Navigation-assisted Surgery for Bone and Soft Tissue Tumors With Bony Extension

Ieguchi, Makoto; Hoshi, Manabu; Takada, Jun; Hidaka, Noriaki; Nakamura, Hiroaki

doi:10.1007/s11999-011-2094-5

Cited by 47 publications

(42 citation statements)

References 25 publications

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“…The results, in terms of the standard deviation of the achieved surgical margins, suggest that the manually controlled cutting errors can be much smaller when using a navigation system. The results in terms of the maximum difference between the planned and the achieved surgical margins are concurrent with recent clinical studies [25,26] that reflect the fact that the navigation technology is capable of enabling tumor-free (extralesional) resections.…”

Section: Discussionsupporting

confidence: 68%

“…Assuming that the absolute-value error in the 10-mm desired safe margin would average approximately 5 mm (standard deviation: 5 mm) with a solely freehand cutting procedure [12], and expecting that this error could decrease by a factor of two with use of the navigation technology [25], the minimum required sample size was 45.…”

Section: Discussionmentioning

confidence: 99%

“…To date, however, few clinical studies have reported quantitative data on achieved margins during navigation-assisted bone tumor resections [15,25,26]. Examples of data reported include maximum differences ranging from 4 to 10 mm between the preoperatively planned margins and those visualized on postoperative CT or excised histological actual margins.…”

Section: Introductionmentioning

confidence: 99%

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Computer-assisted planning and navigation improves cutting accuracy during simulated bone tumor surgery of the pelvis

Cartiaux

Banse

Laurent

et al. 2012

Computer Aided Surgery

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Background: Resection of bone tumors within the pelvis requires good cutting accuracy to achieve satisfactory safe margins. Manually controlled bone cutting can result in serious errors, especially due to the complex three-dimensional geometry, limited visibility, and restricted working space of the pelvic bone. This experimental study investigated cutting accuracy during navigated and non-navigated simulated bone tumor cutting in the pelvis. Methods: A periacetabular tumor resection was simulated using a pelvic bone model. Twenty-three operators (10 senior and 13 junior surgeons) were asked to perform the tumor cutting, initially according to a freehand procedure and later with the aid of a navigation system. Before cutting, each operator used preoperative planning software to define four target planes around the tumor with a 10-mm desired safe margin. After cutting, the location and flatness of the cut planes were measured, as well as the achieved surgical margins and the time required for each cutting procedure. Results: The location of the cut planes with respect to the target planes was significantly improved by using the navigated cutting procedure, averaging 2.8 mm as compared to 11.2 mm for the freehand cutting procedure ( p < 0.001). There was no intralesional tumor cutting when using the navigation system. The maximum difference between the achieved margins and the 10-mm desired safe margin was 6.5 mm with the navigated cutting process (compared to 13 mm with the freehand cutting process). Conclusions: Cutting accuracy during simulated bone cuts of the pelvis can be significantly improved by using a freehand process assisted by a navigation system. When fully validated with complementary in vivo studies, the planning and navigation-guided technologies that have been developed for the present study may improve bone cutting accuracy during pelvic tumor resection by providing clinically acceptable margins.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Computer-assisted planning and navigation improves cutting accuracy during simulated bone tumor surgery of the pelvis

Cartiaux

Banse

Laurent

et al. 2012

Computer Aided Surgery

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“…Although histological examinations of all specimens showed a clear tumor margin in all patients like in previous reports [8,10,14,17,20,21] with this technique, it is important to note that the navigation assistance only reproduces accurately the preoperative plan performed by the surgeon based on fusion images (CT and MRI). However, the surgeon could misinterpret those preoperative images and plan inadequate cuts that could lead to inadequate margins.…”

Section: Discussionmentioning

confidence: 50%

“…In orthopaedic oncology, this technology is reported to aid in achieving adequate margins [8,20] and improve the accuracy of bone cuts [10,14,21]. However, it will likely become more extensively used if it decreases the time of the procedures and shows that clinical outcomes are improved [4,16]; to date, these remain open questions.…”

Section: Introductionmentioning

confidence: 99%

Does Intraoperative Navigation Assistance Improve Bone Tumor Resection and Allograft Reconstruction Results?

