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Improved Accuracy with 3D Planning and Patient-Specific Instruments During Simulated Pelvic Bone Tumor Surgery

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Abstract

In orthopaedic surgery, resection of pelvic bone tumors can be inaccurate due to complex geometry, limited visibility and restricted working space of the pelvis. The present study investigated accuracy of patient-specific instrumentation (PSI) for bone-cutting during simulated tumor surgery within the pelvis. A synthetic pelvic bone model was imaged using a CT-scanner. The set of images was reconstructed in 3D and resection of a simulated periacetabular tumor was defined with four target planes (ischium, pubis, anterior ilium, and posterior ilium) with a 10-mm desired safe margin. Patient-specific instruments for bone-cutting were designed and manufactured using rapid-prototyping technology. Twenty-four surgeons (10 senior and 14 junior) were asked to perform tumor resection. After cutting, ISO1101 location and flatness parameters, achieved surgical margins and the time were measured. With PSI, the location accuracy of the cut planes with respect to the target planes averaged 1 and 1.2 mm in the anterior and posterior ilium, 2 mm in the pubis and 3.7 mm in the ischium (p < 0.0001). Results in terms of the location of the cut planes and the achieved surgical margins did not reveal any significant difference between senior and junior surgeons (p = 0.2214 and 0.8449, respectively). The maximum differences between the achieved margins and the 10-mm desired safe margin were found in the pubis (3.1 and 5.1 mm for senior and junior surgeons respectively). Of the 24 simulated resection, there was no intralesional tumor cutting. This study demonstrates that using PSI technology during simulated bone cuts of the pelvis can provide good cutting accuracy. Compared to a previous report on computer assistance for pelvic bone cutting, PSI technology clearly demonstrates an equivalent value-added for bone cutting accuracy than navigation technology. When in vivo validated, PSI technology may improve pelvic bone tumor surgery by providing clinically acceptable margins.

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Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Grants from the Brussels-Capital Region (“Brains Back to Brussels” grant BB2B 2012-1-05) and Fondation Belge contre le Cancer (grant SCIE 2006/20) were used to pay for the salaries of laboratory personnel and for purchase of the bone models and surgical supplies.

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Authors and Affiliations

  1. Computer Assisted and Robotic Surgery (CARS), Institut de recherche expérimentale et clinique (IREC), Université catholique de Louvain (UCL), Avenue Mounier 53, bte B1.53.07, 1200, Brussels, Belgium

    Olivier Cartiaux, Laurent Paul, Xavier Banse & Pierre-Louis Docquier

  2. Institut de statistique, biostatistique et sciences actuarielles, Université catholique de Louvain, Voie du Roman Pays 20, 1348, Louvain-la-Neuve, Belgium

    Bernard G. Francq

  3. Service d’orthopédie et de traumatologie de l’appareil locomoteur, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium

    Xavier Banse & Pierre-Louis Docquier

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  1. Olivier Cartiaux
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  2. Laurent Paul
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  3. Bernard G. Francq
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  4. Xavier Banse
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Correspondence to Olivier Cartiaux.

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Associate Editor Mona Kamal Marei oversaw the review of this article.

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Cartiaux, O., Paul, L., Francq, B.G. et al. Improved Accuracy with 3D Planning and Patient-Specific Instruments During Simulated Pelvic Bone Tumor Surgery. Ann Biomed Eng 42, 205–213 (2014). https://doi.org/10.1007/s10439-013-0890-7

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  • DOI: https://doi.org/10.1007/s10439-013-0890-7

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