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Wang YT, Liu Y, Ye GH, Xu T, Zhang Y, Liu XJ. Reducing the risk of unfavourable fractures in Le Fort III osteotomy via a navigation-guided technique. J Craniomaxillofac Surg 2024; 52:1394-1405. [PMID: 39322466 DOI: 10.1016/j.jcms.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/11/2024] [Accepted: 08/15/2024] [Indexed: 09/27/2024] Open
Abstract
The aim of this study was to investigate the clinical feasibility of reducing the risk of unfavourable fractures during Le Fort III osteotomy by using a navigation-guided technique. A study was carried out involving 20 patients with Crouzon syndrome treated with Le Fort III osteotomy and distraction osteogenesis from 2018 to 2023 at the International Hospital of Peking University. The Le Fort III osteotomy procedure in experimental group (9 patients) was carried out under the guidance of navigation technique, while in historical control group (11 patients) was carried out by free hand. Immediate postoperative CT scans were acquired within 24h after surgery to observe the osteotomy lines and detect unfavourable fracture lines. There were 4 patients with unfavourable fractures in the navigation group (4/9 = 44%) while 10 patients in the freehand group (10/11 = 91%), with a statistically significant difference in the probability of unfavourable fracture and the number of fracture lines between the two groups (P < 0.05). The difference in unfavourable fracture incidence in the two groups was significant in zygomatic area (P < 0.05) while not significant in mid-palatal area (P > 0.05). And the surgical duration of the navigation group was significantly shorter than that of the freehand group (216 min vs 280 min) (P < 0.05). The above findings suggest that the navigation-guided technique is effective in reducing the risk of unfavourable fractures in Le Fort III osteotomy procedure and decreasing the surgical duration.
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Affiliation(s)
- Yu-Ting Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yue Liu
- Department of Oral and Maxillofacial Surgery, Peking University International Hospital, Beijing, China
| | - Guo-Hua Ye
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Tao Xu
- Department of Oral and Maxillofacial Surgery, Peking University International Hospital, Beijing, China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Xiao-Jing Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing, China.
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Chan HHL, Nayak P, Alshaygy I, Gundle KR, Tsoi K, Daly MJ, Irish JC, Ferguson PC, Wunder JS. Does Freehand, Patient-specific Instrumentation or Surgical Navigation Perform Better for Allograft Reconstruction After Tumor Resection? A Preclinical Synthetic Bone Study. Clin Orthop Relat Res 2024; 482:1896-1908. [PMID: 38813958 PMCID: PMC11419413 DOI: 10.1097/corr.0000000000003116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 04/12/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Joint-sparing resection of periarticular bone tumors can be challenging because of complex geometry. Successful reconstruction of periarticular bone defects after tumor resection is often performed with structural allografts to allow for joint preservation. However, achieving a size-matched allograft to fill the defect can be challenging because allograft sizes vary, they do not always match a patient's anatomy, and cutting the allograft to perfectly fit the defect is demanding. QUESTIONS/PURPOSES (1) Is there a difference in mental workload among the freehand, patient-specific instrumentation, and surgical navigation approaches? (2) Is there a difference in conformance (quantitative measure of deviation from the ideal bone graft), elapsed time during reconstruction, and qualitative assessment of goodness-of-fit of the allograft reconstruction among the approaches? METHODS Seven surgeons used three modalities in the same order (freehand, patient-specific instrumentation, and surgical navigation) to fashion synthetic bone to reconstruct a standardized bone defect. National Aeronautics and Space Administration (NASA) mental task load index questionnaires and procedure time were captured. Cone-beam CT images of the shaped allografts were used to measure conformance (quantitative measure of deviation from the ideal bone graft) to a computer-generated ideal bone graft model. Six additional (senior) surgeons blinded to modality scored the quality of fit of the allografts into the standardized tumor defect using a 10-point Likert scale. We measured conformance using the root-mean-square metric in mm and used ANOVA for multipaired comparisons (p < 0.05 was significant). RESULTS There was no difference in mental NASA total task load scores among the freehand, patient-specific instrumentation, and surgical navigation techniques. We found no difference in conformance root-mean-square values (mean ± SD) between surgical navigation (2 ± 0 mm; mean values have been rounded to whole numbers) and patient-specific instrumentation (2 ± 1 mm), but both showed a small improvement compared with the freehand approach (3 ± 1 mm). For freehand versus surgical navigation, the mean difference was 1 mm (95% confidence