Patient Specific Instruments for Complex Tumor Resection-Reconstruction Surgery within the Pelvis: A Series of 4 Cases

Abstract

The pelvis bone resection-reconstruction surgery is one of the most challenging fields in orthopedics. Being applied for tumors, as for other complex reconstruction cases, this type of surgery needs careful planning and is time consuming, in order to obtain proper accuracy. Unfortunately not all the time the expected accuracy is met, with consequences for the patients. PSI proved to provide good cutting accuracy during simulated tumor surgery within the pelvis. This article present a series of 4 patients operated in our department between June 2014 and Mars 2015 for tumors resectionreconstructions. The patients were imaged using a CT and an MRI scan and the images were reconstructed in 3D. According to the bone bank stock, the most similar allograft was chosen and the stored CT scan was reconstructed in 3D. Patient specific instruments (PSI) were designed and manufactured using rapid-prototyping technology for the resection of the native tissues as for the resection of the careful se... Chirurgia de rezecåie-reconstrucåie la nivelul pelvisului este una dintre cele mai dificile ramuri ale ortopediei. Aplicatã pentru rezecåiile tumorale, cât aei pentru cazurile complexe de reconstrucåie, acest tip de chirurgie necesitã planificare atentã aei este de lungã duratã, totul pentru a obåine acurateåe maximã. Când rezecåia nu este precisã consecinåele pentru pacient sunt grave. Tehnologia PSI (patient specific instrument) s-a dovedit a fi precisã în timpul rezecåiilor tumorale simulate, de la nivelul pelvisului. Acest articol prezintã o serie de 4 pacienåi operaåi la Cliniques Universitaires St. Luc între Iunie 2014 aei Martie 2015 pentru rezecåii-reconstrucåii tumorale. Pacienåii au fost investigaåi cu Ct aei RMN, iar imaginile au fost reconstruite 3D. Din stocul bãncii de os a fost aleasã cea mai apropiatã allogrefã ca formã aei dimensiune, iar imaginile CT stocate au fost reconstruite 3D. S-au conceput aei imprimat ghiduri de taiere specifice pacientului folosind tehnologia Rapid-Prototyping, pentru rezecåia åesutului nativ cât aei pentru rezecåia allogrefei de hemipelvis atent selectatã. Implantarea alogrefelor s-a fãcut cu potrivire exactã aei a permis osteosinteza stabilã.Cuvinte cheie: chirurgia de rezecåie-reconstrucåie, pelvis AbstractThe pelvis bone resection-reconstruction surgery is one of the most challenging fields in orthopedics. Being applied for tumors, as for other complex reconstruction cases, this type of surgery needs careful planning and is time consuming, in order to obtain proper accuracy. Unfortunately not all the time the expected accuracy is met, with consequences for the patients. PSI proved to provide good cutting accuracy during simulated tumor surgery within the pelvis. This article present a series of 4 patients operated in our department between June 2014 and Mars 2015 for tumors resectionreconstructions. The patients were imaged using a CT and an MRI scan and the images were reconstructed in 3D. According to the bone bank stock, the most similar allograft was chosen and the store...

3D-printed Prostheses Assisted by Osteotomy Guide Plates for Reconstruction Following Periacetabular Tumor Resection via Two Approaches

“…In our series, pathological margins were negative after bone tumor resection. According to previous studies, the mean operative duration and intraoperative blood loss ranged from 258-445 min and 2206-6210 ml, respectively [7,11,19,21,22,32,36]. In the current study, the mean operative duration and intraoperative blood loss were reduced to 333 min and 1416 ml, respectively.…”

“…In addition, the cost is another great disadvantage of surgical navigation system [35]. Gerant et al [36] reported that major blood loss occurred during osteotomy. Osteotomy guide plates can help surgeons perform multiplanar osteotomy, achieve precise resection margins, shorten the operative duration and reduce intraoperative blood loss.…”

Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios

“…Surgical resection is the standard of care for RCC, with minimally invasive partial nephrectomy the treatment of choice for localized lesions [ 561 ]. PubMed Search: (3D printing AND kidney cancer) OR (rapid prototyping and kidney cancer) OR (3D printing AND renal cancer) OR (rapid prototyping AND renal cancer) OR (3D printing AND renal mass) OR (3D printing AND kidney mass) OR (rapid prototyping AND renal mass) OR (rapid prototyping AND kidney mass) OR (3D printing AND renal cell carcinoma) OR (3D printing AND RCC) OR (rapid prototyping AND renal cell carcinoma) OR (rapid prototyping AND RCC) Results: [ 308 , 310 – 324 ] The terms renal lymphoma, angiomyolipoma (AML) and renal oncocytoma generated no results when searched with 3D printing or rapid prototyping. Renal Cysts : Renal cysts are common; they are heterogeneous in both origin and pathogenesis; and most are simple and are usually of little clinical significance.…”

