Abstract
Surgical navigation techniques have shown potential benefits in orthopedic oncologic surgery. However, the translation of these results to acral tumor resection surgeries is challenging due to the large number of joints with complex movements of the affected areas (located in distal extremities). This study proposes a surgical workflow that combines an intraoperative open-source navigation software, based on a multi-camera tracking, with desktop three-dimensional (3D) printing for accurate navigation of these tumors. Desktop 3D printing was used to fabricate patient-specific 3D printed molds to ensure that the distal extremity is in the same position both in preoperative images and during image-guided surgery (IGS). The feasibility of the proposed workflow was evaluated in two clinical cases (soft-tissue sarcomas in hand and foot). The validation involved deformation analysis of the 3D-printed mold after sterilization, accuracy of the system in patient-specific 3D-printed phantoms, and feasibility of the workflow during the surgical intervention. The sterilization process did not lead to significant deformations of the mold (mean error below 0.20 mm). The overall accuracy of the system was 1.88 mm evaluated on the phantoms. IGS guidance was feasible during both surgeries, allowing surgeons to verify enough margin during tumor resection. The results obtained have demonstrated the viability of combining open-source navigation and desktop 3D printing for acral tumor surgeries. The suggested framework can be easily personalized to any patient and could be adapted to other surgical scenarios.
Highlights
Surgical navigation allows relating the pose of specific instruments to the patient’s imaging studies in real-time by means of a tracking system and patient-to-image registration [1]
We propose a surgical workflow that includes patient-specific 3D-printed molds to ensure that the distal extremity position depicted in preoperative images resembles the one found during surgery
We measured the distance from the surgical tumor margin, calculated from points recorded after tumor resection, to the tumor segmented on the preoperative computed tomography scan (CT) image
Summary
Surgical navigation allows relating the pose of specific instruments to the patient’s imaging studies in real-time by means of a tracking system and patient-to-image registration [1] This technology has shown potential benefits in orthopedic oncology surgeries on pelvic, sacral, spinal, and bone tumors [2,3,4,5]. Sci. 2020, 10, 8984 and the high cost of these devices Very particular procedures, such as the resection of acral tumors (those located in distal extremities such us hands or feet), have no clear benefit from navigation because it is complicated to adapt commercial systems to the necessities of those surgeries [7,8].
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