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What Is the Expected Learning Curve in Computer-assisted Navigation for Bone Tumor Resection?
Germán L Farfalli1, José I Albergo2, Lucas E Ritacco2
1Carlos E. Ottolenghi Institute of Orthopedics, Italian Hospital of Buenos Aires, Potosí 4247, 1199, Buenos Aires, Argentina. german.farfalli@hospitalitaliano.org.ar.
Clinical Orthopaedics and Related Research
|February 26, 2016
Summary
Computer navigation in oncologic surgery can achieve wide bone margins, though technical issues occurred in 5% of early cases. Navigation time decreased with experience, but accuracy did not improve, suggesting further study is needed.
Area of Science:
- Orthopaedic Oncology
- Surgical Navigation Technology
- Oncologic Surgery
Background:
- Computer navigation assists oncologic surgeons in achieving accurate tumor resections.
- Potential drawbacks include intraoperative technical problems and increased surgical time.
- The learning curve associated with navigation-assisted tumor resections remains unevaluated.
Purpose of the Study:
- To identify intraoperative technical problems during the initial two years of using navigation.
- To assess the learning curve's impact on navigation procedure time.
- To evaluate changes in registration accuracy and the achievement of wide bone margins over time.
Main Methods:
- Prospective collection of 78 patients undergoing navigation-assisted bone tumor resections (2010-2012).
- Two experienced orthopaedic oncologists performed navigation procedures.
- Data collected on technical problems, procedure time, registration accuracy, and surgical margins (histopathology).
Main Results:
- Technical problems occurred in 5% of cases, exclusively within the first 20 procedures.
- Mean navigation time was 31 minutes, with significant time reduction during the learning curve (R²=0.35, p<0.001).
- Median registration error was 0.6 mm, with no significant improvement over time (p=0.15). All cases achieved wide bone margins, but soft tissue margins varied.
Conclusions:
- Navigation is potentially useful for achieving negative bony margins in tumor resections.
- Technical difficulties can preclude navigation use in a small percentage of cases.
- While navigation time improves with experience, registration accuracy did not, necessitating further research on its routine value.
