Surgical System Research Articles

Proof-of-Concept Development of the Distal Module of a Cystoscope Transurethral Continuum Surgical Robotic System

Proof-of-Concept Development of the Distal Module of a Cystoscope Transurethral Continuum Surgical Robotic System

Solutions for Reducing Perioperative Supply Waste.

Health care costs continue to increase in the United States, and unused perioperative supplies can contribute to both these costs and increased waste. Reducing perioperative waste can decrease hospital costs and promote sustainability. Perioperative leaders can consider a variety of solutions to decrease unused perioperative supplies, including streamlining and standardizing surgical packs, implementing surgeon scorecards and a surgical receipt system, and updating surgeon preference cards. The available literature does not provide data on waste reduction for all listed solutions; however, these initiatives have had positive financial effects for hospitals through either direct cost reduction or cost avoidance. Although the cost of implementation may vary among hospitals, streamlining surgical packs (including custom packs) appears to be an effective solution with a lower cost than other strategies, and avoids the wasting of opened supplies that are not needed.

Variation in care in individuals hospitalised with abdominal aortic aneurysm in nine high-income countries: a cross-sectional cohort study

Abstract Background Abdominal aortic aneurysms (AAA) can be safely repaired using either endovascular aneurysm repair (EVAR) or open repair when intact, but after rupture morbidity and mortality are extremely high. Treatment patterns and outcomes for intact AAA are likely to differ between countries due to differences in AAA screening policies, health system capacity and payment approaches, and other factors, such as demographics and lifestyle, but are poorly studied. Methods We conducted a retrospective serial cross-sectional cohort study of adults aged ≥66 years hospitalised for with an intact AAA and repair procedure in the same admission between 2011 and 2019 in nine countries (US, Canada, England, Denmark, Netherlands, Switzerland, Taiwan, South Korea and Israel) using population-representative administrative data. We investigated age-sex standardised (to the 2019 US population) repair rates (open repair or EVAR) and health system performance measures, including hospital length of stay (LOS), 30-day readmission, and all-cause mortality (30 days and 1 year). Results The number of intact AAA hospital admissions between 2011 and 2019 ranged from 1,290 in Israel to 199,764 in the US. The rates of intact AAA repair per 1000 population varied between countries and over time, from 0.11 per 1000 (South Korea) to 0.69 per 1000 (US) in 2011 and from 0.14 per 1000 (Taiwan) to 0.57 per 1000 (the Netherlands) in 2019. Most countries saw a decline in the rate of AAA repair over the study period. The proportion repaired using open repair vs EVAR also varied widely across the countries. In the US, Israel and Taiwan open repair was used in 11% or fewer cases whereas in the remaining countries we observed open repair in 25.1 % (South Korea) to 56.7% (Denmark) of cases. (Figure 1) Mortality was generally higher following open repairs compared to EVAR in all countries. In 2019, following EVAR, 30-day mortality varied from 0.6% (8.1% at 1 year) in South Korea to 2.3% (11.7% at 1 year) in Israel and following open repair varied from 2.9 (4.4% at 1 year) in England to 7.6% (15.1% at 1 year) in the US. (Figure 2) Mean hospital LOS in 2019 ranged from 2.5 days (US) to 12.2 days (South Korea), following EVAR and from 9.1 days (Taiwan) to 21.5 days (South Korea) following open repair. The 30-day readmission rate in 2019 ranged from 8.1% (US) to 31.8% in Israel following EVAR and from 11.4% (US) to 22.2% (South Korea) following open repair. Conclusions We observed substantial between-country variation in surgical approaches, mortality, and health system performance measures for AAA. Further research is needed to understand and plan optimal, evidence-based AAA screening and treatment strategies.Rates of EVAR and open repairAdjusted 30-day all-cause mortality

Case Report: Management of a congenital intrahepatic portosystemic shunt with portal vein aneurysm in a child using 3D computer-assisted partial right hepatectomy

Congenital portosystemic shunts (CPSS) are rare pediatric vascular malformations characterized by abnormal development of the portal vein, which is attributed to incomplete embryonic remodeling of the hepatic and surrounding vasculature. CPSS manifests in two main forms: intrahepatic and extrahepatic. This study details the management of a pediatric patient diagnosed with Congenital Intrahepatic Portosystemic Shunt (CIPS) who was referred to our institution. By using a computer-assisted surgical system, the right hepatectomy was successfully performed, guided by precise intraoperative navigation based on three-dimensional reconstructions of enhanced CT imagery. The patient exhibited a favorable postoperative recovery trajectory, with the absence of complications or recurrence throughout the monitoring period.