interval [CI] 0.5 to 1.1; p = 0.01). For freehand versus patient-specific instrumentation, the mean difference was 1 mm (95% CI -0.1 to 0.9; p = 0.02). For patient-specific instrumentation versus surgical navigation, the mean difference was 0 mm (95% CI -0.5 to 0.2; p = 0.82). In evaluating the goodness of fit of the shaped grafts, we found no clinically important difference between surgical navigation (median [IQR] 7 [6 to 8]) and patient-specific instrumentation (median 6 [5 to 7.8]), although both techniques had higher scores than the freehand technique did (median 3 [2 to 4]). For freehand versus surgical navigation, the difference of medians was 4 (p < 0.001). For freehand versus patient-specific instrumentation, the difference of medians was 3 (p < 0.001). For patient-specific instrumentation versus surgical navigation, the difference of medians was 1 (p = 0.03). The mean ± procedural times for freehand was 16 ± 10 minutes, patient-specific instrumentation was 14 ± 9 minutes, and surgical navigation techniques was 24 ± 8 minutes. We found no differences in procedure times across three shaping modalities (freehand versus patient-specific instrumentation: mean difference 2 minutes [95% CI 0 to 7]; p = 0.92; freehand versus surgical navigation: mean difference 8 minutes [95% CI 0 to 20]; p = 0.23; patient-specific instrumentation versus surgical navigation: mean difference 10 minutes [95% CI 1 to 19]; p = 0.12). CONCLUSION Based on surgical simulation to reconstruct a standardized periarticular bone defect after tumor resection, we found a possible small advantage to surgical navigation over patient-specific instrumentation based on qualitative fit, but both techniques provided slightly better conformance of the shaped graft for fit into the standardized post-tumor resection bone defect than the freehand technique did. To determine whether these differences are clinically meaningful requires further study. The surgical navigation system presented here is a product of laboratory research development, and although not ready to be widely deployed for clinical practice, it is currently being used in a research operating room setting for patient care. This new technology is associated with a learning curve, capital costs, and potential risk. The reported preliminary results are based on a preclinical synthetic bone tumor study, which is not as realistic as actual surgical scenarios. CLINICAL RELEVANCE Surgical navigation systems are an emerging technology in orthopaedic and reconstruction surgery, and understanding their capabilities and limitations is paramount for clinical practice. Given our preliminary findings in a small cohort study with one scenario of standardized synthetic periarticular bone tumor defects, future investigations should include different surgical scenarios using allograft and cadaveric specimens in a more realistic surgical setting.
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Affiliation(s)
- Harley H. L. Chan
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
| | - Prakash Nayak
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Ibrahim Alshaygy
- Department of Orthopaedics, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Kenneth R. Gundle
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Kim Tsoi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Michael J. Daly
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C. Irish
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Peter C. Ferguson
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jay S. Wunder
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
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Eu D, Daly MJ, Taboni S, Sahovaler A, Gilbank AN, Irish JC. Evaluation of a 3D Printed Silicone Oral Cavity Cancer Model for Surgical Simulations. J Pers Med 2024; 14:450. [PMID: 38793031 PMCID: PMC11121819 DOI: 10.3390/jpm14050450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024] Open
Abstract
Adequate surgical margins are essential in oral cancer treatment, this is, however, difficult to appreciate during training. With advances in training aids, we propose a silicone-based surgical simulator to improve training proficiency for the ablation of oral cavity cancers. A silicone-based tongue cancer model constructed via a 3D mold was compared to a porcine tongue model used as a training model. Participants of varying surgical experience were then asked to resect the tumors with clear margins, and thereafter asked to fill out a questionnaire to evaluate the face and content validity of the models as a training tool. Eleven participants from the Otolaryngology-Head and Neck Surgery unit were included in this pilot study. In comparison to the porcine model, the silicone model attained a higher face (4 vs. 3.6) and content validity (4.4 vs. 4.1). Tumor consistency was far superior in the silicone model compared to the porcine model (4.1 vs. 2.8, p = 0.0042). Fellows and staff demonstrated a better margin clearance compared to residents (median 3.5 mm vs. 1.0 mm), and unlike the resident group, there was no incidence of positive margins. The surgical simulation was overall useful for trainees to appreciate the nature of margin clearance in oral cavity cancer ablation.
