Department of Medical Imaging, Radboudumc, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands.
Department of Orthopaedics, Radboudumc, Nijmegen, The Netherlands.
Int J Comput Assist Radiol Surg. 2023 Apr;18(4):775-783. doi: 10.1007/s11548-022-02741-w. Epub 2022 Nov 3.
Navigation has been suggested to guide complex benign bone tumor curettage procedures, but the contribution of navigation to the accuracy of curettage has never been quantified. We explored the accuracy of navigated curettage in a cadaveric observational pilot study, comparing navigated to freehand curettage, performed independently by an expert and a novice user.
The expert performed curettage on 20 cadaveric bones prepared with a paraffin wax mixture tumor, 10 freehand and 10 navigated. We re-used 12 bones for the novice experiments, 6 freehand and 6 navigated. Tumor and curettage cavity volumes were segmented on pre- and post-cone-beam CT scans. Accuracy was quantified using the Dice Similarity Coefficient (DSC), and with remaining tumor volume, bone curettage volume, maximal remaining width and procedure times compared between navigation and freehand groups for both users.
There were little differences in curettage accuracy between a navigated (DSC 0.59[0.17]) and freehand (DSC 0.64[0.10]) approach for an expert user, but there were for a novice user with DSC 0.67(0.14) and 0.83(0.06), respectively. All navigated and freehand procedures had some amount of remaining tumor, generally located in a few isolated spots with means of 2.2(2.6) cm (mean 20% of the tumor volume) and 1.5(1.4) cm (18%), respectively, for the expert and more diffusely spaced with means of 5.1(2.8) cm (33%) and 3.0(2.2) cm (17%), respectively, for the novice.
In an explorative study on 20 cadaveric bone tumor models, navigated curettage in its current setup was not more accurate than freehand curettage. The amount of remaining tumor, however, confirms that curettage could be further improved. The novice user was less accurate using navigation than freehand, which could be explained by the learning curve. Furthermore, the expert used a different surgical approach than the novice, focusing more on removing the entire tumor than sparing surrounding bone.
导航已被建议用于指导复杂良性骨肿瘤刮除术，但导航对刮除术准确性的贡献从未被量化过。我们在一项尸体观察性初步研究中探索了导航刮除术的准确性，将导航与由专家和新手用户独立进行的徒手刮除术进行了比较。
专家在 20 个用石蜡蜡混合物肿瘤准备的尸体骨头上进行刮除术，10 个为徒手，10 个为导航。我们重新使用了 12 块骨头用于新手实验，其中 6 个为徒手，6 个为导航。在锥形束 CT 扫描前后对肿瘤和刮除腔体积进行分割。使用 Dice 相似系数（DSC）量化准确性，并比较两名用户的导航和徒手组之间的剩余肿瘤体积、骨刮除体积、最大剩余宽度和手术时间。
对于专家用户，导航（DSC 0.59[0.17]）和徒手（DSC 0.64[0.10]）方法的刮除术准确性几乎没有差异，但对于新手用户则有差异，分别为 DSC 0.67（0.14）和 0.83（0.06）。所有导航和徒手操作都有一定量的残留肿瘤，通常位于少数几个孤立的位置，平均值为 2.2（2.6）cm（肿瘤体积的 20%）和 1.5（1.4）cm（18%），对于专家，更分散的位置，平均值为 5.1（2.8）cm（33%）和 3.0（2.2）cm（17%），对于新手。
在 20 个尸体骨肿瘤模型的探索性研究中，当前设置的导航刮除术并不比徒手刮除术更准确。然而，残留肿瘤的数量证实刮除术可以进一步改进。新手用户使用导航的准确性低于徒手，这可以通过学习曲线来解释。此外，专家使用的手术方法与新手不同，更侧重于切除整个肿瘤，而不是保护周围的骨骼。