“…PubMed Search: (3D printing AND pediatric genitourinary tumor) OR (rapid prototyping AND pediatric genitourinary tumor) OR (3D printing AND Wilms tumor) OR (rapid prototyping AND Wilms tumor) OR (3D printing AND nephroblastoma) OR (rapid prototyping AND nephroblastoma) Results: None Relevant Musculoskeletal (Retrieved February 2017) Fracture : Simple, Acute Complex Long Bone, Acute Complex Intraarticular, Complex, Acetabular, Non-Pathological Vertebral, Pathological Vertebral, Fracture Malunion. PubMed Search: ((“printing, three-dimensional”[MeSH Terms] OR (“printing”[All Fields] AND “three-dimensional”[All Fields]) OR “three-dimensional printing”[All Fields] OR (“3d”[All Fields] AND “printing”[All Fields]) OR “3d printing”[All Fields]) OR (rapid[All Fields] AND prototyping[All Fields])) AND ((“fractures, bone”[MeSH Terms] OR (“fractures”[All Fields] AND “bone”[All Fields]) OR “bone fractures”[All Fields] OR “fracture”[All Fields]) OR malunion[All Fields]) Results: [ 345 – 406 ] Heterotopic Ossification PubMed Search: ((“printing, three-dimensional”[MeSH Terms] OR (“printing”[All Fields] AND “three-dimensional”[All Fields]) OR “three-dimensional printing”[All Fields] OR (“3d”[All Fields] AND “printing”[All Fields]) OR “3d printing”[All Fields]) OR (rapid[All Fields] AND prototyping[All Fields])) AND (“ossification, heterotopic”[MeSH Terms] OR (“ossification”[All Fields] AND “heterotopic”[All Fields]) OR “heterotopic ossification”[All Fields] OR (“heterotopic”[All Fields] AND “ossification”[All Fields])) Results: None relevant Ligamentous Injury PubMed Search: ((“printing, three-dimensional”[MeSH Terms] OR (“printing”[All Fields] AND “three-dimensional”[All Fields]) OR “three-dimensional printing”[All Fields] OR (“3d”[All Fields] AND “printing”[All Fields]) OR “3d printing”[All Fields]) OR (rapid[All Fields] AND prototyping[All Fields])) AND ((“tendons”[MeSH Terms] OR “tendons”[All Fields] OR “tendon”[All Fields]) OR (“ligaments”[MeSH Terms] OR “ligaments”[All Fields] OR “ligament”[All Fields])) Results: [ 407 , 408 ] Hip Dysplasia PubMed Search: ((“printing, three-dimensional”[MeSH Terms] OR (“printing”[All Fields] AND “three-dimensional”[All Fields]) OR “three-dimensional printing”[All Fields] OR (“3d”[All Fields] AND “printing”[All Fields]) OR “3d printing”[All Fields]) OR (rapid[All Fields] AND prototyping[All Fields])) AND (“hip dislocation”[MeSH Terms] OR (“hip”[All Fields] AND “dislocation”[All Fields]) OR “hip dislocation”[All Fields] OR (“hip”[All Fields] AND “dysplasia”[All Fields]) OR “hip dysplasia”[All Fields]) Results: [ 389 , 409 – 414 ] Bone or Soft Tissues Neoplasm: With or Without Joint and Neurovascular Involvement PubMed Search: ((“printing, three-dimensional”[MeSH Terms] OR (“printing”[All Fields] AND “three-dimensional”[All Fields]) OR “three-dimensional printing”[All Fields] OR (“3d”[All Fields] AND “printing”[All Fields]) OR “3d printing”[All Fields]) OR (rapid[All Fields] AND prototyping[All Fields])) AND (“bone neoplasms”[MeSH Terms] OR (“bone”[All Fields] AND “neoplasms”[All Fields]) OR “bone neoplasms”[All Fields] OR (“bone”[All Fields] AND “tumor”[All Fields]) OR “bone tumor”[All Fields]) Results: [ 324 , 353 , 415 – 443 ] Arthritis, Not Otherwise Specified PubMed Search: (...…”

Surgical applications of three-dimensional printing in the pelvis and acetabulum: from models and tools to implants

“…PSI cutting guides are valuable for tumour resection in the pelvis, allowing for accurate resection margins, graft sizing, opposition and, hence, improving the stability of the reconstructed pelvis [ 22 ] where complex, multi-faceted cuts are sometimes used in conjunction with custom-made endoprostheses. In a series of nine patients with 11 osteotomies reported by Gouin [ 23 ] for pelvic tumour resection, placement of PSI guides was usually straightforward in the pelvis with an accuracy of within 2.5 mm.…”