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Affiliation(s)
- Donovan Eu
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
- Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Otolaryngology-Head and Neck Surgery, National University Health Systems, Singapore 119228, Singapore
| | - Michael J. Daly
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
| | - Stefano Taboni
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
- Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, 35122 Padua, Italy
| | - Axel Sahovaler
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
- Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Oral and Maxillofacial Surgery, University College London Hospitals, London NW1 2BU, UK
| | - Ashley N. Gilbank
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
| | - Jonathan C. Irish
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
- Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
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Wang C, Huang S, Yu Y, Liang H, Wang R, Tang X, Ji T. Fluoroscopically calibrated 3D-printed patient-specific instruments improve the accuracy of osteotomy during bone tumor resection adjacent to joints. 3D Print Med 2024; 10:15. [PMID: 38656431 PMCID: PMC11041006 DOI: 10.1186/s41205-024-00216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Inadequate surface matching, variation in the guide design, and soft tissue on the skeletal surface may make it difficult to accurately place the 3D-printed patient-specific instrument (PSI) exactly to the designated site, leading to decreased accuracy, or even errors. Consequently, we developed a novel 3D-printed PSI with fluoroscopy-guided positioning markers to enhance the accuracy of osteotomies in joint-preserving surgery. The current study was to compare whether the fluoroscopically calibrated PSI (FCPSI) can achieve better accuracy compared with freehand resection and conventional PSI (CPSI) resection. METHODS Simulated joint-preserving surgery was conducted using nine synthetic left knee bone models. Osteotomies adjacent to the knee joint were designed to evaluate the accuracy at the epiphysis side. The experiment was divided into three groups: free-hand, conventional PSI (CPSI), and fluoroscopically Calibrated PSI (FCPSI). Post-resection CT scans were quantitatively analyzed. Analysis of variance (ANOVA) was used. RESULT FCPSI improved the resection accuracy significantly. The mean location accuracy is 2.66 mm for FCPSI compared to 6.36 mm (P < 0.001) for freehand resection and 4.58 mm (P = 0.012) for CPSI. The mean average distance is 1.27 mm compared to 2.99 mm (p < 0.001) and 2.11 mm (p = 0.049). The mean absolute angle is 2.16° compared to 8.50° (p < 0.001) and 5.54° (p = 0.021). The mean depth angle is 1.41° compared to 8.10° (p < 0.001) and 5.32° (p = 0.012). However, there were no significant differences in the front angle compared to the freehand resection group (P = 0.055) and CPSI (P = 0.599) group. The location accuracy observed with FCPSI was maintained at 4 mm, while CPSI and freehand resection exhibited a maximum deviation of 8 mm. CONCLUSION The fluoroscopically calibrated 3D-printed patient-specific instruments improve the accuracy of osteotomy during bone tumor resection adjacent to joint joints compared to conventional PSI and freehand resection. In conclusion, this novel 3D-printed PSI offers significant accuracy improvement in joint preserving surgery with a minimal increase in time and design costs.
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Affiliation(s)
- Chen Wang
- Peking University People's Hospital, Musculoskeletal Tumor Center, Beijing, China
| | - Siyi Huang
- Peking University People's Hospital, Musculoskeletal Tumor Center, Beijing, China
| | - Yue Yu
- LDK Medical Co., Ltd., R&D, Beijing, China
| | - Haijie Liang
- Peking University People's Hospital, Musculoskeletal Tumor Center, Beijing, China
| | - Ruifeng Wang
- Peking University People's Hospital, Musculoskeletal Tumor Center, Beijing, China
| | - Xiaodong Tang
- Peking University People's Hospital, Musculoskeletal Tumor Center, Beijing, China
| | - Tao Ji
- Peking University People's Hospital, Musculoskeletal Tumor Center, Beijing, China.
