appropriate fitting of the donor’s liver graft to both the 3D printed model and actual recipient’s abdominal cavity with no large-for-size syndrome after LT. Median time for manufacturing the model was 576 min (IQR 434 – 680) and estimated median cost for the filament was US$ 1.6 (IQR 1.2 – 1.7). The 3D printed abdominal cavity model can be manufactured in <10 h and was useful for preventing large-for-size syndrome in small-sized recipients. Int J Bioprint. 8(4):609. http://doi.org/10.18063/ijb.v8i4.609 This study demonstrates the use of a cost-effective and time-efficient 3D-printed abdominal cavity model in liver transplantation (LT) to prevent large-for-size syndrome. By using computed tomography data, 16 patients (10 adults and 6 pediatric recipients) underwent LT with the aid of 3D models. The printed models provided a realistic reference for evaluating graft fit into the recipient's abdominal cavity, enabling precise surgical planning and decision-making. Key findings: - Manufacturing time: <10 hours per model. - Median cost: $1.6 per model. - No cases of large-for-size syndrome reported. Benefits: - Low cost and quick production. - Improved preoperative planning. - Better graft fitting evaluation for small recipients or complex cases. 3D printing is revolutionizing surgery by offering patient-specific models for preoperative planning, intraoperative guidance, and personalized care. It is especially impactful in liver transplantation and other complex surgeries by enhancing precision, improving surgical outcomes, and reducing risks associated with anatomical constraints or unexpected complications. 이 연구는 간 이식(LT) 중 과대 크기 증후군(large-for-size syndrome)을 예방하기 위해 비용 효율적이고 시간 절약적인 3D 프린팅 복강 모델을 활용한 사례를 보여줍니다. 컴퓨터 단층 촬영 데이터를 기반으로 16명의 환자(성인 10명, 소아 6명)가 3D 모델을 이용해 간 이식을 받았으며, 출력된 모델은 수혜자의 복강에 이식 간의 적합성을 평가하는 현실적인 참조 자료를 제공하여 정확한 수술 계획과 결정을 가능하게 했습니다. 주요 발견: - 제작 시간: 모델당 10시간 미만. - 중간 비용: 모델당 약 1.6달러. - 과대 크기 증후군 발생 사례 없음. 장점: - 저렴한 비용과 빠른 제작. - 수술 전 계획 개선. - 소형 수혜자 또는 복잡한 사례에서 이식 간의 적합성 평가 용이. 3D 프린팅은 수술 전 계획, 수술 중 가이드, 맞춤형 치료를 위한 환자 맞춤형 모델을 제공함으로써 외과 수술을 혁신하고 있습니다. 특히 간 이식 및 복잡한 수술에서 정확도를 높이고 수술 결과를 개선하며 해부학적 제약이나 예기치 않은 합병증과 관련된 위험을 줄이는 데 큰 영향을 미칩니다.

test

jsrrules — Tue, 26 Nov 2024 07:21:22 +0000

test

[Case Report] Application of three-dimensional printing for intraoperative guidance during liver resection of a hepatocellula

