Fluoroscopy Group Research Articles

Fluoroscopy Cannot Recognize Intraoperative Fracture in Patients Receiving 2-Incision Total Hip Arthroplasty

Intraoperative fluoroscopy is suggested as a standard procedure in 2-incision total hip arthroplasty. Between September 2003 and July 2004, 2-incision total hip arthroplasties were done in 18 hips with and another 18 hips without the use of fluoroscopy. In group 1, the anterior skin incision was initially limited to 5 cm. Fracture or instability was checked by fluoroscopy first and then the incision was enlarged to 8 cm for visualization. In group 2, incisions were made long enough to expose the surgical field. There were 2 femoral neck fractures in the fluoroscopy group. The fractures were linear in the anteromedial femoral neck and could not be detected by fluoroscopy. Such linear fractures if overlooked could result in serious complications such as fracture displacement or implant instability. Surgeons should not rely on intraoperative fluoroscopy to check implant stability, and visualization of the surgical field should not be compromised when doing minimally invasive approach for total hip arthroplasty.

Intraoperative fluoroscopy vs. intraoperative laparoscopic ultrasonography for early colorectal cancer localization in laparoscopic surgery

In colorectal cancer (CRC) surgery, precise tumor localization is important for oncologically correct surgery and adequate tumor and lymph node resection margins. During laparoscopic surgery it is difficult to localize early CRC. The aim of this study was to compare the usefulness of two tumor localization techniques; intraoperative fluoroscopy and intraoperative laparoscopic ultrasonography. Seventeen patients with CRC necessitating preoperative marking were alternately allocated to either the fluoroscopy (F) group (n = 8) or the laparoscopic ultrasonography (LU) group (n = 9). A three-step technique was used. At first lesions were localized preoperatively by metallic clips that were colonoscopically applied proximally and distally to the tumor site. Second, computed tomography (CT) colonography was taken to obtain preoperative staging. The location of the metallic clips was confirmed by CT colonography, preoperatively. Third, in the F group, intraoperative fluoroscopy was performed to localize the applied clips. In the LU group, the applied clips were detected from the serosal aspect of the colon using intraoperative laparoscopic ultrasonography. In all patients, colonoscopic metallic clips were successfully applied and preoperative CT colonography correctly detected the location of the tumor. Marking sites were detected precisely using intraoperative fluoroscopy or intraoperative laparoscopic ultrasonography in all cases, without complications. The mean detection time was 15.8 minutes in the F group and 7.0 minutes in the LU group (p = 0.005). In the LU group, two cases were technically difficult because of interruption of the ultrasound by intestinal air. Both intraoperative fluoroscopy and intraoperative laparoscopic ultrasonography are safe and accurate techniques for intraoperative localization of early CRC. With regard to detection time, intraoperative laparoscopic ultrasonography is superior to intraoperative fluoroscopy. However, when there is a massive amount of intestinal air, intraoperative laparoscopic ultrasonography is cumbersome in localizing the lesion. Computed tomography colonography is useful for preoperative tumor localization and might be effective for shortening detection time during surgery.

Two-Incision Total Hip Replacement: Intra-Operative Fluoroscopy versus Imageless Navigation for Cup Placement

The purpose of this study was to describe the surgical technique and to investigate results of a modified two-incision total hip replacement using either intraoperative fluoroscopy or imageless navigation. Twenty-nine patients (30 hips) with a minimum follow-up of one year were enrolled in this study. The patients were evaluated at 3, 6, 12 weeks, 6 months, and 1-year. The functional recovery as represented by the Harris hip score and WOMAC scale were better in the fluoroscopy group of patients at the early postoperative stage (3 wks). Thereafter, both groups showed rapid recovery with no difference in scores. Injury to the lateral femoral cutaneous nerve was the most commonly seen complication and it occurred in 6 hips (fluoroscopy 2; imageless 4). The symptoms were transient and resolved in 6 months in all 6 cases. This study demonstrated that the role of intraoperative fluoroscopy could safely be replaced by an imageless navigation system for the MIS-2 THA.

Two-incision total hip replacement: Intra-operative fluoroscopy versus imageless navigation for cup placement

The purpose of this study was to describe the surgical technique and to investigate results of a modified two-incision total hip replacement using either intraoperative fluoroscopy or imageless navigation. Twenty-nine patients (30 hips) with a minimum follow-up of one year were enrolled in this study. The patients were evaluated at 3, 6, 12 weeks, 6 months, and 1-year. The functional recovery as represented by the Harris hip score and WOMAC scale were better in the fluoroscopy group of patients at the early postoperative stage (3 wks). Thereafter, both groups showed rapid recovery with no difference in scores. Injury to the lateral femoral cutaneous nerve was the most commonly seen complication and it occurred in 6 hips (fluoroscopy 2; imageless 4). The symptoms were transient and resolved in 6 months in all 6 cases. This study demonstrated that the role of intraoperative fluoroscopy could safely be replaced by an imageless navigation system for the MIS-2 THA.