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Deng Z, Zhang Q, Hao L, Ding Y, Niu X, Liu W. Accuracy of bony resection under computer-assisted navigation for bone sarcomas around the knee. World J Surg Oncol 2023; 21:187. [PMID: 37344874 DOI: 10.1186/s12957-023-03071-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Computer-assisted navigation has made bone sarcoma resections more precise. However, further clinical studies involving accuracy analyses under navigation are still warranted. METHODS A retrospective study for analysis of computer-assisted navigation accuracy was carried out. Between September 2008 and November 2017, 39 cases of bone sarcomas around the knee joint were resected under computer-assisted navigation. The control group comprised 117 cases of bone sarcomas around the knee treated by limb salvage surgery wherein bony cutting was achieved freehand. The length difference (LD) was defined as the specimen length minus the planned resection length. The LDs were detected in both groups and compared. The margin accuracy (MA) was defined as the achieved margin minus the desired margin at the bone cutting site and was detected in the navigation group. RESULTS The LDs between the postoperative specimen length and the preoperative planned length were compared. In the navigation group, the LD was 0.5 ± 2.5 mm (range, - 5 to 5 mm), while in the freehand group, the LD was 3.4 ± 9.6 mm (range, - 20 to 29 mm), with a significant difference (P < 0.01). In the absolute value analysis, the LD absolute value was 2.0 ± 1.6 mm in the navigation group and 8.3 ± 6.0 mm in the freehand group, with a significant difference (P < 0.01). In the navigation group, the MA was 0.3 ± 1.5 mm (range, - 3 to 3 mm) and the MA absolute value was 1.1 ± 1.0 mm. CONCLUSIONS Better accuracy can be achieved when computer-assisted navigation is conducted for bone sarcoma resection around the knee. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Zhiping Deng
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Qing Zhang
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Lin Hao
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yi Ding
- Department of Pathology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Xiaohui Niu
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Weifeng Liu
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China.
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He G, Dai AZ, Mustahsan VM, Shah AT, Li L, Khan JA, Bielski MR, Komatsu DE, Kao I, Khan FA. A novel method of light projection and modular jigs to improve accuracy in bone sarcoma resection. J Orthop Res 2022; 40:2522-2536. [PMID: 35245391 DOI: 10.1002/jor.25300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023]
Abstract
We developed a novel method using a combined light-registration/light-projection system along with an off-the-shelf, instant-assembly modular jig construct that could help surgeons improve bone resection accuracy during sarcoma surgery without many of the associated drawbacks of 3D printed custom jigs or computer navigation. In the novel method, the surgeon uses a light projection system to precisely align the assembled modular jig construct on the bone. In a distal femur resection model, 36 sawbones were evenly divided into 3 groups: manual-resection (MR), conventional 3D-printed custom jig resection (3DCJ), and the novel projector/modular jig (PMJ) resection. In addition to sawbones, a single cadaver experiment was also conducted to confirm feasibility of the PMJ method in a realistic operative setting. The PMJ method improved resection accuracy when compared to MR and 3DCJ, respectively: 0.98 mm versus 7.48 mm (p < 0.001) and 3.72 mm (p < 0.001) in mean corner position error; 1.66 mm versus 9.70 mm (p < 0.001) and 4.32 mm (p = 0.060) in mean maximum deviation error; 0.79°-4.78° (p < 0.001) and 1.26° (p > 0.999) in mean depth angle error. The PMJ method reduced the mean front angle error from 1.72° to 1.07° (p = 0.507) when compared to MR but was slightly worse compared to 0.61° (p = 0.013) in 3DCJ. The PMJ method never showed an error greater than 3 mm, while the maximum error of other two control groups were almost 14 mm. Similar accuracy was found with the PMJ method on the cadaver. A novel method using a light projector with modular jigs can achieve high levels of bone resection accuracy, but without many of the associated drawbacks of 3D printed jigs or computer navigation technology.