jsrrules — Tue, 26 Nov 2024 07:21:01 +0000

Abstract While 3D printing is adapted usefully in certain field of surgery, its application in liver surgery was limited. Here, we introduce our experience for using 3D printing for intraoperative guidance during liver resection in a case for HCC with an intrahepatic metastasis at a sophisticated location. A 50 years old male patient was diagnosed 4.7 cm-sized hepatocellular carcinoma located on segment 3 with and an intrahepatic metastasis located on segment 8 which was between right anterior portal vein, middle hepatic vein and right hepatic vein. Since radiofrequency ablation appeared to be inappropriate, surgical resection was planned. However, the patient had a cirrhotic liver and left liver was estimated to be 47% according to volume measurement. Therefore, we planned a two-step procedure by performing left hemihepatectomy preserving the middle hepatic vein and additionally removing the intrahepatic metastasis by tumorectomy. For better guidance, we made a 3D printed model tailored for using it as a guidance during operation, and the accuracy of 3D-printed model helped the surgical team perform a safe operation. The patient underwent adjuvant proton beam therapy on the site of tumorectomy and did not experience recurrence. (Ann Hepatobiliary Pancreat Surg 2021;25:265-269) Ann Hepatobiliary Pancreat Surg 2021;25:265-269 https://doi.org/10.14701/ahbps.2021.25.2.265 This case report outlines the application of 3D printing technology to aid in liver resection surgery for a 50-year-old patient with hepatocellular carcinoma (HCC) and an intrahepatic metastasis located in a challenging position. The patient's condition involved a cirrhotic liver and complex vascular anatomy, necessitating precise surgical planning. Key points include: Use of 3D Printing: A 3D-printed model of the liver was created to guide the surgery, enabling better visualization of the tumor's location relative to critical vascular structures. Surgical Plan: The patient underwent a two-step surgery involving left hemihepatectomy with preservation of the middle hepatic vein and additional tumorectomy of the intrahepatic metastasis. Outcome: The model improved intraoperative precision, leading to successful tumor removal with clear margins. Post-surgery, the patient received adjuvant proton beam therapy and showed no recurrence during follow-up. Advantages: The 3D model provided a direct, practical guide during the operation, improving safety and efficiency. The cost and time for the model were relatively low. Meaning in the Industry of 3D Printing and Surgery 3D printing is transforming surgical planning and intraoperative guidance, particularly in complex and high-risk cases. Its applications include: Preoperative Planning: 3D-printed models allow surgeons to visualize and understand intricate anatomical relationships, enhancing surgical strategy. Intraoperative Guidance: Models serve as tangible references during procedures, aiding in precision and reducing risks. Education and Communication: They are valuable for training surgeons and explaining procedures to patients. Cost-Effectiveness: While traditionally perceived as expensive, advancements have made 3D printing more accessible, as demonstrated in the case report. Broad Potential: Beyond liver surgery, 3D printing is widely used in orthopedic, cardiovascular, and maxillofacial surgeries, among others. This case highlights the emerging role of 3D printing as a tool for enhancing surgical outcomes in complex procedures, representing a significant step forward in personalized medicine and patient-specific surgical approaches. 논문 요약 이 증례 보고는 50세 환자의 간세포암(HCC)과 복잡한 위치에 있는 간내 전이 치료를 위한 간 절제 수술에서 3D 프린팅 기술을 활용한 사례를 다루고 있습니다. 환자는 간경변과 복잡한 혈관 구조를 가지고 있어 정확한 수술 계획이 필요했습니다. 주요 내용: 3D 프린팅 활용: 간의 3D 프린팅 모델을 제작하여 종양과 주요 혈관 구조의 위치를 명확히 시각화하여 수술을 지원했습니다. 수술 계획: 중간 간정맥을 보존하면서 좌간 절제술을 시행하고, 간내 전이를 추가로 절제하는 2단계 수술을 진행했습니다. 결과: 3D 모델은 수술 중 정확도를 높여 종양을 성공적으로 제거하고 깨끗한 절제 경계를 확보하는 데 기여했습니다. 수술 후 환자는 부가적인 양성자 빔 치료를 받았으며, 추적 관찰 기간 동안 재발이 관찰되지 않았습니다. 장점: 3D 모델은 수술 중 실용적인 가이드를 제공하여 안전성과 효율성을 개선했으며, 제작 비용과 시간이 비교적 저렴했습니다. 3D 프린팅과 수술 산업에서의 의미 3D 프린팅은 복잡하고 고위험인 수술에서 수술 계획 및 수술 중 가이드를 제공하며, 의료 분야를 혁신적으로 변화시키고 있습니다. 그 의미는 다음과 같습니다: 수술 전 계획: 3D 프린팅 모델은 복잡한 해부학적 구조를 명확히 시각화하여 더 나은 수술 전략을 수립하도록 돕습니다. 수술 중 가이드: 모델은 수술 중 참고 자료로 활용되어 정밀도를 높이고 위험을 줄여줍니다. 교육 및 소통: 모델은 의사 교육 및 환자에게 수술 과정을 설명하는 데 유용합니다. 비용 효율성: 전통적으로 비용이 높다고 여겨졌지만, 기술 발전으로 접근성이 개선되었습니다. 본 논문에서도 낮은 비용과 시간을 입증했습니다. 광범위한 적용: 간 수술 외에도 3D 프린팅은 정형외과, 심혈관, 악안면 수술 등 다양한 분야에서 사용됩니다. 이 증례는 3D 프린팅이 복잡한 수술에서 수술 결과를 개선하는 도구로서 부각되고 있으며, 개인 맞춤형 의학 및 환자 중심 수술 접근법에서 중요한 진전을 보여줍니다.

test

jsrrules — Tue, 26 Nov 2024 06:01:32 +0000

test

jsrrules — Tue, 26 Nov 2024 06:00:43 +0000

test

Re:케이테마 카드결제 서비스 제공

devktheme — Thu, 25 Apr 2024 18:08:30 +0000

답글쓰기 테스트

공지사항을 전달합니다.

devktheme — Wed, 13 Mar 2024 16:17:38 +0000

공지사항을 전달합니다. 공지사항을 전달합니다. 공지사항을 전달합니다. 공지사항을 전달합니다. 공지사항을 전달합니다. 공지사항을 전달합니다. 공지사항을 전달합니다. 공지사항을 전달합니다. 공지사항을 전달합니다. 공지사항을 전달합니다. 공지사항을 전달합니다.

제3차 장기요양기본계획 발표

devktheme — Tue, 22 Aug 2023 10:53:33 +0000

오늘은 제3차 장기요양기본계획에 대해서 말씀을 드리겠습니다.

기본계획 수립을 위해 지난 4월부터 장기요양 분야의 가입자·공급자 또한 전문가 등으로 구성된 추진기획단을 만들어서 논의해서 안을 만들게 되었습니다.

아울러, 지난해에는 장기요양 실태조사를 거쳐서 의견 수렴과 공청회를 거쳤습니다. 오늘 위원회 논의를 거쳐서 최종 확정했다는 말씀을 드립니다.

[출처] 대한민국 정책브리핑(www.korea.kr)

「후쿠시마 오염수 방류 관련 일일 브리핑 및 향후계획」

devktheme — Tue, 22 Aug 2023 10:53:03 +0000

최근 한 일본 언론에서 한국 정권과 여당이 내년 총선 영향 최소화를 위해서 일본 측에 조기 방류를 요청했다고 하는 보도가 있었고, 어제 브리핑 때도 질의응답 과정에서 그러한 요청을 한 사실이 전혀 없다는 점을 분명히 말씀드린 바가 있습니다.

[출처] 대한민국 정책브리핑(www.korea.kr)