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Patient-specific instrument can achieve same accuracy with less resection time than navigation assistance in periacetabular pelvic tumor surgery: a cadaveric study

  • Kwok-Chuen Wong
  • Kwan-Yik Sze
  • Irene Oi-Ling Wong
  • Chung-Ming Wong
  • Shekhar-Madhukar Kumta
Original Article

Abstract

Purpose

Inaccurate resection in pelvic tumors can result in compromised margins with increase local recurrence. Navigation-assisted and patient-specific instrument (PSI) techniques have recently been reported in assisting pelvic tumor surgery with the tendency of improving surgical accuracy. We examined and compared the accuracy of transferring a virtual pelvic resection plan to actual surgery using navigation-assisted or PSI technique in a cadaver study.

Methods

We performed CT scan in twelve cadaveric bodies including whole pelvic bones. Either supraacetabular or partial acetabular resection was virtually planned in a hemipelvis using engineering software. The virtual resection plan was transferred to a CT-based navigation system or was used for design and fabrication of PSI. Pelvic resections were performed using navigation assistance in six cadavers and PSI in another six. Post-resection images were co-registered with preoperative planning for comparative analysis of resection accuracy in the two techniques.

Results

The mean average deviation error from the planned resection was no different (\(p=0.19\)) for the navigation and the PSI groups: 1.9 versus 1.4 mm, respectively. The mean time required for the bone resection was greater (\(p=0.0006\)) for the navigation group than for the PSI group: 16.2 versus 1.1 min, respectively.

Conclusions

In simulated periacetabular pelvic tumor resections, PSI technique enabled surgeons to reproduce the virtual surgical plan with similar accuracy but with less bone resection time when compared with navigation assistance. Further studies are required to investigate the clinical benefits of PSI technique in pelvic tumor surgery.

Keywords

Navigation assistance Patient-specific instruments Periacetabular pelvic tumors Surgical accuracy 

Notes

Acknowledgments

We thank Ms. Janice Tsui (Project Assistant, Technology Applications in BioMed Unit, Industrial center, the Hong Kong Polytechnic University, Hong Kong SAR, China) for her assistance in design and fabrication of PSI and the evaluation of the resection accuracy by the navigation and PSI techniques. We thank Mr. Sun Wong (Project Engineer, Stryker China Limited) and Mr. Watson Chan (Sales Manager, Stryker China Limited) for operating the navigation machine in the cadaveric study.

Compliance with ethical standards

Conflict of interest

The institutions of one or more authors (SMK and CMW) have received funding from the Research Grants Council of the Hong Kong Special Administration Region (RGC Grant: CUHK 465412) for the work in the manuscript. Other authors (WKC, SKY and WIOL) declare no conflict of interest.

Ethical standards

This article does not contain any studies with human participants performed by any of the authors. No informed consent is needed as the study does not contain human participants.

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Copyright information

© CARS 2015

Authors and Affiliations

  • Kwok-Chuen Wong
    • 1
  • Kwan-Yik Sze
    • 2
  • Irene Oi-Ling Wong
    • 3
  • Chung-Ming Wong
    • 4
  • Shekhar-Madhukar Kumta
    • 5
  1. 1.Department of Orthopaedics and TraumatologyPrince of Wales HospitalShatinHong Kong
  2. 2.Technology Applications in Biomed Unit, Industrial CentreThe Hong Kong Polytechnic UniversityHung HomHong Kong
  3. 3.Division of Health Economics, Policy and Management, School of Public Health, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
  4. 4.Head of Rapid Prototyping and Tooling Unit, Industrial CentreThe Hong Kong Polytechnic UniversityHung HomHong Kong
  5. 5.Department of Orthopaedics and TraumatologyPrince of Wales Hospital, The Chinese University of Hong KongShatinHong Kong

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