Use Of Electromagnetic Navigation Research Articles

The combined application of electromagnetic navigation and porcine fibrin sealant in microwave ablation of lung tumors

PurposeThis retrospective study aims to assess the efficacy of the combined application of electromagnetic navigation (EMN) and porcine fibrin sealant (PFS) in the microwave ablation (MWA) treatment of lung tumors. Material and methodsIn our department from January 2022 to August 2023, 73 patients underwent MWA under standard computed tomography (CT) guidance (CT group) or CT guidance with additional application of EMN and PFS (CT-EMN-PFS group), respectively. The basic data of patients were recorded and analyzed using the Student's t-test and Chi-square test between the two groups, and single factor and multi-factors binary logistic regression analyses were conducted to determine the risk factors of pneumothorax; meanwhile the incidence of complications, the number of CT scans and dose length product (DLP) were calculated and compared between the two guidance modes. ResultsForty-seven patients underwent standard CT-guided MWA, meanwhile the remaining 26 patients underwent CT-guided MWA with combined application of EMN and PFS. The patients with lesions close to the bronchi or interlobar fissures, and underlying emphysema had a higher risk of pneumothorax, the corresponding odds ratio (OR) was 23.290 (p = 0.004), 33.300 (p = 0.019), and 8.007 (p = 0.012), respectively; the combined use of EMN and PFS could reduce the incidence of pneumothorax, with an OR of 0.094 (95 % confidence interval [CI]: 0.015–0.602, p = 0.013). The incidence rates of pneumothorax, pneumorrhagia and pleural effusion were 59.57 %, 61.70 %, and 19.15 % respectively in the CT group, and 30.77 %, 50.00 % and 7.69 % respectively in the CT-EMN-PFS group. The incidence rate of pneumothorax in the CT-EMN-PFS group was significantly lower than that in the CT group (p = 0.017). The median number of CT scans was 9 in the CT group and 5 in the CT-EMN-PFS group, respectively, meanwhile the median DLP was 1060.69 mGy*cm in the CT group and 600.04 mGy*cm in the CT-EMN-PFS group, respectively, which indicated there was a statistical difference in the amount of radiation exposure between the two groups (p < 0.001). ConclusionThe combined application of EMN and PFS demonstrates for the first time that there is a lower incidence rate of pneumothorax and significantly less radiation exposure during the MWA of the lung tumors.

Применение интраоперационной навигации в эндоскопической хирургии доброкачественных костно-фиброзных образований околоносовых пазух и основания черепа

Objective. Evaluation of the effectiveness and safety of the use of electromagnetic computer navigation in endoscopic surgery of benign fibro-osseous mass of the paranasal sinuses and skull base. Materials and methods. The retrospective study included 21 patients who underwent endoscopic removal of fibro-osseous mass of paranasal sinuses and skull base at the Burdenko Center from 2010 to 2021. The patients were divided into 2 groups: the 1st group included 10 patients with the use of electromagnetic navigation intraoperatively, the 2nd group included 11 patients who were treated without the use of navigation. Median follow-up was 24 months [IQR 12,00, 48,00]. Results. Most often, patients complained of headache (15; 71,4%). In 14 (66,7%) cases, the ethmoid labyrinth was involved; in 11 (52,3%) cases, the sphenoid sinus; in 15 (71,4%) cases, the base of the skull, with intracranial distribution in 5 (23,8%) cases; and in 8 (38%) cases, the wall of the orbit. Surgical treatment was performed radically in 10 (47,6%) patients. The median intraoperative blood loss was 100.00 mL. Intraoperative complications occurred in 3 (14,3%) patients; postoperative complications, in 2 (9,5%) patients. Pathology recurrence occurred in 4 (19,0%) patients, more often in young people (median age 19,50, р = 0,179). The median duration of hospital stay was 3,00 bed-days. It was found that the localization of pathology in the sphenoid sinus is associated with an increased risk of nonradical removal of the formation (р = 0.009). Factors that could influence the choice of the surgeon in favor of intraoperative navigation include visual impairment in the clinical picture of the disease (p = 0,090) or the absence of difficulty in nasal breathing (p = 0.024); localization of the mass only in the sphenoid sinus (p = 0,063) or with involvement of the base of the skull (p = 0.149). The use of intraoperative navigation slightly increases the radicalness of surgical treatment and reduces the incidence of perioperative complications.

Virtual Surgical Planning Combined With Intraoperative Navigation in Mandibular Bilateral Sagittal Split Osteotomy for Accurate Placement of Patient Specific Implants.