Semi-automatic robotic puncture system based on deformable soft tissue point cloud registration.

Traditional surgical puncture robot systems based on computed tomography (CT) and infrared camera guidance have natural disadvantages for puncture of deformable soft tissues such as the liver. Liver movement and deformation caused by breathing are difficult to accurately assess and compensate by current technical solutions. We propose a semi-automatic robotic puncture system based on real-time ultrasound images to solve this problem. Real-time ultrasound images and their spatial position information can be obtained by robot in this system. By recognizing target tissue in these ultrasound images and using reconstruction algorithm, 3D real-time ultrasound tissue point cloud can be constructed. Point cloud of the target tissue in the CT image can be obtained by using developed software. Through the point cloud registration method based on feature points, two point clouds above are registered. The puncture target will be automatically positioned, then robot quickly carries the puncture guide mechanism to the puncture site and guides the puncture. It takes about just tens of seconds from the start of image acquisition to completion of needle insertion. Patient can be controlled by a ventilator to temporarily stop breathing, and patient's breathing state does not need to be the same as taking CT scan. The average operation time of 24 phantom experiments is 64.5 s, and the average error between the needle tip and the target point after puncture is 0.8mm. Two animal puncture surgeries were performed, and the results indicated that the puncture errors of these two experiments are 1.76mm and 1.81mm, respectively. Robot system can effectively carry out and implement liver tissue puncture surgery, and the success rate of phantom experiments and experiments is 100%. It also shows that the puncture robot system has high puncture accuracy, short operation time, and great clinical value.

Effectiveness of robotic metabolic and bariatric surgery in patients with BMI ≥ 50-59.9 and BMI ≥ 60 for the treatment of severe obesity in a national medical center in Mexico.

Obesity is a global health issue that significantly increases morbidity and mortality when the Body Mass Index (BMI) reaches values ≥ 50. While metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity, it carries risks. Robotic surgery is promising but not extensively studied in Mexico, which presents an opportunity for research at a National Hospital with an academic program. This retrospective study reviewed 44 patients who underwent robotic MBS using the da Vinci surgical system from January 2018 to August 2023 at Centro Médico Nacional 20 de Noviembre, ISSSTE. Data collected included surgery type, duration, complications, and weight loss metrics over 54months post-operatively. The study involved 44 patients with severe obesity including BMI ≥ 50-59.9kg/m2 for group 1 and BMI ≥ 60kg/m2 for group 2. The average initial BMI was 54.7kg/m2 for group 1 and 68kg/m2 for group 2. The average operative times for group 1 were 10.09min for docking, 86.23min for robotic console time, and 95.73min for total intraoperative time. Group 2 had average times of 9.80min for docking, 82.4min for robotic console time, and 92.2min for total intraoperative time. Follow-up showed significant weight loss initially, with weight recurrence after 24months due to different factors. No serious complications or mortality were observed. Robotic MBS at a national academic medical center in Mexico shows promising outcomes for patients with BMI ≥ 50-59.9 and BMI ≥ 60, with significant weight and BMI improvements at 54month follow-up. Further studies with larger cohorts and longer follow-up are needed to strengthen these findings.

Influence of the Vertek aiming device on the surgical accuracy of computer-assisted drilling of the equine distal sesamoid bone-An experimental cadaveric study.

