Abstract
AimsResection of bone is performed in over 75% of all orthopaedic procedures and the electrically powered oscillating saw is commonly used to cut bone. Drawbacks are relatively large incisions and tissue damage due to overshooting often occur. Therefore, the goal of this study is to develop an improved bone-cutting system that has minimally invasive characteristics. MethodsA new reusable sawing system was designed that can be used in Minimally Invasive Surgery (MIS) consisting of a steerable wire passer and a tissue saving wire saw guide. The system was tested during surgery on a human cadaveric tibia and calcaneus. ResultsA MIS steerable compliant Nitinol needle was built and successfully used in a cadaveric surgery to position the cutting wire around a tibia and calcaneus. A wire saw operating system was built that was successfully used to cut the tibia and calcaneus. ConclusionA MIS bone-cutting system was successfully designed, manufactured and used in a cadaver study showing that safe minimally invasive bone-cutting is feasible for two bone types with minimal damage to the surrounding tissue. Design optimization is needed to stabilize the compliant Nitinol needle during wire saw positioning and to allow cutting of bones with smaller diameters.
Highlights
We developed two separate devices: 1 minimally invasive surgical (MIS) Cable passer needle to bring the wire saw in place, 2 MIS Wire saw and support system to guide the wire during operation
The curve of the needle of the cable passer describes a diameter is 36 mm being small enough to guide the wire saw around a small calcaneus bone and a larger tibia bone
The wheel-contact experiment conducted with parts of the wire saw support system showed little surface dents in consistent patterns of about 100 μm in length
Summary
Resection of bone is performed in many reconstructive orthopeadic procedures. The electrically powered oscillating saw is the most important tool to create bleeding surface planes in bone. Most of the saws in use are heavy and their manual handling requires considerable training as there is a serious risk of overshooting and damaging surrounding soft tissue [1]. To protect the surrounding tissue, the surgeon’s assistant uses clamps around the bone. These clamps require a larger incision and mainly protect the adjacent tissue of the bone, while the opposite tissue relative to the incisional entry point remains unprotected.
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