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Affiliation(s)
- Guangyu He
- Department of Mechanical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Amos Z Dai
- Department of Orthopedics, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Vamiq M Mustahsan
- Department of Mechanical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Aadit T Shah
- Department of Orthopedics, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Liming Li
- Department of Mechanical Engineering, Stony Brook University, Stony Brook, New York, USA
| | | | - Michael R Bielski
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - David E Komatsu
- Department of Orthopedics, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Imin Kao
- Department of Mechanical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Fazel A Khan
- Department of Orthopedics, Stony Brook University Hospital, Stony Brook, New York, USA
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He G, Dai AZ, Mustahsan VM, Shah AT, Li L, Khan JA, Bielski MR, Komatsu DE, Kao I, Khan FA. A novel intraoperative method to project osteotomy lines for accurate resection of primary bone sarcomas. J Orthop 2022; 32:60-67. [DOI: 10.1016/j.jor.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/01/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022] Open
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Projected cutting guides using an augmented reality system to improve surgical margins in maxillectomies: A preclinical study. Oral Oncol 2022; 127:105775. [DOI: 10.1016/j.oraloncology.2022.105775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/21/2022]
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He G, Dai AZ, Mustahsan VM, Blum CL, Kao I, Khan FA. A Novel 3D Light Assisted Drawing (3D-LAD) Method to Aid Intraoperative Reproduction of Osteotomy Lines Surrounding a Bone Tumor During Wide Resection: An Experimental Study. Orthop Res Rev 2022; 14:101-109. [PMID: 35422661 PMCID: PMC9005132 DOI: 10.2147/orr.s349240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Computer navigation and customized 3D-printed jigs improve accuracy during bone tumor resection, but such technologies can be bulky, costly, and require intraoperative radiation, or long lead time to be ready in OR. Methods We developed a method utilizing a compact, inexpensive, non-X-ray based 3D surface light scanner to provide a visual aid that helps surgeons accurately draw osteotomy lines on the surface of exposed bone to reproduce a well-defined preoperative bone resection plan. We tested the accuracy of the method on 18 sawbones using a distal femur hemimetaphyseal resection model and compared it with a traditional, freehand method. Results The method significantly reduces the positional error from 2.53 (±1.13) mm to 1.04 (±0.43) mm (p<0.001), and angular error of the front angle from 2.10° (±0.83°) to 0.80° (±0.66°) (p=0.001). The method also reduces the mean maximum deviation of the bone resection, with respect to the preoperative path, from 3.75mm to 2.69mm (p=0.003). However, no increased accuracy was observed at the back side of the bone surface where this method would not be expected to provide information. Discussion In summary, we developed a novel 3D-LAD navigation technology. From the experimental study, we demonstrated that the method can improve the ability of surgeons to accurately draw the preoperative osteotomy lines and perform resection of a primary bone sarcoma, with comparison to traditional methods, using 18 sawbones.
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Affiliation(s)
- Guangyu He
- Department of Mechanical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Amos Z Dai
- Department of Orthopedics, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Vamiq M Mustahsan
- Department of Mechanical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Christopher L Blum
- Department of Orthopedics, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Imin Kao
- Department of Mechanical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Fazel A Khan
- Department of Orthopedics, Stony Brook University Hospital, Stony Brook, NY, USA
- Correspondence: Fazel A Khan, Email
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Sahovaler A, Daly MJ, Chan HHL, Nayak P, Tzelnick S, Arkhangorodsky M, Qiu J, Weersink R, Irish JC, Ferguson P, Wunder JS. Automatic Registration and Error Color Maps to Improve Accuracy for Navigated Bone Tumor Surgery Using Intraoperative Cone-Beam CT. JB JS Open Access 2022; 7:JBJSOA-D-21-00140. [PMID: 35540727 PMCID: PMC9071254 DOI: 10.2106/jbjs.oa.21.00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Computer-assisted surgery (CAS) can improve surgical precision in orthopaedic oncology. Accurate alignment of the patient’s imaging coordinates with the anatomy, known as registration, is one of the most challenging aspects of CAS and can be associated with substantial error. Using intraoperative, on-the-table, cone-beam computed tomography (CBCT), we performed a pilot clinical study to validate a method for automatic intraoperative registration.
