Tumor resection at the pelvis using three-dimensional planning and patient-specific instruments: a case series

Jentzsch, Thorsten; Vlachopoulos, Lazaros; Fürnstahl, Philipp; Müller, Daniel; Fuchs, Bruno

doi:10.1186/s12957-016-1006-2

Cited by 69 publications

(59 citation statements)

References 18 publications

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“…Case series focused on subjective measures. Clinical outcomes in all cases were satisfactory, with some of that success attributed to the use of 3D models.…”

Section: Resultsmentioning

confidence: 99%

“…The surgeons were able to better understand the patient's anatomy, with the models resulting in an altered surgical plan or approach in some cases . Simulated surgery aided in instrument selection resulting in less need for adjustment intraoperatively as well as providing a better understanding of landmarks such as resection margins and screw placements . Surgeons commented that they felt the models were less useful for simple pathologies but could greatly improve understanding of more complex fractures and deformities …”

Section: Resultsmentioning

confidence: 99%

“…19,21,26,37 Simulated surgery aided in instrument selection resulting in less need for adjustment intraoperatively as well as providing a better understanding of landmarks such as resection margins and screw placements. [17][18][19][20][21][22][23][24][25][26][27][28] Surgeons commented that they felt the models were less useful for simple pathologies but could greatly improve understanding of more complex fractures and deformities. 18 Case reports described similar results.…”

Section: Resultsmentioning

confidence: 99%

“…The lack of soft tissue structures in some 3D printed models is a disadvantage mentioned by surgeons . While the models provide a good representation of the bony anatomy, the associated soft tissues and vital structures such as blood vessels or nerves are often not included . This reduces the usefulness of the model in cases such as complex tumour resection near vital structures.…”

Section: Discussionmentioning

confidence: 99%

“…19,21,28,37,54 These models can also be sterilized and taken into the surgical field to provide the surgeons with a template to review intraoperatively. 1,10,18,20 Even common, inexpensive printing materials such as polylactic acid can withstand high-pressure steam without deforming, 10,20 but there has been limited work in validating the sterility of such models. As such, a standardized protocol for each of the 3D printing technology has yet to be established.…”

Section: Role Of 3d Printingmentioning

confidence: 99%

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Three‐dimensional printing in orthopaedic preoperative planning improves intraoperative metrics: a systematic review

Jiang

Chen

Coles‐Black

et al. 2019

ANZ Journal of Surgery

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Background Three‐dimensional (3D) printing has seen increasing interest in surgery, where it improves the visualization of difficult anatomy in complex cases. This literature review investigates the benefits and limitations of 3D printed models in preoperative planning in the field of orthopaedic surgery. Methods A literature search was performed using the Ovid platform on the Embase and MEDLINE databases using the terms ‘3D printing’, ‘Orthopaedics’ and ‘Surgical Planning’. Studies using 3D printed models as a part of preoperative planning were included. All others were excluded. Data regarding the metrics used to assess the benefit of the use of 3D models, surgical outcome, and surgeon or patient opinion on the technology were extracted. Results A total of 41 studies resulted. Eight (19.5%) were case–control studies, the remainder were case reports or case series. Assessment of benefit was mostly subjective, although the case–control studies included objective metrics such as operation time, intraoperative blood loss and intraoperative fluoroscopy time. The use of 3D printing technology showed subjective benefit for both patient and surgeon as well as indicating clinically significant improvements in intraoperative metrics. Conclusion Despite the current absence of large scale trials, 3D printing has clear benefits in preoperative planning, particularly when utilized in complex cases. A streamlined workflow for case selection, in‐house model creation and preoperative rehearsals is still required to be developed before the process is ready for routine use. Evidence supports an improvement in intraoperative metrics and patient engagement but data to support improved clinical outcome is lacking.

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“…Case series focused on subjective measures. Clinical outcomes in all cases were satisfactory, with some of that success attributed to the use of 3D models.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Role Of 3d Printingmentioning

confidence: 99%

See 3 more Smart Citations

Three‐dimensional printing in orthopaedic preoperative planning improves intraoperative metrics: a systematic review

Jiang

Chen

Coles‐Black

et al. 2019

ANZ Journal of Surgery

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Evaluation of CT‐MR image registration methodologies for 3D preoperative planning of forearm surgeries