To determine the effect of the Vertek aiming device (VAD) on the surgical accuracy of navigated drilling of the distal sesamoid bone (DSB). Experimental cadaveric study. A total of 30 paired equine cadaveric limbs from 15 horses. Each specimen was placed in a purpose-built frame (PBF). Preoperative cone beam computed tomography (CBCT) images were acquired with an imaging unit coupled with a surgical navigation system. In the DSB of each specimen, a 4.5 mm glide hole and a 3.2 mm thread hole were drilled under navigation guidance, to simulate drilling for the repair of a mid-sagittal DSB fracture. In the VAD group navigated drilling was assisted by using the VAD. In the free-hand drilling group navigated drilling was performed without the VAD. Pre-and postoperative CBCT scans were merged and surgical accuracy aberrations (SAA) between the planned drill corridor and the created bone tunnel were measured. Descriptive statistics and repeated-measures analyses of variance (rep.-meas. ANOVA) were performed to compare SAA measurements between the study groups. The SAA measurements ranged from 0 to 2.9 mm in the free-hand group and from 0 to 2.8 mm in the VAD group. The median overall SAA was lower in the VAD group than in the free-hand navigated group (0.6 mm ± [0.5-0.7] vs. 0.8 mm ± [0.7-1], rep.-meas. ANOVA p = .007). The additional use of the VAD in the described set-up for navigated drilling significantly improved surgical accuracy. The combined use of the VAD and PBF may help improve surgical accuracy in navigated lag screw repair of DSB fractures.

Multiobjective design of automated order fulfillment systems: A case study for an existing surgical complex

We present a case study that introduces a systematic framework for designing an automated guided vehicle (AGV) order fulfillment system. The multi-stage framework integrated discrete event simulation (DES), super-efficiency data envelopment analysis (S-DEA) model, and Design of Experiments (DOE) methodologies for the design of an AGV system in an existing large-scale surgical complex within a comprehensive hospital in Singapore. Performance metrics derived from this model were consolidated into a single relative efficiency score using the S-DEA model. This efficiency score was then utilized in a DOE methodology, combined with a post-hoc model selection process, to robustly identify appropriate models for evaluating alternative system designs. The proposed framework optimizes AGV deployment by first identifying opportunities for AGVs to add value within the surgical system through a value-stream mapping approach. It then derives the optimal system design by balancing cost efficiency, manpower reallocation, and order fulfillment rates, facilitated by the S-DEA model augmented with the DOE approach and post-hoc model selection. Application of this framework to the surgical complex revealed several insights that can significantly enhance AGV efficiency prior to actual deployment. However, a key limitation of this case-study-based approach is its limited generalizability across different systems. Despite this, the methodology provides a robust foundation for AGV system design in similar healthcare environments.

Current status analysis of the prevalence and regional disparities of robot-assisted laparoscopic prostatectomy in Japan using diagnosis procedure combination data

The introduction of the “da Vinci S HD Surgical System” marked a significant shift towards robotic surgeries in Japan. However, initial high costs and lack of efficacy data posed barriers to its widespread adoption. By 2023, more than 570 da Vinci units were operational in Japan, highlighting the growing acceptance of robotic surgery despite these challenges. This study aimed to investigate the prevalence and regional disparities in the adoption of robot-assisted laparoscopic prostatectomy (RALP) across Japan using diagnosis procedure combination data. This retrospective observational study analyzed data from 2857 urban and 4184 regional hospitals across 47 prefectures in Japan. The study focused on the number of RALP procedures, da Vinci systems, and certified urological surgery proctors. Multiple regression analysis was performed to identify significant factors influencing RALP adoption. Urban areas demonstrated a higher prevalence of RALP procedures and more da Vinci systems compared to regional areas, with urban hospitals performing an average of 937 RALP procedures compared to 195.5 in regional hospitals. The number of certified urological surgeons also showed significant urban-regional disparities, contributing to the overall imbalance. Our findings highlight substantial regional disparities in access to robot-assisted surgery in Japan, with urban areas benefiting from better access to advanced medical technologies and specialist training. Addressing these disparities will require targeted policies to improve the dissemination of robotic surgery systems and enhance training opportunities in regional cities.

Application value of surgical navigation system based on deep learning and mixed reality for guiding puncture in percutaneous nephrolithotomy: a retrospective study.