Aponte-Tinao

Ritacco

Ayerza

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Bone tumor resections for limb salvage have become standard treatment. Recently, computer-assisted navigation has been introduced to improve the accuracy of joint arthroplasty and possible tumor resection surgery; however, like with any new technology, its benefits and limitations need to be characterized for surgeons to make informed decisions about whether to use it. Questions/purposes We wanted to (1) assess the technical problems associated with computer-assisted navigation; (2) assess the accuracy of the registration technique; (3) define the time required to perform a navigated resection in orthopedic oncology; and (4) the frequency of complications such as local recurrence, infection, nonunion, fracture, and articular collapse after tumor resection and bone reconstruction with allografts using intraoperative navigation assistance. Methods We analyzed 69 consecutive patients with bone tumors of the extremities that were reconstructed with massive bone allografts using intraoperative navigation assistance with a minimum followup of 12 months (mean, 29 months; range, 12-43 months). All patients had their tumors reconstructed in three-dimensional format in a virtual platform and planning was performed to determine the osteotomy position according to oncology margins in a CT-MRI image fusion. Tumor resections and allograft reconstructions were performed using a computer navigation system according to the previously planned cuts. We analyzed intraoperative data such as technical problems related to the navigation procedure, registration technique error, length of time for the navigation procedure, and postoperative complications such as local recurrence, infection, nonunion, fracture, and articular collapse. Results In three patients (4%), the navigation was not carried out as a result of technical problems. Of the 66 cases in which navigation was performed, the mean registration error was 0.65 mm (range, 0.3-1.2 mm). The mean required time for navigation procedures, including bone resection and allograft reconstruction during surgery, was 35 minutes (range, 18-65 minutes). Complications that required a second surgical procedure were recorded for nine patients including one local recurrence, one infection, two fractures, one articular collapse, and four nonunions. In two of these nine patients, the allograft needed to be removed. At latest followup, three patients died of their original disease. Conclusions The navigation procedure could not be performed for technical reasons in 4% of the series. The mean registration error was 0.65 mm in this series and the navigation procedure itself adds a mean of 35 minutes during

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Fluorescence guidance improves the accuracy of radiological imaging‐guided surgical navigation

Henderson

Hebert

Werth

et al. 2022

Journal of Surgical Oncology

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Background Imaging‐based navigation technologies require static referencing between the target anatomy and the optical sensors. Imaging‐based navigation is therefore well suited to operations involving bony anatomy; however, these technologies have not translated to soft‐tissue surgery. We sought to determine if fluorescence imaging complement conventional, radiological imaging‐based navigation to guide the dissection of soft‐tissue phantom tumors. Methods Using a human tissue‐simulating model, we created tumor phantoms with physiologically accurate optical density and contrast concentrations. Phantoms were dissected using all possible combinations of computed tomography (CT), magnetic resonance, and fluorescence imaging; controls were included. The data were margin accuracy, margin status, tumor spatial alignment, and dissection duration. Results Margin accuracy was higher for combined navigation modalities compared to individual navigation modalities, and accuracy was highest with combined CT and fluorescence navigation (p = 0.045). Margin status improved with combined CT and fluorescence imaging. Conclusions At present, imaging‐based navigation has limited application in guiding soft‐tissue tumor operations due to its inability to compensate for positional changes during surgery. This study indicates that fluorescence guidance enhances the accuracy of imaging‐based navigation and may be best viewed as a synergistic technology, rather than a competing one.

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Navigation-assisted Surgery for Bone and Soft Tissue Tumors With Bony Extension

Abstract: Background The navigation system was introduced to orthopaedic surgery in the 1990s. More recently, CT-based navigation systems have been used more commonly in spine and joint replacement surgery because of their precision.

Cited by 47 publications

References 25 publications

Computer-assisted planning and navigation improves cutting accuracy during simulated bone tumor surgery of the pelvis

Computer-assisted planning and navigation improves cutting accuracy during simulated bone tumor surgery of the pelvis

Does Intraoperative Navigation Assistance Improve Bone Tumor Resection and Allograft Reconstruction Results?

Fluorescence guidance improves the accuracy of radiological imaging‐guided surgical navigation

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