Gerber

Carrillo

Abegg

et al. 2020

Journal Orthopaedic Research

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Computerised surgical planning for forearm procedures that considers both soft and bony tissue, requires alignment of preoperatively acquired computed tomography (CT) and magnetic resonance (MR) images by image registration. Normalised mutual information (NMI) registration techniques have been researched to improve efficiency and to eliminate the user dependency associated with manual alignment. While successfully applied in various medical fields, application of NMI registration to images of the forearm, for which the relative pose of the radius and ulna likely differs between CT and MR acquisitions, is yet to be described. To enable the alignment of CT and MR forearm data, we propose an NMI-based registration pipeline, which allows manual steering of the registration algorithm to the desired image subregion and is, thus, applicable to the forearm. Successive automated registration is proposed to enable planning incorporating multiple target anatomical structures such as the radius and ulna. With respect to gold-standard manual registration, the proposed registration methodology achieved mean accuracies of 0.08 ± 0.09 mm (0.01 -0.41 mm range) in comparison to 0.28 ± 0.23 mm (0.03 -0.99 mm range) associated with a landmark-based registration when tested on 40 patient datasets. Application of the proposed registration pipeline required less than 10 minutes on average compared to 20 minutes required by the landmark-based registration. The clinical feasibility and relevance of the method were tested on two different clinical applications, a forearm tumour resection and radioulnar joint instability analysis, obtaining accurate and robust CT-MR image alignment for both cases.

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Internal hemipelvectomy: A single institution's learning curve and longitudinal experience

Vucicevic,

Zavras,

Fice

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesWide margin resection for pelvic tumors via internal hemipelvectomy is among the most technically challenging procedures in orthopedic oncology. As such, surgeon experience and technique invariably affect patient outcomes. The aim of this clinical study was to assess how an individual surgeon's experiences and advancements in technology and techniques in the treatment of internal hemipelvectomy have impacted patient outcomes at our institution.MethodsThis study retrospectively examined a single tertiary academic institution's consecutive longitudinal experience with internal hemipelvectomy for primary sarcoma or pelvic metastases over a 26‐year period between the years 1994 and 2020. Outcomes were assessed using two separate techniques. The first stratified patients into cohorts based on the date of surgery with three distinct “eras” (“early,” “middle,” and “modern”), which reflect the implementation of new techniques, including three‐dimensional (3D) computer navigation and cutting guide technology into our clinical practice. The second method of cohort selection grouped patients based on each surgeon's case experience with internal hemipelvectomy (“inexperienced,” “developing,” and “experienced”). Primary endpoints included margin status, complication profiles, and long‐term oncologic outcomes. Whole group multivariate analysis was used to evaluate variables predicting blood loss, operative time, tumor‐free survival, and mortality.ResultsA total of 72 patients who underwent internal hemipelvectomy were identified. Of these patients, 24 had surgery between 1994 and 2007 (early), 28 between 2007 and 2015 (middle), and 20 between 2016 and 2020 (modern). Twenty‐eight patients had surgery while the surgeon was still inexperienced, 24 while developing, and 20 when experienced. Evaluation by era demonstrated that a greater proportion of patients were indicated for surgery for oligometastatic disease in the modern era (0% vs. 14.3% vs. 35%, p = 0.022). Fewer modern cases utilized freehand resection (100% vs. 75% vs. 55%, p = 0.012), while instead opting for more frequent utilization of computer navigation (0% vs. 25% vs. 20%, p = 0.012), and customized 3D‐printed cutting guides (0% vs. 0% vs. 25%, p = 0.002). Similarly, there was a decline in the rate of massive blood loss observed (72.2% vs. 30.8% vs. 35%, p = 0.016), and interdisciplinary collaboration with a general surgeon for pelvic dissection became more common (4.2% vs. 32.1% vs. 85%, p < 0.001). Local recurrence was less prevalent in patients treated in middle and modern eras (50% vs. 15.4% vs. 25%, p = 0.045). When stratifying by case experience, surgeries performed by experienced surgeons were less frequently complicated by massive blood loss (66.7% vs. 40% vs. 20%, p = 0.007) and more often involved a general surgeon for pelvic dissection (17.9% vs. 37.5% vs. 65%, p = 0.004). Whole group multivariate analysis demonstrated that the use of patient‐specific instrumentation (PSI) predicted lower intraoperative blood loss (p = 0.040). However, surgeon experience had no significant effect on operative time (p = 0.125), tumor‐free survival (p = 0.501), or overall patient survival (p = 0.735).ConclusionWhile our institution continues to utilize neoadjuvant and adjuvant therapies following current guideline‐based care, we have noticed changing trends from early to modern periods. With the advent of new technologies, we have seen a decline in freehand resections for hemipelvectomy procedures, and a transition to utilizing more 3D navigation and customized 3D cutting guides. Furthermore, we have employed the use of an interdisciplinary team approach more regularly for these complicated cases. Although our results do not demonstrate a significant change in perioperative outcomes over the years, our institution's willingness to treat more complex cases likely obscures the benefits of surgeon experience and recent technological advances for patient outcomes.

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Tumor resection at the pelvis using three-dimensional planning and patient-specific instruments: a case series

Cited by 69 publications

References 18 publications

Three‐dimensional printing in orthopaedic preoperative planning improves intraoperative metrics: a systematic review

Three‐dimensional printing in orthopaedic preoperative planning improves intraoperative metrics: a systematic review

Evaluation of CT‐MR image registration methodologies for 3D preoperative planning of forearm surgeries

Internal hemipelvectomy: A single institution's learning curve and longitudinal experience

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