This study was conducted to investigate the clinical value of a navigation system based on deep learning and mixed reality for the treatment of kidney stones with percutaneous nephrolithotomy (PNL), and to improve its theoretical basis for the treatment of kidney stones. The data of 136 patients with kidney stones from October 2021 to December 2023 were retrospectively analyzed. All patients underwent PNL, and were categorized into a control group (Group 1) and a surgical navigation group (Group 2) according to puncture positioning method. Preoperative computed tomography (CT) was performed in both groups. In group 1, procedures were performed under standard ultrasound guidance. PNL was performed with navigation system fused with ultrasound to guide percutaneous puncture in group 2. The baseline information and procedural characteristics of both groups were compared. PNL was successfully performed in both groups. No significant difference was found in the baseline date between the two groups. In group 2, real-time ultrasound images could be accurately matched with CT images with the aid of navigation system. The success rate of single puncture, puncture time, and decrease in hemoglobin were significantly improved in group 2 compared to group 1. (p < 0.05). The application of navigation system based on deep learning and mixed reality in PNL for kidney stones allows for real-time intraoperative navigation, with acceptable accuracy and safety. Most importantly, this technique is easily mastered, particularly by novice surgeons in the field of PNL.

Intraoperative navigation in craniofacial surgery

Craniofacial surgery requires comprehensive anatomical knowledge of the head and neck to ensure patient safety and surgical precision. Over recent decades, there have been significant advancements in imaging techniques and the development of real-time surgical navigation systems. Intraoperative navigation technology aligns surgical instruments with imaging-derived information on patient anatomy, enabling surgeons to closely follow preoperative plans. This system functions as a radiologic map, improving the accuracy of instrument placement and minimizing surgical complications. The introduction of first-generation navigation systems in the early 1990s revolutionized surgical procedures by enabling real-time tracking of instruments using preoperative imaging. Initially utilized in neurosurgery, intraoperative navigation has since become standard practice in otolaryngology, cranio-maxillofacial surgery, and orthopedics. Since the 2000s, second-generation navigation systems have been developed to meet the growing demand for precision across various surgical specialties. The adoption of these systems in craniofacial surgery has been slower, but their use is increasing, particularly in procedures such as foreign body removal, facial bone fracture reconstruction, tumor resection, and craniofacial reconstruction and implantation. In Korea, insurance coverage for navigation in craniofacial surgery began in 2021, and new medical technologies for orbital wall fracture treatment were approved in August 2022. These technologies have only recently become clinically available, but are expected to play an increasingly important role in craniofacial surgery. Intraoperative navigation enhances operative insight, improves target localization, and increases surgical safety. Although these systems have a steep learning curve and initially prolong surgery, efficiency improves with experience. Calibration issues, registration errors, and soft tissue deformation can introduce inaccuracies. Nonetheless, navigation technology is evolving, and the integration of intraoperative computed tomography data holds promise for further enhancements of surgical accuracy. This paper discusses the various types and applications of navigation employed in craniofacial surgery, highlighting their benefits and limitations.

Intraoperative 'space suits' do not reduce periprosthetic joint infections in shoulder arthroplasty.

Body exhaust suits or surgical helmet systems (colloquially, 'space suits') are frequently used in many forms of arthroplasty, with the aim of providing personal protection to surgeons and, perhaps, reducing periprosthetic joint infections, although this has not consistently been borne out in systematic reviews and registry studies. To date, no large-scale study has investigated whether this is applicable to shoulder arthroplasty. We used the New Zealand Joint Registry to assess whether the use of surgical helmet systems was associated with lower all-cause revision or revision for deep infection in primary shoulder arthroplasties. We analyzed 16,000 shoulder arthroplasties (hemiarthroplasties, anatomical, and reverse geometry prostheses) recorded on the New Zealand Joint Registry from its inception in 2000 to the present day. We assessed patient factors including age, BMI, sex, and American Society of Anesthesiologists (ASA) grade, as well as whether or not the operation took place in a laminar flow operating theatre. A total of 2,728 operations (17%) took place using surgical helmet systems. Patient cohorts were broadly similar in terms of indication for surgery (osteoarthritis, rheumatoid arthritis, fractures) and medical comorbidities (age and sex). There were 842 revisions (5% of cases) with just 98 for deep infection (0.6% of all cases or 11.6% of the revisions). There were no differences in all-cause revisions or revision for deep infection between the surgical helmet systems and conventional gowns (p = 0.893 and p = 0.911, respectively). We found no evidence that wearing a surgical helmet system reduces the incidence of periprosthetic joint infection in any kind of primary shoulder arthroplasty. We acknowledge the limitations of this registry study and accept that there may be other benefits in terms of personal protection, comfort, or visibility. However, given their financial and ecological footprint, they should be used judiciously in shoulder surgery.

