What Is the Expected Learning Curve in Computer-assisted Navigation for Bone Tumor Resection?

Abstract

Background Computer navigation during surgery can help oncologic surgeons perform more accurate resections. However, some navigation studies suggest that this tool may result in unique intraoperative problems and increased surgical time. The degree to which these problems might diminish with experience-the learning curve-has not, to our knowledge, been evaluated for navigation-assisted tumor resections. Questions/purposes (1) What intraoperative technical problems were observed during the first 2 years using navigation? (2) What was the mean time for navigation procedures and the time improvement during the learning curve? (3) Have there been any differences in the accuracy of the registration technique that occurred over time? (4) Did navigation achieve the goal of achieving a wide bone margin? Methods All patients who underwent preoperative virtual planning for tumor bone resections and operated on with navigation assistance from 2010 to 2012 were prospectively collected. Two surgeons (GLF, LAA-T) performed the intraoperative navigation assistance. Both surgeons had more than 5 years of experience in orthopaedic oncology with more than 60 oncology cases per year per surgeon. This study includes from the very first patients performed with navigation. Although they did not take any formal training in orthopaedic oncology navigation, both surgeons were trained in navigation for knee prostheses. Between 2010 and 2012, we performed 124 bone tumor resections; of these, 78 (63%) cases were resected using intraoperative navigation assistance. During this period, our general indications for use of navigation included pelvic and sacral tumors and those tumors that were reconstructed with massive bone allografts to obtain precise matching of the host and allograft osteotomies. Seventy-eight patients treated with this technology were included in the study. Technical problems (crashes) and time for the navigation procedure were reported after surgery. Accuracy of the registration technique was defined and the surgical margins of the removed specimen were determined by an experienced bone pathologist after the surgical procedure as intralesional, marginal, or wide margins. To obtain these One of the authors certifies that he (LAA-T) or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Stryker Americas (Miramar, FL, USA 123 Clin Orthop Relat Res (2017) 475:668-675 DOI 10.1007/s11999-016-4761-z Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® data, we performed a chart review and review of operative notes.Results In four patients (of 78 [5%]), the navigation was not completed as a result of technical problems; all occurred during the first 20 cases of the utilization of this technology. The mean time for navigation procedures during the operation was 31 minutes (range, 11-61 minutes), and the early navigations took more time (the regression analysis shielded R 2 = 0.35 ...

Sacroiliac joint cut accuracy: Comparing new technologies in an idealized sawbones model

“…For computerized navigation, one study demonstrated that after 2 years, the intraoperative time decreased yet registration error did not improve. 31 For pelvic PSIs, some authors report that the guide was consistently situated within 5 minutes 15 and that the learning curve for using PSIs was 10 cases. 32 Operations using PSI technology may prove to be faster than computerized navigation in pelvic resections 11 and freehand techniques in total knee arthroplasties.…”

Three-Dimensional Printing and Navigation in Bone Tumor Resection

“…Surgical precision, understood as the correspondence between a target osteotomy and an executed osteotomy, is not the only factor to consider when evaluating navigation-assisted surgery. Some complications associated with intraoperative navigation, such as increased procedure time or uncompleted navigation due to technical problems, have shown to decrease as the surgeon team familiarizes with the technology (increasing their total amount of surgeries performed under navigation) [19]. On the contrary, the accuracy level in the registration process appears to be independent of the learning curve and not decreasing with user experience.…”

CORR Insights®: Reconstruction After Hemipelvectomy With the Ice-Cream Cone Prosthesis: What Are the Short-term Clinical Results?

“…Preoperative three-dimensional (3-D) planning of the osteotomy may have implications not only for the adequacy of the resection margins, but also for the biomechanical stability and design of the prosthesis [3][4][5][6]. The difficulty remains in how we transfer insights of the preoperative 3-D planning process to the operating field.…”

“…The difficulty remains in how we transfer insights of the preoperative 3-D planning process to the operating field. We have two options if we wish to reproduce this planning in the operative room and increase accuracy: (1) Computer-assisted navigation technologies [3,6] or (2) Patient-specific templates that make a guided osteotomy feasible [4,5].…”

“…The aim of surgical navigation is to perform surgery according to previously planned margins. Previous studies [3,6] have detailed the accuracy of 3-D planning and navigation in bone tumor resection [6]. Although 3-D planning and navigation could be ideal for complex anatomies, as well as help the surgeon focus on the position of the prosthesis, this technology is rarely used in pelvic tumor surgery.…”