Cartiaux Olivier, Banse Xavier, Paul Laurent, Francq Bernard G, Aubin Carl-Éric, Docquier Pierre-Louis
Center for Research in Computer Assisted and Robotic Surgery, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium.
Comput Aided Surg. 2013;18(1-2):19-26. doi: 10.3109/10929088.2012.744096. Epub 2012 Nov 26.
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.
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.
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).
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.
骨盆内骨肿瘤的切除需要良好的切割精度，以获得满意的安全切缘。手动控制的骨切割可能会导致严重误差，尤其是由于骨盆骨复杂的三维几何结构、有限的视野和受限的工作空间。本实验研究调查了在导航和非导航模拟骨盆骨肿瘤切割过程中的切割精度。
使用骨盆骨模型模拟髋臼周围肿瘤切除术。邀请23名操作者（10名资深外科医生和13名初级外科医生）进行肿瘤切割，最初按照徒手操作程序，随后借助导航系统进行操作。在切割前，每位操作者使用术前规划软件在肿瘤周围定义四个目标平面，期望安全切缘为10毫米。切割后，测量切割平面的位置和平整度，以及实际获得的手术切缘和每个切割程序所需的时间。
使用导航切割程序时，切割平面相对于目标平面的位置有显著改善，平均为2.8毫米，而徒手切割程序为11.2毫米（p < 0.001）。使用导航系统时未发生肿瘤内切割。导航切割过程中实际切缘与10毫米期望安全切缘的最大差值为6.5毫米（徒手切割过程为13毫米）。
使用导航系统辅助的徒手操作可显著提高模拟骨盆骨切割的精度。当通过补充的体内研究充分验证时，本研究开发的规划和导航引导技术可能通过提供临床可接受的切缘来提高骨盆肿瘤切除术中的骨切割精度。