Comparison of Intraosseous Temperature Rise in Different Surgical Guide Systems: An In Vitro Study

Aim: This study proposes to investigate the influence of various surgical guide designs on the generation temperature in the cortical and cancellous regions of the osteotomy site. The working hypothesis was that open guides are more efficacious in controlling excessive heat generation in cortical and cancellous areas. Materials and Methods: Implant osteotomy was performed on specimens simulating D3 bone density using surgical guides produced with three different designs: an open guide, a guide with an external cooling channel, and a closed guide. Temperature increases occurring in the cortical layer from a depth of 2 mm and in the cancellous layer from a depth of 10 mm were measured with type K thermocouples. Results: Temperature averages recorded from a depth of 2 mm during osteotomy show statistically significant differences between groups ( p = .003). The temperature rise in the group using a closed surgical guide was significantly higher than in the groups using an open surgical guide and a surgical guide with an external cooling channel on the cortical layer, while the temperature increase did not show any significant difference in both cortical and cancellous layers between the open guide and guide with external cooling channel. Temperature averages recorded from a depth of 10 mm do not show statistically significant differences between groups ( p = .054). Conclusion: Using open surgical guides or surgical guides with external cooling channels among the guided surgical systems is a more reliable way to keep the thermal increase under control.

Semi-Automated Virtual Endoscopy of the Frontal Recess.

Virtual endoscopy (VE) is the computer-based reprocessing of diagnostic imaging to simulate endoscopy of an anatomic region of interest. VE of the Frontal Sinus Outflow Tract (FSOT) may assist surgical planning and education. VE was performed on 16 normal sinus computed tomography (CT) scans for a total of 32 sides using the "path-to-target" tool on the TruDi surgical navigation system (ver. 2.3; Acclarent, Irving, CA, USA). To aid orientation during VE, planning points were placed on the middle turbinate, ethmoidal bulla, and skull base. The VE representation of anatomy and FSOT accuracy was manually confirmed by reviewing the corresponding orthogonal CT images and comparing them to the computed pathway. Of the 32 sides, the software successfully calculated the FSOT in 22 sides (69%). Of those 22 sides, the calculated FSOT, depicted in the VE sequences accurately represented the FSOT. Among sides with an accurately calculated FSOT, the VE sequences depicted a "fly-through" from a starting point in the middle meatus around various frontal recess cells to the end point in the frontal sinus. This pilot study demonstrates that software-generated VE of the FSOT is indeed feasible but requires confirmation by the surgeon for accuracy. Instances in which the software did not achieve its objective may drive further refinements of the protocol. VE of the FSOT should be explored as a tool for preoperative planning and surgical education.

Artificial Intelligence in Oral and Maxillofacial Surgery: Bridging the Gap between Technology and Clinical Practice a Narrative Review

Objective: To provide a comprehensive overview of current applications and future prospects of artificial intelligence (AI) in oral and maxillofacial surgery (OMFS), while critically analyzing implementation challenges and exploring potential advancements.  Methods A systematic literature review was conducted using PubMed/MEDLINE and Embase databases, encompassing English-language articles up to December 30, 2023. Search terms combined OMFS and AI concepts, with database-specific syntax employed.  Results AI applications in OMFS span multiple domains, including image analysis, surgical planning, intraoperative guidance, and clinical decision support. Deep learning models have demonstrated high accuracy in detecting mandibular fractures, performing cephalometric analyses, and classifying maxillofacial pathologies. AI-enhanced surgical planning and robotic systems show promise in improving precision and outcomes across various OMFS procedures. However, challenges persist in data quality, clinical validation, and seamless workflow integration.  Conclusions AI technologies have the potential to significantly enhance diagnostic accuracy, surgical precision, and treatment outcomes in OMFS. Future research directions include developing multimodal AI systems, advancing AI-powered surgical navigation, and exploring federated learning approaches. Successful implementation of AI in OMFS practice will require collaborative efforts among clinicians, researchers, engineers, and policymakers to address technical, ethical, and regulatory challenges. As these hurdles are overcome, AI is poised to become an integral part of OMFS, augmenting surgical capabilities and elevating patient care standards.

