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What are the optimal targeting visualizations for performing surgical navigation of iliosacral screws? A user study

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Complex orthopaedic procedures, such as iliosacral screw (ISS) fixations, can take advantage of surgical navigation technology to achieve accurate results. Although the impact of surgical navigation on outcomes has been studied, no studies to date have quantified how the design of the targeting display used for navigation affects ISS targeting performance. However, it is known in other contexts that how task information is displayed can have significant effects on both accuracy and time required to perform motor tasks, and that this can be different among users with different experience levels. This study aimed to investigate which visualization techniques helped experienced surgeons and inexperienced users most efficiently and accurately align a surgical tool to a target axis.

Methods

We recruited 21 participants and conducted a user study to investigate five proposed 2D visualizations (bullseye, rotated bullseye, target-fixed, tool-fixed in translation, and tool-fixed in translation and rotation) with varying representations of the ISS targets and tool, and one 3D visualization. We measured the targeting accuracy achieved by each participant, as well as the time required to perform the task using each of the visualizations.

Results

We found that all 2D visualizations had equivalent translational and rotational errors, with mean translational errors below 0.9 mm and rotational errors below 1.1\(^\circ\). The 3D visualization had statistically greater mean translational and rotational errors (4.29 mm and 5.47\(^\circ\), p < 0.001) across all users. We also found that the 2D bullseye view allowed users to complete the simulated task most efficiently (mean 30.2 s; 95% CI 26.4–35.7 s), even when combined with other visualizations.

Conclusions

Our results show that 2D bullseye views helped both experienced orthopaedic trauma surgeons and inexperienced users target iliosacral screws accurately and efficiently. These findings could inform the design of visualizations for use in a surgical navigation system for screw insertions for both training and surgical practice.

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Funding

This study was funded by the Canadian Network for Research and Innovation in Machining Technology, Natural Sciences and Engineering Research Council of Canada, the Orthopaedic Trauma Association, and WorkSafeBC.

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Authors and Affiliations

  1. School of Biomedical Engineering, University of British Columbia, 2222 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada

    Prashant U. Pandey

  2. Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada

    Pierre Guy & Kelly A. Lefaivre

  3. Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada

    Antony J. Hodgson

Authors
  1. Prashant U. Pandey
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  2. Pierre Guy
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  3. Kelly A. Lefaivre
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  4. Antony J. Hodgson
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Corresponding author

Correspondence to Prashant U. Pandey.

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Conflict of interest

Prashant U. Pandey received grants from WorkSafeBC and from Natural Sciences and Engineering Research Council of Canada which funded the research work submitted in this manuscript. Pierre Guy received a grant from the Orthopaedic Trauma Association which funded the research work submitted in this manuscript. Dr Guy is a shareholder in Traumis Surgical Systems, and a consultatnt for Stryker, both of which have no relations to the submitted work. Kelly A. Lefavire is a shareholder in Curvafix, a consultant for Zimmer/Biomet, and receives research support from Zimmer/Biomet. All of these have no relation to the submitted work. Antony J. Hodgson received grants from Natural Sciences and Engineering Research Council of Canada, grants from Canadian Institutes of Health Research, during the conduct of the study and related to the submitted work. Dr. Hodgson is a shareholder in Traumis Surgical Systems, which has no relation to the submitted work. Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

This study was performed with institutional ethics board approval.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Pandey, P.U., Guy, P., Lefaivre, K.A. et al. What are the optimal targeting visualizations for performing surgical navigation of iliosacral screws? A user study. Arch Orthop Trauma Surg 143, 677–690 (2023). https://doi.org/10.1007/s00402-021-04120-7

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  • DOI: https://doi.org/10.1007/s00402-021-04120-7

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