Navigation-assisted surgery for bone and soft tissue tumors with bony extension.

Abstract

10073 Background: In recent times,minimally invasive surgery, such as endoscopic surgery, has gained a lot of popularity.The navigation system was introduced to orthopedic surgery in the 1990s. These days, computed tomography (CT)-based navigation systems are commonly used in spine and joint replacement surgery because of their precision. The aim of our study was to evaluate the accuracy and efficacy of navigation-assisted excision of bone and soft tissue tumors. Methods: From January 2006 to December 2009, we performed navigation-assisted surgery in 16 patients (11 men and 5 women; mean age, 39 years; range, 13-70 years). We diagnosed 9 benign bone tumors and 7 malignant bone and soft tissue tumors. In 2 patients, the malignant soft tissue tumors infiltrated the adjacent bones. We performed excisional biopsies for the benign tumors and en bloc excisions for the malignant tumors. In all the cases, the point registration method was used with 10 skin markers that were placed around the tumor. Each excisional difference between the preoperative and postoperative plans was evaluated histologically or by postoperative CT. Results: The mean preoperative registration matching time was 12.8 min (range, 8-25 min). The total mean preparation time was 24 min (range, 16-35 min). The mean accuracy of this system, which was determined using the skin markers, was 0.93 mm (range, 0.6-1.5 mm). All biopsied and excised specimens were evaluated by pathologic examination and postoperative CT imaging. The mean difference between the planned margin and postoperative CT or the excised histological specimen was 0 to 4 mm. The mean follow-up period was 53.2 months (range, 10-70 months). There were no local recurrences, except for a case of chordoma that required excision of skip metastases and a case of extraskeletal osteosarcoma, in which the patient died from the disease. Conclusions: We report our experience with navigation-assisted surgery for bone and soft tissue tumors performed using skin markers. Navigation-assisted surgery was indicated in the case of sufficiently reliable, accurate, and minimally invasive resections.