Delayed onset Spontaneous Hyphema after OMNI® Surgical System

Minimally invasive glaucoma surgery (MIGS) offers options for glaucoma treatment that have generally improved safety profiles compared with filtering surgery. MIGS vary in design and procedure, but all angle-based MIGS function by bypassing or removing aqueous humor outflow resistance at the level of the trabecular meshwork. This can lower intraocular pressure but also remove the blood-aqueous barrier. Most studies of MIGS report on relatively short-term safety, but awareness of potential long-term complications is critical for optimal patient management. This case report describes a patient with recurrent and refractory delayed onset spontaneous hyphema after OMNI procedure. To the best of our knowledge, this is the first case report describing this complication of the OMNI surgical system.

Speech-mediated manipulation of da Vinci surgical system for continuous surgical flow

AbstractWith the advent of robot-assisted surgery, user-friendly technologies have been applied to the da Vinci surgical system (dVSS), and their efficacy has been validated in worldwide surgical fields. However, further improvements are required to the traditional manipulation methods, which cannot control an endoscope and surgical instruments simultaneously. This study proposes a speech recognition control interface (SRCI) for controlling the endoscope via speech commands while manipulating surgical instruments to replace the traditional method. The usability-focused comparisons of the newly proposed SRCI-based and the traditional manipulation method were conducted based on ISO 9241-11. 20 surgeons and 18 novices evaluated both manipulation methods through the line tracking task (LTT) and sea spike pod task (SSPT). After the tasks, they responded to the globally reliable questionnaires: after-scenario questionnaire (ASQ), system usability scale (SUS), and NASA task load index (TLX). The completion times in the LTT and SSPT using the proposed method were 44.72% and 26.59% respectively less than the traditional method, which shows statistically significant differences (p &lt; 0.001). The overall results of ASQ, SUS, and NASA TLX were positive for the proposed method, especially substantial reductions in the workloads such as physical demands and efforts (p &lt; 0.05). The proposed speech-mediated method can be a candidate suitable for the simultaneous manipulation of an endoscope and surgical instruments in dVSS-used robotic surgery. Therefore, it can replace the traditional method when controlling the endoscope while manipulating the surgical instruments, which contributes to enabling the continuous surgical flow in operations consequentially.

Simulation of osteotomy in total knee arthroplasty with femoral extra-articular deformity assisted by artificial intelligence: a study based on three-dimensional models

BackgroundThe impact of extra-articular deformities (EADs) on lower limb alignment and collateral ligament integrity during total knee arthroplasty (TKA) poses significant challenges, increasing surgical complexity. Our study aims to evaluate the influence of EADs on mechanical axis alignment and the risk of collateral ligament injury during TKA using an AI-assisted surgical planning system, with the goal of minimizing ligament damage through precise and scientific planning.MethodsA healthy volunteer underwent CT and MRI scans of the lower limbs. The scan images were imported into Mimics 20.0 software, and the reconstructed models were spatially aligned using 3-maticResearch 11.0 software. Using Unigraphics NX9.0 software, 50 three-dimensional models of femoral lateral joint deformities with varying positions and angles were created. Finally, TKA was simulated using the AI JOINT preoperative planning system.ResultsThe larger the deformity angle and the closer it is to the knee joint, the more pronounced the deviation of the mechanical axis. During MA-aligned osteotomy, nine types of deformities can damage the collateral ligaments. After adjusting the varus/valgus of the prosthesis within a safe range of 3° and leaving a residual 3° varus/valgus in the lower limb alignment, only the 25° varus and 25° valgus deformities located at 90% of the femoral anatomical axis remain uncorrected.ConclusionFor patients with osteoarthritis and concurrent EAD undergoing TKA, using reconstructed 3D models of the collateral ligaments for preoperative planning helps visually assess collateral ligament damage, providing a practical solution. Minimizing intra-articular osteotomies within a safe range and allowing some residual alignment deviation can reduce the risk of collateral ligament injury.

Computed tomography and structured light imaging guided orthopedic navigation puncture system: effective reduction of intraoperative image drift and mismatch.

