Abstract
Purpose
Mandibular reconstruction using fibula free flap is a challenging surgical procedure. To assist osteotomies, computer-assisted surgery (CAS) can be used. Nevertheless, precise registration is required and often necessitates anchored markers that disturb the patient and clinical flow. This work proposes a new contactless surface-based method adapted to featureless anatomies such as fibula to achieve a fast, precise, and reproducible registration.
Methods
Preoperatively, a CT-scan of the patient is realized and osteotomies are virtually planned. During surgery, a structured light camera digitizes the fibula. The obtained intraoperative point cloud is coarsely registered with the preoperative model using 3 points defined in the CT-scan and located on the patient’s bone with a laser beam. Then, a fine registration is performed using an ICP algorithm. The registration accuracy was evaluated comparing the position of points engraved in a 3D-printed fibula with their position in the registered model and evaluating resulting osteotomies. Accuracy and execution time were compared to a conventional stylus-based registration method. The work was validated in vivo.
Results
The experiment performed on a 3D-printed model showed that execution time is equivalent to surface-based registration using a stylus, with a better accuracy (mean TRE of 0.9 mm vs 1.3 mm using stylus) and guarantee good osteotomies. The preliminary in vivo study proved the feasibility of the method.
Conclusion
The proposed contactless surface-based registration method using structured light camera gave promising results in terms of accuracy and execution speed and should be useful to implement CAS for mandibular reconstruction.
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Acknowledgements
This work was supported in part by the French National Agency for Research (Agence Nationale pour la Recherche, ANR) within the Investissements d’Avenir Program (Labex CAMI, ANR-11-LABX0004, Labex NUMEV, ANR-10-LABX-20) and by the ROBOTEX 2.0 (Grants ROBOTEX ANR-10-EQPX-44-01 and TIRREX ANR-21-ESRE-0015).
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Written informed consent was obtained from all individual participants before study commencement. All procedures performed in our study were in accordance with the 1964 Helsinki declaration and its later amendments. Institutional review and approval were not required due to the noninvasive nature of our study.
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Cuau, L., De Boutray, M., Cavalcanti Santos, J. et al. Contactless surface registration of featureless anatomy using structured light camera: application to fibula navigation in mandible reconstruction. Int J CARS 18, 2073–2082 (2023). https://doi.org/10.1007/s11548-023-02966-3
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DOI: https://doi.org/10.1007/s11548-023-02966-3