Automated elaborate resection planning for bone tumor surgery

Abstract

Purpose Planning for bone tumor resection surgery is a technically demanding and time-consuming task, reliant on manual positioning of planar cuts in a virtual space. More elaborate cutting approaches may be possible through the use of surgical robots or patient-specific instruments; however, methods for preparing such a resection plan must be developed. Methods This work describes an automated approach for generating conformal bone tumor resection plans, where the resection geometry is defined by the convex hull of the tumor, and a focal point. The resection geometry is optimized using particle swarm, where the volume of healthy bone collaterally resected with the tumor is minimized. The approach was compared to manually prepared planar resection plans from an experienced surgeon for 20 tumor cases. Results It was found that algorithm-generated hull-type resections greatly reduced the volume of collaterally resected healthy bone. The hull-type resections resulted in statistically significant improvements compared to the manual approach (paired t test, p < 0.001). Conclusions The described approach has potential to improve patient outcomes by reducing the volume of healthy bone collaterally resected with the tumor and preserving nearby critical anatomy.

Robot-assisted implantation of additively manufactured patient-specific orthopaedic implants: evaluation in a sheep model

“…New cutting tools are under development to allow deeper cuts and reduce kerf. More complex cutting geometries such as those described in [25] will also be investigated. Confirmation of the approach on human anatomy and direct comparison to free-hand cutting methods will also be the subject of future work.…”

“…Existing technologies largely limit surgeons to combinations of planar cuts. However, robotics may allow performance of more complex geometries conforming closely to a tumour shape, saving bone and other anatomical structures [25].…”