Image-guided surgical navigation systems are widely regarded as the benchmark for computer-assisted surgical robotic platforms, yet a persistent challenge remains in addressing intraoperative image drift and mismatch. It can significantly impact the accuracy and precision of surgical procedures. Therefore, further research and development are necessary to mitigate this issue and enhance the overall performance of these advanced surgical platforms. The primary objective is to improve the precision of image guided puncture navigation systems by developing a computed tomography (CT) and structured light imaging (SLI) based navigation system. Furthermore, we also aim to quantifying and visualize intraoperative image drift and mismatch in real time and provide feedback to surgeons, ensuring that surgical procedures are executed with accuracy and reliability. A CT-SLI guided orthopedic navigation puncture system was developed. Polymer bandages are employed to pressurize, plasticize, immobilize and toughen the surface of a specimen for surgical operations. Preoperative CT images of the specimen are acquired, a 3D navigation map is reconstructed and a puncture path planned accordingly. During surgery, an SLI module captures and reconstructs the 3D surfaces of both the specimen and a guiding tube for the puncture needle. The SLI reconstructed 3D surface of the specimen is matched to the CT navigation map via two-step point cloud registrations, while the SLI reconstructed 3D surface of the guiding tube is fitted by a cylindrical model, which is in turn aligned with the planned puncture path. The proposed system has been tested and evaluated using 20 formalin-soaked lower limb cadaver specimens preserved at a local hospital. The proposed method achieved image registration RMS errors of 0.576 ± 0.146 mm and 0.407 ± 0.234 mm between preoperative CT and intraoperative SLI surface models and between preoperative and postoperative CT surface models. In addition, preoperative and postoperative specimen surface and skeletal drifts were 0.033 ± 0.272 mm and 0.235 ± 0.197 mm respectively. The results indicate that the proposed method is effective in reducing intraoperative image drift and mismatch. The system also visualizes intraoperative image drift and mismatch, and provides real time visual feedback to surgeons.

Spinal Cord Stimulation with implantation of Surgical Leads is a sufficient salvage therapy for patients suffering from persistent spinal pain syndrome – a retrospective single-center experience

ObjectivePersistent spinal pain syndrome (PSPS) poses a significant medical challenge, often leading to diminished quality of life for affected individuals. In response to this clinical dilemma, Spinal Cord Stimulation (SCS) has emerged as a promising intervention aimed at improving the functional outcomes and overall well-being of patients suffering from these debilitating syndrome. In case a therapy with percutaneous lead fails, e.g. due to a dislocation, surgical lead can be used as a stable alternative. This is resulting in a more invasive procedure and does not allow for intraoperative monitoring. The aim of the study is to investigate the efficacy and safety of the use of surgical leads, as there have been only a few case series published so far. MethodsWe included PSPS patients that gave consent to a SCS therapy and were treated with Surgical Leads. Outcome scores concerning the quality of life (SF-36), pain related disability (Oswestry disability index [ODI]), sleeping quality (Pittsburgh Sleep Quality Index [PSQI]), and pain intensity (NRS) were obtained prior surgery and at outpatient visits after permanent implantation. ResultsIn this study, 36 patients were implanted with a Surgical Lead SCS system. One patient developed a new neurological deficit characterized by left-sided leg paresis attributable to postoperative hemorrhage, and another patient experienced a wound infection. These complications contributed to an overall morbidity rate of 5.6%. In overall 5 patients (20.8%) the electrodes were explanted within the first month. Follow-up data of 24 subjects with a median time of 21 [15-47] months were available. The mean pain intensity at rest and in motion was reduced. Further pain depending disability improved from a median ODIpreop=38 [30-57]% to ODIfollow-up =21 [9-35]% (p<0.01). Additionally the Sleeping Quality and the Quality of Life improved concerning the physical (Median PCS preop=22.5 [20.4-30.4] vs. PCSfollow-up = 41.8 [35.2-47.0], p < 0.01).) and mental (Median MCSpreop=45.4 [31.1-55.5] vs. MCSfollow-up=58.1 [47.6-59.8], p=0.018). component. ConclusionSCS with surgical leads is a safe secondary technique to treat PSPS, where treatment with percutaneous leads fail. The results show a promising long-term effect concerning pain intensity and functional outcome.