PII: S0090-3019(05)00196-5

Ommaya reservoirs are used for administration of intrathecal chemotherapy and cerebrospinal fluid sampling. Ventricular catheter placement for these purposes requires a high degree of accuracy. Various options exist to optimize catheter placement. We analyze a cohort of patients receiving catheters using 2 different technologies.Retrospective chart review was performed on patients undergoing Ommaya reservoir placement between 2011 and 2014. Most procedures were assisted by either frameless stereotactic neuronavigation or fluoroscopic guidance with pneumoencephalogram. Catheter accuracy, revision rates, perioperative complications, and operative time were measured. Preoperative similarities and differences in diagnosis, demographics, and ventricular size were also recorded to avoid a biased assessment of our results.One-hundred and forty-five patients were included, 57 using fluoroscopic guidance and 88 using frameless stereotaxy. Common diagnoses in both groups were lymphoma and leptomeningeal disease. Qualitative measures of catheter placement accuracy showed no significant difference between the 2 groups. Proximity to the foramen of Monro favored fluoroscopy by a small margin (8.6 mm vs. 10.2 mm, P = 0.03). Overall revision rates were not significantly different between the groups (3.5% vs. 4.5%, P = 1.00). Early surgical complications occurred in 6.8% of the frameless stereotaxy group and 1.8% of the fluoroscopy group (P = 0.25).Ommaya reservoirs can be placed accurately using different methods. Although there are slight differences between fluoroscopy and frameless stereotaxy in quantitative accuracy and procedure time, there is no significant advantage of 1 method over the other when evaluating revision or complication rates. Technique familiarity and surgeon preference may dictate the preferred procedure.

Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy: A comparison of indications, complications and outcomes in 370 patients

Objective: Percutaneous access to the stomach can be achieved by endoscopic or fluoroscopic methods. Our objective was to compare indications, complications, efficacy and outcomes of these two techniques. Methods: Records of 370 patients with feeding tubes placed either endoscopically by gastroenterology, or fluoroscopically by radiology, at our university-based tertiary care center over a 54-month period were reviewed. Results: 177 gastrostomies were placed endoscopically and 193 fluoroscopically. Nutrition was the most common indication in each group (94 and 92%), but the most common underlying diagnosis was neurologic impairment in the endoscopic group ( n = 89, 50%) and malignancy in the fluoroscopic group ( n = 134, 69%) ( p < 0.001). Complications in the first 30 days were more common with fluoroscopic placement (23% versus 11%, p = 0.002), with infection most frequent. Correlates of late complications were inpatient status (OR 0.26, 95%CI: 0.13–0.51) and a diagnosis of malignancy (OR 2.2, 95%CI: 1.03–4.84). Average follow-up time was 108 days in the fluoroscopic group and 174 days in the endoscopic group. Conclusions: Both endoscopic and fluoroscopic gastrostomy tube placement are safe and effective. Outpatient status was associated with greater early and late complication rates; minor complications such as infection were greater in the fluoroscopic group, while malignancy was associated with late complications.

Value of Computed Tomographic Fluoroscopy for Cervical and Lumbar Facet Blocks

The objective of this study is to compare the diagnostic accuracy and efficacy of computed tomographic fluoroscopy (CTF)-guided cervical and lumbar facet blocks with conventional fluoroscopy. Two hundred one cervical and lumbar facet blocks were performed over a 2-year period. One hundred one procedures were performed with CTF and 100 with conventional fluoroscopy. Patients were asked to rate pain on a scale of 1 to 10 before and after the procedure, and these results were compared between the 2 groups. The average pre- and postscores for the conventional fluoroscopy group were 7.0 ± 2.1 and 3.0 ± 2.6. Scores for the CTF-guided group were 6.0 ± 2.3 and 1.5 ± 2.2. The CTF group had a greater percentage decrease in pain (77.2% ± 31.1%) than the conventional fluoroscopy group (53.9% ± 38.7%; P < 0.0005). The use of CTF for cervical and lumbar facet blocks has greater diagnostic accuracy and therapeutic effect than conventional fluoroscopy.

