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Updated: Feb 17, 2026

A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement
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Advances in stereotactic navigation for pelvic surgery.

A R Wijsmuller1,2, L G C Romagnolo3, V Agnus4

  • 1IRCAD/ EITS, Department of General, Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France. a.wijsmuller@vumc.nl.

Surgical Endoscopy
|December 8, 2017
PubMed
Summary

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Stereotactic navigation for rectal cancer surgery is feasible despite anatomical shifts. Using a 10-degree wedge minimizes positional changes, enabling accurate surgical guidance for improved patient outcomes.

Area of Science:

  • Surgical Navigation
  • Medical Imaging
  • Rectal Cancer Surgery

Background:

  • Stereotactic navigation offers potential for enhanced rectal cancer surgery.
  • Significant anatomical variations exist between supine and lithotomy positions, posing challenges for pelvic navigation.
  • Understanding these positional differences is crucial for developing effective stereotactic navigation strategies.

Purpose of the Study:

  • To quantify anatomical, sacral tilt, and fiducial position differences between supine and lithotomy positions.
  • To evaluate the feasibility and optimal setup for stereotactic pelvic navigation in rectal cancer surgery.
  • To investigate the impact of a wedge on mitigating positional anatomical changes.

Main Methods:

  • CT scans of anatomical specimens in supine and lithotomy positions.
Keywords:
AnatomyComputer-assistedNeuronavigationOperativeRectal neoplasmsStereotaxis techniquesSurgerySurgical procedures

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  • Image analysis to compare anatomy, sacral tilt, and skin fiducial positions.
  • Surgical procedure simulations to assess stereotactic navigation accuracy with and without a wedge.

    • Main Results:

    • Up-to-supracentimetric anatomical changes observed between positions, reduced by a wedge.
    • Sacral retroversion occurred regardless of wedge use; significant skin fiducial motion noted.
    • Optimal accuracy (1.9 mm error) achieved with supine registration, straight legs, no pneumoperitoneum, and identical positioning.

    Conclusions:

    • A 10-degree wedge minimizes anatomical changes during positional shifts, enabling accurate stereotactic navigation.
    • This approach holds promise for improving surgical quality in complex rectal cancer cases.
    • Stereotactic navigation can enhance the identification and dissection of anatomical planes in challenging rectal cancer surgeries.