The aim of the study is to evaluate clinical methods to obtain a significantly improved fitting of patient specific implants (PSI) in bilateral sagittal split osteotomies and to evaluate the use of electromagnetic navigation as a potential guide for condyle positioning. A prospective study using (1) a solid bite registration index during preoperative computed tomography, (2) critical planning with regard to the condylar rotation, (3) a piezoelectric saw throughout the mandibular osteotomy, and (4) intraoperative navigation to determine the position of the PSIs and the mandibular segments intraoperatively was performed. Ten patients were treated. Five underwent bilateral sagittal split osteotomies and 5 bimaxillary osteotomy. All of the PSIs fitted precisely onto the mandible and the screws into the predrilled screw holes. The predetermined occlusion was obtained. A precise fitting of the PSIs in the lower jaw seems to be possible to achieve with above-mentioned methods. The intraoperative navigation system gives a possibility to verify the surgical outcome during surgery but is not accurate enough to be used as a virtual drill guide alone.

COMPARISON OF DIAGNOSTIC YIELD OF ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY-GUIDED TRANSBRONCHIAL FORCEPS BIOPSY TO TRANSBRONCHIAL NEEDLE ASPIRATION IN THE DIAGNOSIS OF PERIPHERAL PULMONARY LESIONS

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The use of electromagnetic navigation as an adjunct to flexible bronchoscopy in the diagnosis of pulmonary lesions has been shown to improve yield. In this study, we compared the diagnostic yield of concurrently performed transbronchial needle aspiration (TBNA) and transbronchial forceps biopsy (TBFB) in patients undergoing electromagnetic navigation-guided bronchoscopy (ENB) for diagnosis of peripheral pulmonary lesions. METHODS: A retrospective study was conducted on all patients who underwent concurrent ENB-guided transbronchial needle aspirations and transbronchial forceps biopsies at Ochsner LSU Health Shreveport, LA between July 2018 to December 2019. RESULTS: 86 ENB procedures were performed on 82 patients (mean age 62 years; 35 females, 47 males); four patients needed repeat procedures for new pulmonary lesions or for prior negative studies. 72 (88%) patients had a history of nicotine use and 37 (45%) had a history of malignancy. Of 86 procedures done, samples were inadequate or non-diagnostic in 6 cases, while 9 cases were lost to follow up, and as such final diagnoses of the lung lesions could not be confirmed. Of the remaining 71 procedures, ENB was diagnostic in 53 cases (75%; 42 malignant, 11 non-malignant) and was falsely negative in 18 cases (25%; 16 malignant and 2 non-malignant). False negatives were diagnosed with CT-guided biopsy or at lobectomy. Overall, the sensitivity of concurrent ENB-guided TBNA with TBFB in the diagnosis of malignant and benign peripheral pulmonary lesions was 72% (p = 0.03). Of 58 total malignant cases, transbronchial needle aspiration (TBNA) positively compared to transbronchial forceps biopsy (TBFB) with 39/58 vs 32/58 (sensitivity 67.2% vs 55.2%; p = 0.0001). Sensitivity for diagnosis of malignant lesions increased to 72.4% (P < 0.0001) when both methods were combined. Of the 13 nonmalignant cases, TBFB gave a definite diagnosis in 10/13 vs 8/13 for TBNA (sensitivity 60% vs 30%; p = > 0.05). Using both methods, sensitivity increased to 70% (p = 0.0699). There were no significant complications. The average follow up period was from 3 months to 2 years; patients followed up for less than 6 months showed improvement or resolution of symptoms and or image findings on follow up. CONCLUSIONS: While TBNA alone appeared to have a better performance than TBFB alone in the diagnosis of malignant pulmonary lesions during ENB, the combination of both methods significantly increased diagnostic yield for both malignant and non-malignant lesions. Thus, more widespread use of both instruments during ENB, and even during simple endobronchial bronchoscopies, could increase the sensitivities of both procedures. CLINICAL IMPLICATIONS: To the best our knowledge, this is the first study comparing diagnostic yield of concurrently performed transbronchial needle aspiration (TBNA) and transbronchial forceps biopsy (TBFB) at electromagnetic navigation guided bronchoscopy. DISCLOSURES: No relevant relationships by Olaedo Abana, source=Web Response No relevant relationships by UZAIR Ghori, source=Web Response Site Investigator for EMPROVE relationship with Olympus-Spiration Please note: $1001 - $5000 Added 06/15/2020 by Robert Holladay, source=Web Response, value=Grant/Research Support Site Investigator for DAS 181 relationship with Ansun pharmaceutical Please note: $1001 - $5000 Added 06/15/2020 by Robert Holladay, source=Web Response, value=Grant/Research Support No relevant relationships by Rusella Mirza, source=Web Response No relevant relationships by Derek Rainwater, source=Web Response

Electromagnetic navigation system for acetabular component placement in total hip arthroplasty is more precise and accurate than the freehand technique: a randomized, controlled trial with 84 patients