Fluoroscopy-Based Surgical Navigation versus Fluoroscopic Guidance to Control Guide Wire Insertion for Osteosynthesis of Femoral Neck Fractures

Long fluoroscopic times and related radiation exposure are a universal concern when C-arm fluoroscopy is used to guide percutaneous procedures. Fluoroscopy-based surgical navigation has been proposed as an alternative guidance method requiring limited fluoroscopic times to achieve precision. The purpose of this experimental study was to compare fluoroscopy-based surgical navigation with C-arm fluoroscopy for guidance with respect to the precision achieved, the fluoroscopic time, and the resources needed. 114 guide wires were placed in 38 synthetic bone models using either C-arm fluoroscopy (group A) or fluoroscopy-based surgical navigation (group B) for guidance. Precision of guide wire placement was rated on the basis of an individual CT scan on all fracture models of both groups. The fluoroscopic time, the procedure time, and the number of attempts required to place the guide wires were documented as well. An average fluoroscopic time of 26 s was needed with C-arm fluoroscopy to place three guide wires compared with an average fluoroscopic time of 2 s that was needed when fluoroscopy-based surgical navigation was used for guidance (p < 0.0001). Precision of guide wire placement and procedure times required to place the guide wires did not differ significantly between both groups. The number of attempts required for correct placement was found significantly reduced with fluoroscopy-based surgical navigation when compared with fluoroscopic guidance (p = 0.04). Fluoroscopic times to achieve precision are reduced with fluoroscopy-based surgical navigation compared with C-arm fluoroscopy. The impact of this new technique on minimally invasive, percutaneous procedures has to be evaluated in controlled prospective clinical studies.

Comparison of virtual fluoroscopy to conventional fluoroscopy for C1–C2 transarticular screw fixation

Purpose of study: To compare virtual fluoroscopy to conventional fluoroscopy for transarticular screw fixation in a cadaveric model.Methods used: Twenty-two C1–C2 transarticular screws were placed in 11 cadavers using either virtual fluoroscopy or conventional fluoroscopy. One side of each cadaver was treated using virtual fluoroscopy, and the other side was treated using conventional fluoroscopy; the order of techniques was alternated between consecutive cadavers. Procedure time and fluoroscopy time were recorded. After the procedure, the spines were harvested and analyzed to determine the accuracy of screw placement and length using a standard technique. Measurement of anatomic vertebral parameters was also performed allowing new recommendations for safe screw placement.of findings: Significantly less fluoroscopy time (p=.046) was required in the virtual fluoroscopy group (3.2 vs. 5.7 seconds), although the fluoroscopy time was small in both groups. No significant differences (p<.05) in procedure time were found. In the conventional fluoroscopy group, two screws were found to be partially malpositioned without endangering vital or neurovascular structures. In the virtual fluoroscopy group, there were five malpositioned screws with one screw demonstrating contact with the vertebral artery. Three of the 11 cadavers were found to have unsatisfactory anatomy for C1–C2 screw placement in that the bony corridor for screw placement was small than the diameter of the screw.Relationship between findings and existing knowledge: Virtual fluoroscopy is gaining acceptance in many areas of musculoskeletal surgery. However, there are no reports of the use of virtual fluoroscopy to guide the placement of C1–C2 transarticular screws.Overall significance of findings: Although C1–C2 transarticular screws are known to provide rigid fixation of the atlantoaxial complex, the operative setup and surgical technique remain a challenge. Traditionally, a combination of anatomic and fluoroscopy landmarks are used to guide implant placement. Virtual fluoroscopy has the potential to simplify the setup and procedure, but screw accuracy remains a concern. The results of this study suggest virtual fluoroscopy may lead to decreased accuracy, and therefore further refinement of the technique should be undertaken before it can be recommended for clinical applications.Disclosures: Device or drug: screw. Status: not approved.Conflict of interest: No conflicts.

Clinical results of percutaneous pelvic surgery. Computer assisted surgery using ultrasound compared to standard fluoroscopy.

This study presents early results of clinical experience with the application of Computer Assisted Surgery (CAS) to percutaneous iliosacral screwing, with comparison to a historical series of patients treated using percutaneous fluoroscopy. Four patients were instrumented using a CAS system, with 10 screws being inserted. Thirty patients were treated by percutaneous fluoroscopic screwing, with 51 screws being inserted. The follow-up assessment included the following criteria; operative time, parameters of radiation exposure, neurological examination, screw placement evaluation on CT-scan, antalgic drug consumption, pain, Majeed grading, and loosening of implants. In the CAS group, the average radiation time was 0.35 min per patient and 0.14 min per screw. No trajectories outside the bone and no postoperative neurological deficits were found. In the fluoroscopic group, the average radiation time was 1.03 min per patient and 0.6 min per screw. Twelve screws had outside-bone trajectories, and iatrogenic neurological deficits were found in seven patients. The average operative time was 50 min in the CAS group and 35 min in the fluoroscopic group. The present CAS technique shows better placement of iliosacral screws, with no outside-bone trajectories and lower radiation exposure.

