Amir Sternheim1, Dani Rotman2, Prakash Nayak3, Michelle Arkhangorodsky4, Michael J Daly4, Jonathan C Irish4,5,6, Peter C Ferguson7,8, Jay S Wunder7,8. 1. National Unit of Orthopaedic Oncology, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Amirsternheim@gmail.com. 2. National Unit of Orthopaedic Oncology, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India. 4. The TECHNA Institute, University Health Network, Toronto, ON, Canada. 5. Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada. 6. Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada. 7. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. 8. University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada.
Abstract
PURPOSE: Several technologies have been implemented in orthopedic surgery to improve surgical outcomes, usually focusing on more accurate execution of a surgical plan, but the development of the plan itself is also of great importance. The purpose of this study is to examine whether the use of preoperative computer planning platforms can improve the surgical plan? METHODS: Eight surgeons created a preoperative surgical plan to resect a distal femur parosteal osteosarcoma in two settings: (1) Using a 2-D and 3-D CT scan only (current standard); and (2) using a computer-assisted planning platform. The plans were thereafter virtually executed using a novel surgical navigation system and a Sawbones model. This simulated model was derived from, and identical to, an actual patient scenario. The outcomes of interest were the number of positive margin cuts, and the volume of the resected specimen. RESULTS: Using the surgical plan developed with computer assistance, there were 4 positive margin cuts made by 2 surgeons. In comparison, using standard planning, there were 14 positive margin cuts made by all 8 surgeons (p = 0.02). The resection volume was larger in the computer-assisted plans (96 ± 10 mm3) than in the standard plans (88 ± 7 mm3) (p = 0.055). CONCLUSIONS: Computer-assisted planning significantly decreased the risk of a positive margin resection in this Sawbones tumor model used to simulate resection of a primary bone sarcoma. This proof of concept study highlights the importance of advanced surgical planning and sets the ground for developing beneficial surgical planning systems.
PURPOSE: Several technologies have been implemented in orthopedic surgery to improve surgical outcomes, usually focusing on more accurate execution of a surgical plan, but the development of the plan itself is also of great importance. The purpose of this study is to examine whether the use of preoperative computer planning platforms can improve the surgical plan? METHODS: Eight surgeons created a preoperative surgical plan to resect a distal femur parosteal osteosarcoma in two settings: (1) Using a 2-D and 3-D CT scan only (current standard); and (2) using a computer-assisted planning platform. The plans were thereafter virtually executed using a novel surgical navigation system and a Sawbones model. This simulated model was derived from, and identical to, an actual patient scenario. The outcomes of interest were the number of positive margin cuts, and the volume of the resected specimen. RESULTS: Using the surgical plan developed with computer assistance, there were 4 positive margin cuts made by 2 surgeons. In comparison, using standard planning, there were 14 positive margin cuts made by all 8 surgeons (p = 0.02). The resection volume was larger in the computer-assisted plans (96 ± 10 mm3) than in the standard plans (88 ± 7 mm3) (p = 0.055). CONCLUSIONS: Computer-assisted planning significantly decreased the risk of a positive margin resection in this Sawbones tumor model used to simulate resection of a primary bone sarcoma. This proof of concept study highlights the importance of advanced surgical planning and sets the ground for developing beneficial surgical planning systems.
Authors: Anthony M Griffin; Janet A Parsons; Aileen M Davis; Robert S Bell; Jay S Wunder Journal: Clin Orthop Relat Res Date: 2005-09 Impact factor: 4.176
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Authors: Axel Sahovaler; Michael J Daly; Harley H L Chan; Prakash Nayak; Sharon Tzelnick; Michelle Arkhangorodsky; Jimmy Qiu; Robert Weersink; Jonathan C Irish; Peter Ferguson; Jay S Wunder Journal: JB JS Open Access Date: 2022-05-05