Surgical Navigation, Augmented Reality, and 3D Printing for Hard Palate Adenoid Cystic Carcinoma En-Bloc Resection: Case Report and Literature Review

Revolutionizing bone tumor management: cutting-edge breakthroughs in limb-saving treatments

Limb salvage surgery has revolutionized the approach to bone tumors in orthopedic oncology, steering away from historical amputations toward preserving limb function and enhancing patient quality of life. This transformative shift underscores the delicate balance between tumor eradication and optimal postoperative function. Primary and metastatic bone tumors present challenges in early detection, differentiation between benign and malignant tumors, preservation of function, and the risk of local recurrence. Conventional methods, including surgery, radiation therapy, chemotherapy, and targeted therapies, have evolved with a heightened focus on personalized medicine. A groundbreaking development in limb salvage surgery is the advent of 3D-printed patient-specific implants, which significantly enhance anatomical precision, stability, and fixation. These implants reduce soft tissue disruption and the associated risks, fostering improved osseointegration and correction of deformities for a more natural and functional postoperative outcome. Biological and molecular research has reshaped the understanding of bone tumors, guiding surgical interventions with advancements such as genomic profiling, targeted intraoperative imaging, precision targeting of molecular pathways, and immunotherapy tailored to individual tumor characteristics. In the realm of imaging technologies, MRI, CT scans, and intraoperative navigation systems have redefined preoperative planning, minimizing collateral damage and optimizing outcomes through accurate resections. Postoperative rehabilitation plays a crucial role in restoring function and improving the quality of life. Emphasizing early mobilization, effective pain management, and a multidisciplinary approach, rehabilitation addresses the physical, psychological, and social aspects of recovery. Looking ahead, future developments may encompass advanced biomaterials, smart implants, AI algorithms, robotics, and regenerative medicine. Challenges lie in standardization, cost-effectiveness, accessibility, long-term outcome assessment, mental health support, and fostering global collaboration. As research progresses, limb salvage surgery emerges not just as a preservation tool but as a transformative approach, restoring functionality, resilience, and hope in the recovery journey. This review summarizes the recent advances in limb salvage therapy for bone tumors over the past decade.

Augmented reality hologram combined with pre-bent distractor enhanced the accuracy of distraction vector transfer in maxillary distraction osteogenesis, a study based on 3D printed phantoms

BACKGROUND

Vector control is a significant concern in maxillary distraction osteogenesis (DO). Distraction vector planning on the patient's 3D-printed skull phantom is more intuitive for surgeons and cost-efficient than virtual surgical planning. However, the accuracy of transferring the planned vector to intraoperative (vector transfer) according to the shape of the pre-bent footplate alone is relatively limited. The application of augmented reality (AR) in surgical navigation has been studied for years. However, few studies have focused on its role in maxillary DO vector transfer. This study aimed to evaluate the accuracy of AR surgical navigation combined with the pre-bent distractor in vector transfer by comparing it with the pre-bent distractor alone.

METHODS

Ten patients with maxillary hypoplasia were enrolled with consent, and three identical 3D-printed skull phantoms were manufactured based on per patient's corresponding pre-operative CT data. Among these, one phantom was for pre-operative planning (n = 10), while and the other two were for the AR+Pre-bending group (n = 10) and the Pre-bending group (n = 10) for the experimental surgery, respectively. In the Pre-bending group, the distraction vector was solely determined by matching the shape of footplates and maxillary surface. In the AR+Pre-bending group, the distractors were first confirmed to have no deformation. Then AR surgical navigation was applied to check and adjust the vector in addition to the steps as in the Pre-bending Group.

RESULTS

For the angular deviation of the distraction vector, the AR+Pre-bending group was significantly smaller than the Pre-bending group in spatial (p < 0.001), x-y plane (p = 0.002), and y-z plane (p < 0.001), and there were no significant differences in the x-z plane (p = 0.221). The AR+Pre-bending group was more accurate in deviations of the Euclidean distance (p = 0.004) and the y-axis (p = 0.011). In addition, the AR+Pre-bending group was more accurate for the distraction result.

CONCLUSIONS

In this study based on 3D printed skull phantoms, the AR surgical navigation combined with the pre-bent distractor enhanced the accuracy of vector transfer in maxillary DO, compared with the pre-bending technique alone.

Three-dimensional modeling in complex liver surgery and liver transplantation

Liver resection and transplantation are the most effective therapies for many hepatobiliary tumors and diseases. However, these surgical procedures are challenging due to the anatomic complexity and many anatomical variations of the vascular and biliary structures. Three-dimensional (3D) printing models can clearly locate and describe blood vessels, bile ducts and tumors, calculate both liver and residual liver volumes, and finally predict the functional status of the liver after resection surgery. The 3D printing models may be particularly helpful in the preoperative evaluation and surgical planning of especially complex liver resection and transplantation, allowing to possibly increase resectability rates and reduce postoperative complications. With the continuous developments of imaging techniques, such models are expected to become widely applied in clinical practice.