Clinical Results of Percutaneous Pelvic Surgery. Computer Assisted Surgery Using Ultrasound Compared to Standard Fluoroscopy

This study presents early results of clinical experience with the application of Computer Assisted Surgery (CAS) to percutaneous iliosacral screwing, with comparison to a historical series of patients treated using percutaneous fluoroscopy. Four patients were instrumented using a CAS system, with 10 screws being inserted. Thirty patients were treated by percutaneous fluoroscopic screwing, with 51 screws being inserted. The follow-up assessment included the following criteria; operative time, parameters of radiation exposure, neurological examination, screw placement evaluation on CT-scan, antalgic drug consumption, pain, Majeed grading, and loosening of implants. In the CAS group, the average radiation time was 0.35 min per patient and 0.14 min per screw. No trajectories outside the bone and no postoperative neurological deficits were found. In the fluoroscopic group, the average radiation time was 1.03 min per patient and 0.6 min per screw. Twelve screws had outside-bone trajectories, and iatrogenic neurological deficits were found in seven patients. The average operative time was 50 min in the CAS group and 35 min in the fluoroscopic group. The present CAS technique shows better placement of iliosacral screws, with no outside-bone trajectories and lower radiation exposure.

Gastrostomy by Various Techniques: Evaluation of Indications, Outcome, and Complications

Background: Gastrostomy can be performed with a percutaneous fluoroscopic technique, a percutaneous endoscopic technique, or open surgery. Since all three methods are in use at our hospital, we made this retrospective study to compare indications, complications, and outcomes for the different techniques. Methods and Results: During the period January 1990 to December 1994, 147 patients admitted to Lund University Hospital required gastrostomy. The records of these patients were retrospectively studied. Six patient records could not be found, and these patients were therefore excluded. Of the remaining 141 patients, 94 had undergone fluoroscopic percutaneous gastrostomy, 12 percutaneous endoscopic gastrostomy (PEG), and 35 gastrostomy at open surgery. The 30-day overall mortality was 15% in the fluoroscopy group, 17% in the endoscopy group, and 29% in the open surgery group. The 30-day mortality as related to the procedure was 3.2% in the fluoroscopy group, 0% in the PEG group, and 2.9% among the patients with open surgery. The morbidity related to the procedure was 16%, 8%, and 20%, respectively. For the 30-day overall mortality and for the procedure-related mortality there was no statistically significant difference between the groups (P = 0.2019, P = 0.8215). For the percutaneous procedures the indication was nutrition in most patients. For the patients receiving gastrostomy at open surgery drainage was the main indication. Even though the complication rate was higher in this group, most complications were minor, and there was only one procedure-related death. Gastrostomy at open surgery is often performed in severely ill patients. Despite this, it does not seem to cause more complications than the percutaneous techniques in our study. Conclusion: The study shows that gastrostomies are safe procedures, with few complications and a low procedure-related mortality independent of the technique being used.

Does fluoroscopic guidance for Maloney esophageal dilation impact on the clinical endpoint of therapy: relief of dysphagia and achievement of luminal patency

Background: Use of fluoroscopy for Maloney esophageal dilation is controversial. We designed this prospective, randomized, single-blinded study to determine whether fluoroscopic guidance has an impact on relief of dysphagia and achievement of luminal patency.Methods: Patients with benign esophageal strictures were randomized to undergo Maloney dilation with or without fluoroscopic guidance. Strictures were dilated to size 48F. Dysphagia scores were obtained before and 1 week after dilation.Results: Eighty-three patients underwent 100 dilation sessions with fluoroscopic guidance being used for 50 sessions (156 dilations) and blinded technique for 50 (161 dilations). A 12.5 mm barium pill passed after dilation following 62.0% of the fluoroscopic dilation sessions and 42.0% of the blinded dilations ( p = 0.045). Dysphagia was improved in 93.0% of patients receiving fluoroscopic dilations and 69.0% of patients receiving blinded dilations ( p = 0.006). The mean improvement in dysphagia score was –2.10 points for the fluoroscopic group versus -1.50 points for the blinded group ( p = 0.057). Differences in these parameters between techniques were even greater in 12 patients re-randomized to both techniques at different sessions.Conclusions: The use of fluoroscopic guidance impacts favorably on the efficacy of Maloney dilation, resulting in greater relief of dysphagia and increased luminal patency compared to the blinded technique. Based on these results, use of fluoroscopy is recommended when Maloney esophageal dilation is performed. (Gastrointest Endosc 1996;43:93-7.)