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Affiliation(s)
- Axel Sahovaler
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- Head & Neck Surgery Unit, University College London Hospitals, London, United Kingdom
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Prakash Nayak
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgical Oncology, Bone and Soft Tissue Disease Management Group, Tata Memorial Centre, Mumbai, India
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sharon Tzelnick
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Michelle Arkhangorodsky
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Robert Weersink
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Peter Ferguson
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jay S Wunder
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
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11
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Wilson JM, Pflederer JA, Schwartz AM, Farley KX, Reimer NB. Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues. Arthroplast Today 2021; 8:226-230. [PMID: 33937463 PMCID: PMC8079330 DOI: 10.1016/j.artd.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/13/2020] [Accepted: 02/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Intraoperative vascular injury during total hip arthroplasty represents a catastrophic complication. Acetabular screw placement represents one possible mode of injury. The purpose of this study was to evaluate the utility of various fluoroscopic views in the detection of intrapelvic screw penetration. METHODS A radiopaque pelvis Sawbones model was instrumented with a hemispherical acetabular component. Four intrapelvic quadrants were defined. Screws were placed, 3 in each quadrant, and imaged sequentially at 3 depths: 0 mm, 5 mm, and 10 mm penetrated. Eight fluoroscopic images were used: anteroposterior, inlet, outlet, iliac oblique, obturator oblique, "down the wing," obturator outlet, and a "quad" view. Three blinded, independent surgeons evaluated the images for intrapelvic screw penetration. Images were analyzed in isolation and as a "triple-shot series" consisting of the "quad," obturator outlet, and iliac oblique views. Sensitivity and specificity values were then calculated. RESULTS In isolation, the "quad" view had the highest sensitivity for screw penetration (62%). The triple-shot series was found to be 100% sensitive in all 4 quadrants for detecting 10 mm of screw penetration. The specificity of the series was found to be 100% in all quadrants except for the posterior superior quadrant where it was 67%. Interobserver agreement approached perfection (Kappa ≥0.947) between all surgeons (P < .001) when using the 3-view series. CONCLUSIONS This study is the first to assess the use of fluoroscopy in the detection of intrapelvic penetration of transacetabular screws. We found that a 3-radiograph series provided a sensitive and specific metric for the detection of intrapelvic screw penetration.
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12
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Computer-assisted surgical planning of complex bone tumor resections improves negative margin outcomes in a sawbones model. Int J Comput Assist Radiol Surg 2021; 16:695-701. [PMID: 33725339 DOI: 10.1007/s11548-021-02337-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/25/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE Several technologies have been implemented in orthopedic surgery to improve surgical outcomes, usually focusing on more accurate execution of a surgical plan, but the development of the plan itself is also of great importance. The purpose of this study is to examine whether the use of preoperative computer planning platforms can improve the surgical plan? METHODS Eight surgeons created a preoperative surgical plan to resect a distal femur parosteal osteosarcoma in two settings: (1) Using a 2-D and 3-D CT scan only (current standard); and (2) using a computer-assisted planning platform. The plans were thereafter virtually executed using a novel surgical navigation system and a Sawbones model. This simulated model was derived from, and identical to, an actual patient scenario. The outcomes of interest were the number of positive margin cuts, and the volume of the resected specimen. RESULTS Using the surgical plan developed with computer assistance, there were 4 positive margin cuts made by 2 surgeons. In comparison, using standard planning, there were 14 positive margin cuts made by all 8 surgeons (p = 0.02). The resection volume was larger in the computer-assisted plans (96 ± 10 mm3) than in the standard plans (88 ± 7 mm3) (p = 0.055). CONCLUSIONS Computer-assisted planning significantly decreased the risk of a positive margin resection in this Sawbones tumor model used to simulate resection of a primary bone sarcoma. This proof of concept study highlights the importance of advanced surgical planning and sets the ground for developing beneficial surgical planning systems.
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13
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Joyce DM. Navigation in Pelvic Surgery. SURGERY OF PELVIC BONE TUMORS 2021:135-153. [DOI: 10.1007/978-3-030-77007-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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14
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Woolman M, Qiu J, Kuzan-Fischer CM, Ferry I, Dara D, Katz L, Daud F, Wu M, Ventura M, Bernards N, Chan H, Fricke I, Zaidi M, Wouters BG, Rutka JT, Das S, Irish J, Weersink R, Ginsberg HJ, Jaffray DA, Zarrine-Afsar A. In situ tissue pathology from spatially encoded mass spectrometry classifiers visualized in real time through augmented reality. Chem Sci 2020; 11:8723-8735. [PMID: 34123126 PMCID: PMC8163395 DOI: 10.1039/d0sc02241a] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Integration between a hand-held mass spectrometry desorption probe based on picosecond infrared laser technology (PIRL-MS) and an optical surgical tracking system demonstrates in situ tissue pathology from point-sampled mass spectrometry data. Spatially encoded pathology classifications are displayed at the site of laser sampling as color-coded pixels in an augmented reality video feed of the surgical field of view. This is enabled by two-way communication between surgical navigation and mass spectrometry data analysis platforms through a custom-built interface. Performance of the system was evaluated using murine models of human cancers sampled in situ in the presence of body fluids with a technical pixel error of 1.0 ± 0.2 mm, suggesting a 84% or 92% (excluding one outlier) cancer type classification rate across different molecular models that distinguish cell-lines of each class of breast, brain, head and neck murine models. Further, through end-point immunohistochemical staining for DNA damage, cell death and neuronal viability, spatially encoded PIRL-MS sampling is shown to produce classifiable mass spectral data from living murine brain tissue, with levels of neuronal damage that are comparable to those induced by a surgical scalpel. This highlights the potential of spatially encoded PIRL-MS analysis for in vivo use during neurosurgical applications of cancer type determination or point-sampling in vivo tissue during tumor bed examination to assess cancer removal. The interface developed herein for the analysis and the display of spatially encoded PIRL-MS data can be adapted to other hand-held mass spectrometry analysis probes currently available. Integration between a hand-held mass spectrometry desorption probe based on picosecond infrared laser technology (PIRL-MS) and an optical surgical tracking system demonstrates in situ tissue pathology from point-sampled mass spectrometry data.![]()
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Affiliation(s)
- Michael Woolman
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473.,Department of Medical Biophysics, University of Toronto 101 College Street Toronto ON M5G 1L7 Canada
| | - Jimmy Qiu
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473
| | - Claudia M Kuzan-Fischer
- Peter Gilgan Centre for Research and Learning, Hospital for Sick Children 686 Bay Street Toronto ON M5G 0A4 Canada.,Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children Toronto ON M5G 1X8 Canada
| | - Isabelle Ferry
- Peter Gilgan Centre for Research and Learning, Hospital for Sick Children 686 Bay Street Toronto ON M5G 0A4 Canada.,Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children Toronto ON M5G 1X8 Canada
| | - Delaram Dara
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473
| | - Lauren Katz
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473.,Department of Medical Biophysics, University of Toronto 101 College Street Toronto ON M5G 1L7 Canada
| | - Fowad Daud
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473.,Department of Medical Biophysics, University of Toronto 101 College Street Toronto ON M5G 1L7 Canada
| | - Megan Wu
- Peter Gilgan Centre for Research and Learning, Hospital for Sick Children 686 Bay Street Toronto ON M5G 0A4 Canada
| | - Manuela Ventura
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473
| | - Nicholas Bernards
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473
| | - Harley Chan
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473
| | - Inga Fricke
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473
| | - Mark Zaidi
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473
| | - Brad G Wouters
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473.,Department of Medical Biophysics, University of Toronto 101 College Street Toronto ON M5G 1L7 Canada
| | - James T Rutka
- Peter Gilgan Centre for Research and Learning, Hospital for Sick Children 686 Bay Street Toronto ON M5G 0A4 Canada.,Department of Surgery, University of Toronto 149 College Street Toronto ON M5T 1P5 Canada.,Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children Toronto ON M5G 1X8 Canada
| | - Sunit Das
- Peter Gilgan Centre for Research and Learning, Hospital for Sick Children 686 Bay Street Toronto ON M5G 0A4 Canada.,Department of Surgery, University of Toronto 149 College Street Toronto ON M5T 1P5 Canada.,Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children Toronto ON M5G 1X8 Canada
| | - Jonathan Irish
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473
| | - Robert Weersink
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473
| | - Howard J Ginsberg
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473.,Department of Surgery, University of Toronto 149 College Street Toronto ON M5T 1P5 Canada.,Keenan Research Center for Biomedical Science, The Li Ka Shing Knowledge Institute, St. Michael's Hospital 30 Bond Street Toronto ON M5B 1W8 Canada
| | - David A Jaffray
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473.,Department of Medical Biophysics, University of Toronto 101 College Street Toronto ON M5G 1L7 Canada
| | - Arash Zarrine-Afsar
- Techna Institute for the Advancement of Technology for Health, University Health Network 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th floor (STTARR) Toronto ON M5G 1P5 Canada +1-416-581-8473.,Department of Medical Biophysics, University of Toronto 101 College Street Toronto ON M5G 1L7 Canada.,Department of Surgery, University of Toronto 149 College Street Toronto ON M5T 1P5 Canada.,Keenan Research Center for Biomedical Science, The Li Ka Shing Knowledge Institute, St. Michael's Hospital 30 Bond Street Toronto ON M5B 1W8 Canada
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15
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Abstract
Pediatric musculoskeletal tumors can arise in both bone and soft tissues. The overwhelming majority of these are benign; however, rarely, malignant neoplasms do occur. These are collectively termed sarcomas, indicating their mesenchymal origin. Sarcoma management requires careful adherence to the well-described tenets of tumor management. This article summarizes the basic principles and recent advances in the management of soft tissue and bone tumors.
