Digital chain for pelvic tumor resection with 3D-printed surgical cutting guides

Abstract

Surgical cutting guides are 3D-printed customized tools that help surgeons during complex surgeries. However, there does not seem to be any set methodology for designing these patient-specific instruments. Recent publications using pelvic surgical guides showed various designs with no clearly classified or standardized features. We, thus, developed a systematic digital chain for processing multimodal medical images (CT and MRI), designing customized surgical cutting guides, and manufacturing them using additive manufacturing. The aim of this study is to describe the steps in the conception of surgical cutting guides used in complex oncological bone tumor pelvic resection. We also analyzed the duration of the surgical cutting guide process and tested its ergonomics and usability with orthopedic surgeons using Sawbones models on simulated tumors. The original digital chain made possible a repeatable design of customized tools in short times. Preliminary testing on synthetic bones showed satisfactory results in terms of design usability. The four artificial tumors (Enneking I, Enneking II, Enneking III, and Enneking I+IV) were successfully resected from the Sawbones model using this digital chain with satisfactory ergonomic outcomes. This work validates a new digital chain conception and production of surgical cutting guides. Further works with quantitative margin assessments on anatomical subjects are needed to better assess the design implications of patient-specific surgical cutting guide instruments in pelvic tumor resections.

What to choose in bone tumour resections? Patient specific instrumentation versus surgical navigation: a systematic review

“…Similar results stating the superiority of PSI in terms of shorter surgical time compared to SN in pelvis were presented by Gouin et al [31] , reporting a maximum of 5 min time needed for PSI guide positioning [31] . 14 min was instead the time reported by Fujiwara et al for SN intraoperative use, again far more than the 60–92 s reported by Biscaccianti et al for PSI use [46] . On the other side, Evrard et al reported no difference in intraoperative time between PSI and free hand technique [34] .…”

Current Concepts in the Resection of Bone Tumors Using a Patient-Specific Three-Dimensional Printed Cutting Guide

“…Using Digital Imaging and Communication in Medicine approaches (DICOM), the 3D images of tumors with normal anatomy are reconstructed using segmented thin-slice computed tomography (CT) and magnetic resonance imaging (MRI) [ 11 ]. The reconstructed anatomical 3D images of bony tissues and tumors are then exported as a series of polygons, the number of which directly correlates with the resolution in the standard triangulation language format [ 12 ].…”

“…One of the most important advantages of PSGs is the achievement of an accurate resection of bone tumors with safe margins [ 11 , 18 , 19 ]. From previous cadaver studies, manual resection can result in inaccuracies of up to 5–15 mm, which might lead to unexpected intralesional resection [ 20 , 21 , 22 , 23 ].…”

“…Even for experienced surgeons, consistent maintenance of the surgical margin during pelvic surgery remains challenging [ 5 ]. Patient-specific cutting guides (PSGs) have recently been used to facilitate surgeons in more precise planning of surgical interventions [ 6 , 10 , 11 ]. In this article, we review the basic technology for the production of PSGs and its current status, highlighting its advantages and limitations in the field of orthopedic oncology.…”

The application of additive manufacturing technology in pelvic surgery: A bibliometrics analysis

“…Additive manufacturing technology has demonstrated unparalleled superiority in pelvic tumor surgery due to its personalization, high-precision, and rapidly accessible manufacturing ( Chen et al, 2016 ). Preoperative surgical planning, intraoperative guides for precise osteotomy planes, and implant reconstruction with 3D printed prostheses have led to the increasing application of additive manufacturing technology in pelvic tumor surgery ( Biscaccianti et al, 2022 ).…”