Dataset Information

Computer-assisted navigation in bone tumor surgery: seamless workflow model and evolution of technique.

ABSTRACT:

Background

Computer-assisted navigation was recently introduced to aid the resection of musculoskeletal tumors. However, it has not always been possible to directly navigate the osteotomy with real-time manipulation of available surgical tools. Registration techniques vary, although most existing systems use some form of surface matching.

Questions/purposes

We developed and evaluated a workflow model of computer-assisted bone tumor surgery and evaluated (1) the applicability of currently available software to different bones; (2) the accuracy of the navigated excision; and (3) the accuracy of a new registration technique of fluoro-CT matching.

Methods

Our workflow involved detailed preoperative planning with CT-MRI image fusion, three-dimensional mapping of the tumor, and planning of the resection plane. Using the workflow model, we reviewed 15 navigation procedures in 12 patients, including four with joint-saving resections and three with custom implant reconstructions. Intraoperatively, registration was performed with either paired points and surface matching (Group 1, n = 10) or a new technique of fluoro-CT image matching (Group 2, n = 5). All osteotomies were performed under direct computer navigation. Postoperatively, each case was evaluated for histologic margin and gross measurement of the achieved surgical margin.

Results

The margins were free from tumor in all resected specimens. In the Group 1 procedures, the correlation between preoperative planned margins and actual achieved margins was 0.631, whereas in Group 2 procedures (fluoro-CT matching), the correlation was 0.985.

Conclusions

Our findings suggest computer-assisted navigation is accurate and useful for bone tumor surgery. The new registration technique using fluoro-CT matching may allow more accurate resection of margins.

SUBMITTER: So TY

PROVIDER: S-EPMC2947663 | biostudies-literature | 2010 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Computer-assisted navigation in bone tumor surgery: seamless workflow model and evolution of technique.

So Timothy Y C TY Lam Ying-Lee YL Mak Ka-Lok KL

Clinical orthopaedics and related research 20101101 11

<h4>Background</h4>Computer-assisted navigation was recently introduced to aid the resection of musculoskeletal tumors. However, it has not always been possible to directly navigate the osteotomy with real-time manipulation of available surgical tools. Registration techniques vary, although most existing systems use some form of surface matching.<h4>Questions/purposes</h4>We developed and evaluated a workflow model of computer-assisted bone tumor surgery and evaluated (1) the applicability of cu ...[more]

PMID: 20635175

Similar Datasets

Project description:Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS) total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures.A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction.Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years.Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a standard practice in the future in various forms like navigation or robotics.

Project description:PURPOSE:In the surgical treatment for lower-leg intra-articular fractures, the fragments have to be positioned and aligned to reconstruct the fractured bone as precisely as possible, to allow the joint to function correctly again. Standard procedures use 2D radiographs to estimate the desired reduction position of bone fragments. However, optimal correction in a 3D space requires 3D imaging. This paper introduces a new navigation system that uses pre-operative planning based on 3D CT data and intra-operative 3D guidance to virtually reduce lower-limb intra-articular fractures. Physical reduction in the fractures is then performed by our robotic system based on the virtual reduction. METHODS:3D models of bone fragments are segmented from CT scan. Fragments are pre-operatively visualized on the screen and virtually manipulated by the surgeon through a dedicated GUI to achieve the virtual reduction in the fracture. Intra-operatively, the actual position of the bone fragments is provided by an optical tracker enabling real-time 3D guidance. The motion commands for the robot connected to the bone fragment are generated, and the fracture physically reduced based on the surgeon's virtual reduction. To test the system, four femur models were fractured to obtain four different distal femur fracture types. Each one of them was subsequently reduced 20 times by a surgeon using our system. RESULTS:The navigation system allowed an orthopaedic surgeon to virtually reduce the fracture with a maximum residual positioning error of [Formula: see text] (translational) and [Formula: see text] (rotational). Correspondent physical reductions resulted in an accuracy of 1.03 ± 0.2 mm and [Formula: see text], when the robot reduced the fracture. CONCLUSIONS:Experimental outcome demonstrates the accuracy and effectiveness of the proposed navigation system, presenting a fracture reduction accuracy of about 1 mm and [Formula: see text], and meeting the clinical requirements for distal femur fracture reduction procedures.

Dataset Information

Computer-assisted navigation in bone tumor surgery: seamless workflow model and evolution of technique.

Background

Questions/purposes

Methods

Results

Conclusions

Publications

Computer-assisted navigation in bone tumor surgery: seamless workflow model and evolution of technique.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure