Comparison of patient-specific instrumentation, navigation, and mixed reality technologies for accurate glenoid positioning in reverse total shoulder arthroplasty: a systematic review and meta-analysis.

Effect of surgeon expertise on the accuracy and time required for fluoroscopic, navigated, and robot-assisted thoracolumbar pedicle screw placement

This study aims to analyze digital readiness and innovation in Indonesian hospitals in the context of post-pandemic healthcare management ‎using a Systematic Literature Review (SLR) approach. The literature search was conducted in Scopus, Web of Science, PubMed, and ‎Google Scholar databases for the period 2019–2025 using the keywords digital readiness, hospital innovation, digital transformation, and ‎post-pandemic healthcare. Of the 659 articles identified, 29 met the inclusion criteria for thematic analysis. The study results indicate that ‎digital readiness in hospitals is significantly influenced by transformational leadership, adaptive organizational culture, human resource digi-‎tal competency, and national policy support. Innovation in healthcare management focuses on the development of telemedicine, the integra-‎tion of the Internet of Things (IoT), and the use of artificial intelligence (AI) to improve service efficiency. However, challenges such as ‎limited digital infrastructure, resistance to change, and low interoperability of information systems remain major obstacles. Overall, these ‎findings confirm that digital transformation is a strategic foundation for strengthening hospital resilience and competitiveness in the post-‎pandemic era. This study contributes to policy direction and managerial strategies for realizing a sustainable digital transformation oriented ‎toward value-based healthcare in Indonesia‎.

Retrospective cost-analysis study. The primary aim of this study was to determine the cost-effectiveness from a public payer's perspective between RAN, NAV, and FH. Robotic-assisted navigation (RAN) and image-guided intraoperative navigation (NAV) are associated with higher pedicle screw placement accuracy and lower complication rates than freehand (FH) technique to treat idiopathic scoliosis. However, RAN and NAV are underutilized and payer coverage remains limited. A Markov decision-analysis model for a cost-utility analysis of FH/NAV/RAN for patients with IS was created, and a probability sensitivity analysis was performed. Probabilities of health states, associated reimbursement costs, and quality-adjusted life years (QALYs) were estimated from literature. For each technique, incremental cost-utility ratio (ICURs), net costs, incremental net monetary benefit, net monetary benefit, and QALYs were calculated. Cost-effectiveness acceptability (CEA) curve analysis was performed by varying WTPT between $10,000 and $250,000. Deterministic sensitivity analysis (DSA) was performed by varying probabilities, QALYs, and costs. For cost-effective treatment strategies, cost savings to payers, if present, were calculated over a seven-year horizon. When compared with FH technique, the ICUR of RAN ($10,672/QALY) and NAV (-$108,831/QALY) were below the societal willingness-to-pay threshold (WTPT) of $50,000. RAN was not more cost-effective than NAV (ICUR: $255,518/QALY) at a WTPT of $50,000. However, CEA demonstrated that RAN was the most cost-effective strategy for all WTPTs above $50,000. The mean cost of NAV per patient was lower than FH by $3610 (95% CI: $3419-$3801; P < 0.001). Mean cost of RAN per patient was higher than FH by $527 (95% CI: $267-$786; P < 0.001) and NAV by $4137 (95% CI: $3953-4320; P < 0.001). DSA demonstrated sensitivity to < 25% of variables. NAV and RAN are both more cost-effective than FH. NAV can save payers $45 million over seven years. Payers should consider increasing reimbursement coverage for NAV and RAN. Level III.

Ectopic thyroid tissue results from the embryonic failure of the thyroid gland to descend along the thyroglossal duct, resulting in the presence of thyroid tissue in an abnormal location. One of the most common locations where ectopic thyroid tissue (ETT) is found is at the base of the tongue, referred to as a lingual thyroid, having an estimated prevalence of 1 out of 100,000 to 300,000 in healthy individuals. We present the case of a 15-year-old female with a progressively enlarging mass at the base of her tongue, associated with dysphagia and sleep apnoea. Hormonal tests revealed hypothyroidism. Adopting a transoral approach, total resection was performed via electrocautery. Histopathology report revealed squamous lined tissue exhibiting mucous gland, confirming the diagnosis of ectopic lingual thyroid. The patient was started on thyroxine maintenance therapy and showed significant improvement.

Brain-computer interface (BCI) systems, a branch of human-computer interaction (HCI), are normally adopted to create a direct communication pathway between the brain and external environments.Existing BCI methods struggle to deal with high-dimensional EEG features and computational complexity.This paper introduces a new feature optimization strategy for this struggle, called Evolutionary Strategy for Feature Selection with Dimension Reduction (ES_FSDR), in the EEG classification model.The ES_FSDR employs machine learning techniques to select the most related features by a new representation of evolutionary strategies in a subset of features and hybridize them by reducing the features' dimensions for the least amount of complexity and efficient operation for this subset of features, which consequently affects the EEG signal classification performance.;this strategy is applied to instantaneous frequency features in signal processing.This strategy aims to learn robust and meaningful feature representations for the BCI classifiers.ES_FSDR is particularly useful in EEG no stationary signal processing situations involving numerous features and high dimensionality.Individually, participants completed five different mental activities while 15 EEG channels were chosen to create a baseline.Mental tasks include "dynamic imagery," e.g., hand motor imagery (HAND), feet motor imagery (FEET), and "non-dynamic imagery," e.g., mental word association (condition WORD), mental subtraction (SUB), and spatial navigation (NAV).Both withinday analysis and between-day offline modeling investigated classification of five distinct mental task imagery from nine users with disability central nervous CNS system impairment for the available dataset from BNCI Horizon 2020.Findings demonstrate how effectively the suggested model increases accuracy obtained using multi-classification in the dataset within a day, which is around 98.31%.And between a day dataset, the results are around 95%.Moreover, the model that is suggested outperforms the classifying accuracy compared with other different performance methods.

Robotic-assisted pedicle screw placement improves accuracy, precision, and breach rates compared with freehand and image-guided navigation techniques: a cadaveric study.

Introduction Intraoperative navigation (NAV), augmented reality (AR), and robotics have emerged as promising new technologies in shoulder arthroplasty. Previous research in these areas has focused on the use of these technologies by surgeons, but not on understanding patient knowledge and perceptions. This study aimed to characterize patients’ baseline understanding and perceptions of new technology in shoulder arthroplasty and see if educational content in this area enhances or changes their views of these technologies. Methods A 38-question survey was administered to adult patients to assess baseline knowledge and perception of NAV, AR, and robotic surgery technologies. Subjects were recruited from local public areas (e.g., golf clubs, and grocery stores) and orthopedic clinics across Palm Beach County to provide a broad array of demographics. Baseline assessments were performed, and then educational materials were provided about each of the technologies. After learning about the different technologies, the participants repeated the survey. Bivariate analysis of categorical variables was performed. Multivariable logistic regression model evaluated factors associated with a preference for the use of technology in shoulder procedures. Results Of the 77 responders, the majority were not familiar with NAV (57.1%) or AR (70.1%). Patients were somewhat familiar with robotics (51.9%). NAV and robotic surgery were perceived to lead to better results in 51.9% and 53.2% of responders, respectively. AR was perceived to have no specific benefit (51.9%) after shoulder surgery. After reading the provided educational materials, most patients expected faster recovery (57.1%) and fewer complications (53.2%) with NAV. In contrast, with AR and robotics, most patients (&gt;50%) expected no specific benefits. Most respondents did not see these technologies would be helpful for pain relief. The primary reported concerns of respondents were lack of surgeon experience with the technology and increased cost. Overall, 50% of participants had a preference for surgeons who use these technologies, and most (68.8%) thought surgeons using these technologies are of similar skill compared to surgeons who do not utilize technology. Multivariate regression modeling revealed that respondents of Asian race were more likely to prefer surgeons who do not use technology (p= 0.042). Conclusion The public appears to be unaware of various forms of technology used today in shoulder surgery and there are misperceptions of superior outcomes with these technology-assisted surgeries. Brief descriptions of these technologies did appropriately enhance patients’ understanding and expectation for these technologies applied in shoulder surgery. More patient-directed education is needed if we are to incorporate these innovative technologies in surgery. Furthermore, this may prove to be a powerful marketing tool for surgeons and hospitals.

The human brain functional connectivity network (FCN) is constrained and shaped by the communication processes in the structural connectivity network (SCN). The underlying communication mechanism thus becomes a critical issue for understanding the formation and organization of the FCN. A number of communication models supported by different routing strategies have been proposed, with shortest path (SP), random diffusion (DIF), and spatial navigation (NAV) as the most typical, respectively requiring network global knowledge, local knowledge, and both for path seeking. Yet these models all assumed every brain region to use one routing strategy uniformly, ignoring convergent evidence that supports the regional heterogeneity in both terms of biological substrates and functional roles. In this regard, the current study developed a hybrid communication model that allowed each brain region to choose a routing strategy from SP, DIF, and NAV independently. A genetic algorithm was designed to uncover the underlying region-wise hybrid routing strategy (namely HYB). The HYB was found to outperform the three typical routing strategies in predicting FCN and facilitating robust communication. Analyses on HYB further revealed that brain regions in lower-order functional modules inclined to route signals using global knowledge, while those in higher-order functional modules preferred DIF that requires only local knowledge. Compared to regions that used global knowledge for routing, regions using DIF had denser structural connections, participated in more functional modules, but played a less dominant role within modules. Together, our findings further evidenced that hybrid routing underpins efficient SCN communication and locally heterogeneous structure-function coupling.

Correct acetabular component placement plays a critical role in reducing early revisions after dislocations in total hip arthroplasty (THA). Although the transverse acetabular ligament (TAL) guides anteversion, inclination can only be accurately guided by navigation. In order to overcome the initial disadvantages with navigation, an imageless, easy-to-use inertial navigation system has been recently introduced. This study aims to analyze the accuracy of inclination with this navigation system compared to the standard manual technique. Two cohorts, manual technique (MT) and navigation (NAV) cohorts, consisted of 83 and 95 patients, respectively, after exclusion criteria were applied. Inclination target was 38° and anteversion was guided by TAL. Demographic data were collected, and anteroposterior (AP) pelvic and cross-table lateral radiographs were obtained 6 weeks post-operatively. Inclination and anteversion were determined on the AP pelvic and cross-table lateral radiograph, respectively. A mean inclination of 41.8° (±6.8°) and 38.9° (±4.4°) was found in the MT and NAV cohorts, respectively. There was no statistical difference in gender, age, and BMI. If the inclination was set within 10° of the target (i.e., 38°), 88% of the MT cohort and 97% of the NAV cohort were within the target zone. Accuracy decreased to 53% and 83%, respectively, if the target zone range was narrowed down to±5°. Combining inertial imageless navigation for inclination and TAL as a landmark for anteversion is significantly more accurate compared to the manual technique, without having the limitations and disadvantages of current standard navigational techniques.

BackgroundComponent malpositioning and joint malalignment following unicompartmental knee arthroplasty (UKA) increase the risk for revision. This study investigates whether accelerometer-based navigation (NAV) decreases radiographic outliers with respect to component placement and joint alignment in comparison to conventional instrumentation in UKA. MethodsA radiographic review of UKAs was performed by a single surgeon following adoption of an accelerometry-guided navigation system (OrthAlign, Aliso Viejo, CA). This cohort was then compared to previous patients undergoing UKA with conventional instrumentation. Six-week postoperative radiographs were used to compare femoral coronal and sagittal angles, tibial coronal and sagittal angles, the net coronal angle, tibial component rotation, and medial tibial overhang. Outliers in implant positioning were compared between groups. Patient variables including age, gender, body mass index, American Society of Anesthesiology, and surgical time (incision until the start of closure) were also compared between groups. ResultsEighty-eight UKA’s were reviewed (49 conventional instrumentation [CI] patients; 39 NAV patients). Using 2-sample t-tests, no significant differences were found in patient demographics, radiographic parameters, and operative times between the CI and NAV cohorts. Using chi-squared tests, no significant difference was found in the number of radiographic outliers between the CI and NAV cohorts. ConclusionsOur study found that a high-volume UKA surgeon achieved a low rate of radiographic outliers in both NAV and CI cohorts. This data suggests that NAV is no different from conventional instrumentation with respect to implant positioning, overall joint alignment, and operative time when used by a high-volume UKA surgeon.

ABSTRACTBACKGROUND:Imaging tests are important for diagnosis during the management of pulmonarynodules; however, biopsy is required to confirm the malignancy.OBJECTIVES:To compare the effects of different techniques used for the biopsy of apulmonary nodule.DESIGN AND SETTING:Systematic review and meta-analysis were conducted using Cochrane methodologyin São Paulo, São Paulo, Brazil.METHODS:We conducted a systematic review of randomized controlled trials (RCTs) onminimally invasive techniques, including tomography-guided percutaneousbiopsy (PERCUT), transbronchial biopsies with fluoroscopy (FLUOR),endobronchial ultrasound (EBUSR), and electromagnetic navigation (NAVIG).The primary outcomes were diagnostic yield, major adverse events, and needfor another approach.RESULTS:Seven RCTs were included (913 participants; 39.2% female, mean age: 59.28years). Little to no increase was observed in PERCUT over FLUOR (P = 0.84),PERCUT over EBUSR (P = 0.32), and EBUSR over NAVIG (P = 0.17), whereas aslight increase was observed in NAVIG over FLUOR (P = 0.17); however, theevidence was uncertain. EBUSR may increase the diagnostic yield over FLUOR(P = 0.34). PERCUT showed little to no increase in all bronchoscopictechniques, with uncertain evidence (P = 0.02).CONCLUSION:No biopsy method is definitively superior to others. The preferred approachmust consider availability, accessibility, and cost, as safety anddiagnostic yield do not differ. Further RCTs planned, conducted, andreported with methodological rigor and transparency are needed, andadditional studies should assess cost and the correlation between nodulesize and location, as well as their association with biopsy results.SYSTEMATIC REVIEW REGISTRATION:PROSPERO database, CRD42018092367 -https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=92367.

32.4 #IamSafe: A Multi-Site Randomized Controlled Trial of a Youth and Family-Based Suicide Prevention Intervention for Adolescents Presenting to the Emergency Department With Suicide-Risk Behaviors

Total knee arthroplasty (TKA) performed for valgus osteoarthritis (OA) presents a challenge to the arthroplasty surgeon in regards to achieving appropriate soft tissue balance and alignment. Robotic assisted surgery (RAS) with navigation (NAV) has been proposed as a potential solution to assist surgeons when performing these difficult cases. Here, we present the case of a complex primary TKA in a patient with posttraumatic valgus arthritis performed using a novel RAS system with NAV. Appropriate balance was unable to be achieved with bony cuts alone, as the knee was found to be tight laterally in extension following bone preparation. Soft tissue releases were ultimately required. Use of the novel RAS system with NAV allowed for a titrated soft tissue release resulting in a balanced knee without overcorrection of the patient’s deformity. We also present a similar case of a patient with valgus knee OA in which there was residual tightness laterally in flexion. The different management strategies for each of these cases is discussed. Finally, we provide a review of the available literature regarding TKA in valgus knee OA and propose a new classification system and treatment algorithm that can be employed using a novel RAS system with predictive balancing technology to achieve optimal alignment and soft tissue balancing in valgus knees that remain unbalanced following bony cuts.

The differences in clinical and radiographic outcomes between 3-dimensional computer navigation (NAV) and fluoroscopic-guided (FLUO) minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) are currently unclear, with different studies showing different advantages of each technique. This study aimed to compare the clinical and radiographic outcomes of NAV and FLUO MIS-TLIF. Furthermore, we determined the correlation between radiographic findings and predictable clinical outcomes. Between January 2016 and October 2018, 97 consecutive patients who had undergone MIS-TLIF with the lumbosacral degenerative disease in our institute were retrospectively reviewed. Radiographic outcomes (angle of screw convergence, screw-to-pedicle diameter ratio, %screw depth, screw penetration, %fusion, and facet joint violation) were analyzed by 2 independent orthopedists using thin-slice computed tomography. Clinical outcomes were assessed with Oswestry Disability Index (ODI), visual analog scale (VAS), and satisfaction score. The association between radiographic and clinical outcomes was then analyzed to determine the predictable variable outcomes. Sixty-one patients (270 screws) in the FLUO group and 36 patients (172 screws) in the NAV group were compared. The NAV group showed a significantly higher %screw depth (89.04% ± 6.07% vs 85.18% ± 7.54%; P = 0.011), larger angle of screw convergence (27.7° ± 3.93° vs 18.44° ± 7.54°; P < 0.001), lower incidence of pedicle penetration (0% vs 3.7%; P = 0.016), and less facet joint violation (1.0% vs 8.1%; P = 0.003). The clinical results revealed a significantly better VAS and ODI in the NAV group at 6 and 12 months. The %screw depth correlated with the VAS back pain score at the 1-year follow-up. NAV MIS-TLIF showed superior screw placement accuracy, better screw convergence and depth, and lower cranial facet joint violation than FLUO MIS-TLIF. Furthermore, better clinical scores were revealed in the NAV group at the 6-month and 1-year follow-up.

The efficacy of microwave ablation in treating hepatic tumors requires advanced ultrasound skills. Failure of proper technique has the potential for either under- or over-treatment and possible harm to the patient. Emprint SX™ navigation provides surgeons with intra-operative, real-time navigation through augmented reality localization of the ablation antenna and the expected ablation zone. We hypothesize that incorporating this technology leads to improved targeting and optimizes ablation coverage. This study utilizes a simulated model to evaluate ablation outcomes using Emprint SX™ navigation vs standard ultrasound. Surgical residents and faculty were recruited from a single institution. Using a novel tumor ablation simulator, participants performed ablations via 2 modes: standard ultrasound guidance (STD) and Emprint SX™ navigation (NAV). Primary outcome was the percentage of under-ablation. Secondary outcomes included percentage of over-ablation, time to complete trial, and number of attempts to position antenna. 281 trials were performed by fifteen participants, with 47% female and 60% novice ablationists. Under-ablation volume decreased by a mean of 16.3% (SEM ±12.9, P < .001) with NAV compared to STD. Over-ablation volume decreased by a mean of 14.0% (±8.2, P < .001). NAV time was faster by a mean of 32 seconds (±24.9, P < .001) and involved fewer antenna placement attempts by a mean of 1.3 (±1.0, P < .001). For novice ablationists, all outcomes were improved with NAV and novices saw larger improvements compared to experienced ablationists (P = .018). In a simulated model, NAV improves ablation efficacy and efficiency, with novices gaining the greatest benefit over standard ultrasound.

Higher education has increasingly embraced what is variously called public, civic, or community engagement over the past two decades, and more and more students arrive on campus having participated in community service or service-learning as part of their K-12 education.

72. Impact of navigation on 30-day outcomes for adult deformity surgery

Retrospective Cohort. To evaluate the effect of computer-assisted navigation (NAV) on rates of complications and reoperations after spinal fusion (SF) for adolescent idiopathic scoliosis (AIS) using a nationally representative claims database. Significant controversy surrounds the reported benefits of NAV in SF for AIS. Previous studies have demonstrated decreased rates of pedicle screw breaches with NAV compared to free-hand methods but no impact on complication rates. Thus, the clinical utility of NAV remains uncertain. Analyses were performed using the IBM MarketScan databases. Patients aged 10 to 18 undergoing SF for AIS were grouped by use of NAV. Patients with nonidiopathic scoliosis were excluded. Univariate and risk-adjusted multivariate analyses were performed. Primary outcomes were neurological complications, any medical complications, and reoperations. Secondary outcomes included adjusted total reimbursements and length of stay. A total of 12,046 patients undergoing SF for AIS were identified, and 8640 had 90-day follow-up. NAV was used in 467 patients (5.4%), increasing from 2007 to 2015. After risk adjustment, the odds for any complication within 90 days were lower with NAV (OR = 0.61, P = 0.025), but neurological complications were unrelated to NAV (P = 0.742). NAV was not associated with reoperation within 90 days (P = 0.757) or 2 years (P = 0.095). We observed a $25,038 increase in adjusted total reimbursements (P < 0.001) and a 0.32-day decrease in length of stay (P = 0.022) with use of NAV. In this national sample, NAV was associated with a lower rate of total complications but no change in rates of neurological complications or reoperations. In addition, NAV was associated with a large increase in total payments, despite a modest decrease in hospital stay. Considering the increasing popularity of NAV, this study provides important context regarding the utility of NAV for AIS.Level of Evidence: 3.

Background:The use of computer assisted surgery, navigation (NAV) in shoulder arthroplasty is still under discussion, regarding the clinical outcome and prosthesis longevity, especially when combining these factors with cost, time and surgeon’s experience. Beside the NAV, there has been in use patient-specific instrumentation (PSI) as an additional tool for more precise glenoid implant position. Surgical NAV and PSI for glenoid implant positioning in anatomic and reverse total shoulder arthroplasty are in last years under observation and discussion.Objective:To critically review and evaluate the current literature regarding the use of computer navigation and PSI in shoulder arthroplasty.Methods:Critical review of the existing literature.Results:Cost-effectiveness, prosthesis longevity and revision arthroplasty rate have not yet been proven clinically. Moreover, heterogeneity is high in studies that include different positioning systems (NAV, PSI and standard instrumentation). Heterogeneity is due to differences in surgical technique, implants, surgeon’s expertise, radiographic image analysis technique.Conclusion:The use of navigation systems and PSI should be clinically proven in the shoulder arthroplasty. Independent experts’ opinion and independent high level studies lack at the moment. There will be still a lot of talk regarding this topic in future.