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

Abstract

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.

Patient-specific instrument can achieve same accuracy with less resection time than navigation assistance in periacetabular pelvic tumor surgery: a cadaveric study

“…The result concurred with the accuracy of the two techniques reported in other clinical, sawbone or cadaveric studies [5,11,19,[22][23][24]. When we compared the accuracy between the two techniques in simulated pelvic bone resections, no statistical difference was noted.…”

Validation of a fibula graft cutting guide for mandibular reconstruction: experiment with rapid prototyping mandible model

“…Recent studies on preoperative 3D surgical simulation planning used simulation results to prepare a surgical guide for application in the actual surgery. [3,4] Studies showed that, when the 3D surgical simulation planning was performed, the error between the bony segments could be decreased for mandibular reconstructions with the fibula. [5,6] When the mandibular reconstruction with the fibula was performed in patient groups with or without advance 3D surgical simulation planning for the plating, the results showed no significant difference between groups in the midline deviation; however, with advance simulation planned plating, less error was observed in the deviation at the condylar position, and the errors were partially reduced in the mandible body axis and the angular shift.…”

Osteosarcoma

“…8). An osteosarcoma in the pelvis is an example in which computer-assisted surgery will help navigate precise bone cuts due to the complex three-dimensional anatomy and preserve critical structures [104][105][106].…”