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Published on: May 17, 2018
Intraoperative Metal Detection vs. Preoperative computed tomography for Combat-related Shrapnel Localization: A
Erez Hassidov1, Dan Paz2, Felicity Kassis3
1Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Background:
Combat-related penetrating neck injuries (PNI) present distinct challenges in surgical settings. Accurate identification and removal of metallic fragments are crucial for minimizing complications. Although computed tomography (CT) remains the gold standard for preoperative assessment, use of intraoperative metal detectors may offer supplementary advantages by enhancing surgical accuracy and efficiency.
Objectives:
To assess the technical feasibility of intraoperative metal detector assistance vs. a CT-guided primary approach.
Methods:
Cadaver heads were implanted with metallic fragments from verified military-grade ordnance and subsequently underwent a CT scan. Two extraction approaches were evaluated: intraoperative metal detector assistance vs. CT-guided primary approach. Key metrics included incision length, dissection time, incision extension, and surgeon workload as assessed by the Surgery Task Load Index questionnaire.
Results:
Metal detector-assisted extraction resulted in reduced initial incision lengths (3.50 cm vs. 4.87 cm) and smaller incision extensions (0.33 cm vs. 0.67 cm), indicating improved precision. However, the average dissection time was longer in the metal detector group (15:00 vs. 12:20 minutes), likely due to learning curves and additional scanning requirements. Surgeons reported lower situational stress (2.25 vs. 4.5) and reduced task complexity (4.0 vs. 4.5) when using a metal detector, despite noting increased mental demand associated with interpreting device signals during surgery.
Conclusions:
Intraoperative metal detection technology shows significant potential as an adjunctive modality for shrapnel localization in combat-associated PNIs. It facilitates minimized incisions and improved surgical precision. While further optimization and clinical adaptation are necessary, this method holds promise for improving outcomes in both military and civilian trauma scenarios.