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Affiliation(s)
- Amit Singla
- Department of Orthopaedic Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, 6th Floor, Bronx, NY 10467, USA.
| | - David S Geller
- Department of Orthopaedic Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, 6th Floor, Bronx, NY 10467, USA
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16
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Ferrari M, Daly MJ, Douglas CM, Chan HHL, Qiu J, Deganello A, Taboni S, Thomas CM, Sahovaler A, Jethwa AR, Hasan W, Nicolai P, Gilbert RW, Irish JC. Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study. Oral Oncol 2019; 99:104463. [PMID: 31683173 DOI: 10.1016/j.oraloncology.2019.104463] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/16/2019] [Accepted: 10/22/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer. MATERIALS AND METHODS Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using real-time tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: "intratumoral" when 0 mm or negative, "close" when greater than 0 mm and less than or equal to 5 mm, "adequate" when greater than 5 mm and less than or equal to 15 mm, and "excessive" over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared. RESULTS The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001). CONCLUSION This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting - with rigorous assessment of oncological outcomes - would be the proposed next step.
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Affiliation(s)
- Marco Ferrari
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Catriona M Douglas
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Carissa M Thomas
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Ashok R Jethwa
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Wael Hasan
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.
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17
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Hasan W, Daly MJ, Chan HHL, Qiu J, Irish JC. Intraoperative cone‐beam CT‐guided osteotomy navigation in mandible and maxilla surgery. Laryngoscope 2019; 130:1166-1172. [DOI: 10.1002/lary.28082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/08/2019] [Accepted: 05/08/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Wael Hasan
- Guided Therapeutics (GTx) Program, TECHNA InstituteUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
- Department of Otolaryngology–Head & Neck Surgery/Surgical OncologyUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Michael J. Daly
- Guided Therapeutics (GTx) Program, TECHNA InstituteUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Harley H. L Chan
- Guided Therapeutics (GTx) Program, TECHNA InstituteUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, TECHNA InstituteUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Jonathan C. Irish
- Guided Therapeutics (GTx) Program, TECHNA InstituteUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
- Department of Otolaryngology–Head & Neck Surgery/Surgical OncologyUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
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18
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19
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Xiao ZR, Xiong G. Computer-assisted Surgery for Scaphoid Fracture. Curr Med Sci 2018; 38:941-948. [PMID: 30536054 DOI: 10.1007/s11596-018-1968-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/11/2018] [Indexed: 01/09/2023]
Abstract
The computer-assisted surgery (CAS) has significantly improved the accuracy, reliability and outcomes of traumatic, spinal, nerve surgery and many other operations with a less invasive way. The application of CAS for scaphoid fractures remains experimental. The related studies are scanty and most of them are cadaver researches. Some intrinsic defects from the registration procedure, scan and immobilization of limbs may inevitably result in deviations. Some deviations become more obvious with operations of small bones (such as scaphoid) although they are acceptable for spine and other orthopedic surgeries. We reviewed the current literatures on the applications of CAS for scaphoid operation and summarized technical principles, scan and registration methods, immobilization of limbs and their outcomes. On the basis of the data, we analyzed the limitations of this technique and envisioned its future development.
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Affiliation(s)
- Zi-Run Xiao
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China.,Department of Orthopaedic Surgery, the 91st Central Hospital of Chinese People's Liberation Army, Henan, 454000, China
| | - Ge Xiong
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China.
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