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Intraoperative O-arm-navigated resection in musculoskeletal tumors
Tomohiro Fujiwara1, Toshiyuki Kunisada2, Ken Takeda3
1Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 7008558, Japan; Department of Intelligent Orthopaedic System, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 7008558, Japan.
Background:
Although emerging evidence has suggested that computer-assisted navigation allows surgeons to plan the optimal level of resection without compromising the surgical margins, the precise accuracy of the procedures has been unclear. The aim of this study was to investigate the accuracy and safety of the musculoskeletal tumor resection using O-arm/Stealth intraoperative navigation assistance.
Methods:
A retrospective study of six patients with bone and soft tissue tumors who underwent surgical resection using O-arm/Stealth navigation system was performed. The histological diagnosis was osteosarcoma, metastatic bone tumor, leiomyosarcoma, undifferentiated sarcoma, and synovial sarcoma, respectively. Tumor resection was performed according to planned osteotomy planes determined on O-arm/Stealth three-dimensional intraoperative images. The resection accuracy, length of time for the procedures, surgical margins, and perioperative complications were evaluated.
Results:
The distances between the entry and exit points for the planned and actual cuts were 1.5 ± 0.3 mm and 2.3 ± 0.3 mm, respectively, and the mean discrepancy of the osteotomy angle was 2.8 ± 1.2°. The mean length of time required for navigation was 14 min. A histological examination revealed clear margins in all patients. There were no complications related to navigation, and no patients developed local recurrence during a mean follow-up of 30.6 months.
Conclusions:
The O-arm/Stealth intraoperative CT navigation system provides safe and accurate osteotomy in musculoskeletal tumor resections. However, surgeons should keep in mind and be careful of minimal errors during osteotomy, which are around 2 mm from the planned line.
Insights
The O-arm/Stealth navigation system accurately resects musculoskeletal tumors with minimal deviation. This computer-assisted surgery ensures clear margins and safety, with no recurrence observed in a 30-month follow-up.
Area of Science:
- Orthopedic Surgery
- Surgical Navigation
- Oncology
Background:
- Computer-assisted navigation aids in planning optimal tumor resection.
- The precise accuracy of these navigation systems in musculoskeletal tumor resection remains under investigation.
Purpose of the Study:
- To evaluate the accuracy and safety of musculoskeletal tumor resection using the O-arm/Stealth intraoperative navigation system.
Main Methods:
- Retrospective study of six patients with bone and soft tissue tumors.
- Resection performed using O-arm/Stealth navigation based on 3D intraoperative images.
- Evaluation of resection accuracy, procedure time, surgical margins, and complications.
Main Results:
- Mean discrepancy between planned and actual cuts was 2.3 ± 0.3 mm.
- Mean osteotomy angle discrepancy was 2.8 ± 1.2°.
- All patients achieved clear surgical margins with no navigation-related complications or local recurrence.
Conclusions:
- The O-arm/Stealth system offers safe and accurate osteotomy for musculoskeletal tumor resection.
- Surgeons must remain aware of minor osteotomy errors, approximately 2 mm from the planned line.
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