Background and purpose — The accuracy of conventional navigation systems depends on precise registration of bony landmarks. We investigated the clinical use of electromagnetic navigation (EMN), with a unique device for precise determination of the anterior pelvic plane. Patients and methods — We randomly allocated patients scheduled for total hip arthroplasty into 2 groups of 42 patients each. In the study group, cups were placed at the predetermined target angles (inclination: 42.5°; anteversion: 15°) with the support of EMN. In the control group, cups were placed freehand aiming at the same target angles. Postoperatively the true position of the cup was determined using computed tomography scan of the pelvis. Precision (root mean squared error, RMSE) bias (mean bias error, ME), accuracy, and duration of surgery were compared between the methods. Results — Cup anteversion was more accurate and precise in the navigated group. The ME in the navigated and freehand group was –1.7° (95% CI –2.4 to 1.1) and –4.5° (CI –6.5 to 2.5), respectively. The RMSE in the navigated and freehand group was 2.8° (CI 2.3–3.2) and 8.0° (CI 6.3–9.5), respectively. The inclination was also more precise in the navigated group, with the RMSE in the navigated and freehand group at 4.6° (CI 3.4–5.9) and 6.5° (CI 5.4–7.5), respectively. The accuracy of the inclination and the duration of surgeries were similar between the groups. Interpretation — Cup placement with the help of EMN is more precise than the freehand technique and it does not affect the duration of surgery.

Application of intraoperative electromagnetic frameless navigation in transcranial and endoscopic neurosurgical interventions

The study purpose was to evaluate the use of electromagnetic navigation in surgical treatment of patients with various brain lesions. The system of electromagnetic navigation was used for 102 operations in 98 patients (42 males and 56 females, including 18 children; median age, 34.8 years (min, 2.2 years; max, 69 years)) in the period from December 2012 to December 2016. In 36 patients, the system was used for endoscopic interventions. In 19 patients, electromagnetic navigation was used in combination with neurophysiological monitoring. In our series of cases, the frameless electromagnetic navigation system was used in 66 transcranial operations. The mean error of navigation was 1.9±0.5 mm. In 5 cases, we used the data of preoperative functional MRI (fMRI) and tractography for navigation. At the same time, in all 7 operations with simultaneous direct stimulation of the cortex, there was interference and significant high-frequency noise, which distorted the electrophysiological data. A navigation error of more than 3 mm was associated with the use of neuroimaging data with an increment of more than 3 mm, image artifacts from the head locks, high rate of patient registration, inconsequence of touching points on the patient's head, and unsatisfactory fixation to the skin or subsequent displacement of a non-invasive localizer of the patient. In none of the cases, there was a significant effect of standard metal surgical tools (clamps, tweezers, aspirators) located near the patient's head on the navigation system. In two cases, the use of massive retractors located near the patient's localizer caused noise in the localizer and navigation errors of more than 10 mm due to significant distortions of the electromagnetic field. Thirty-six transnasal endoscopic interventions were performed using the electromagnetic frameless navigation system. The mean navigation error was 2.5±0.8 mm. In general, electromagnetic navigation is an accurate, safe, and effective technique that can be used in surgical treatment of patients with various brain lesions. The mean navigation error in our series of cases was 1.9±0.5 mm for transcranial surgery and 2.5±0.8 mm for endoscopic surgery. Electromagnetic navigation can be used for different, both transcranial and endoscopic, neurosurgical interventions. Electromagnetic navigation is most convenient for interventions that do not require fixation of the patient's head, in particular for CSF shunting procedures, drainage of various space-occupying lesions (cysts, hematomas, and abscesses), and optimization of the size and selection of options for craniotomy. In repeated interventions, disruption of the normal anatomical relationships and landmarks necessitates application of neuronavigation systems in almost mandatory manner. The use of electromagnetic navigation does not limit application of the entire range of necessary intraoperative neurophysiological examinations at appropriate surgical stages. Succession in application of neuronavigation should be used to get adequate test results.

Potentials of intraoperative navigation during balanced orbital bony decompression in thyroid eye disease (preliminary results)

Precise instrument localization is of great importance in orbital decompression surgery. Different navigation systems were designed to fulfill this task and gained wide acceptance. to describe principal features and determine advantages of intraoperatively navigated orbital bony decompression. Data on orbital decompression surgery performed with or without intraoperative image guidance is presented. Each time two surgeons were involved - an ophthalmologist (lateral wall decompression) and otolaryngologist (medial wall decompression). In lateral wall decompression, electromagnetic navigation was mostly used to enlarge the created bone window upward and backward, which is particularly challenging in case of bone thinning in the posterior part of its inner rim. In transethmoidal decompression, the image guidance allowed a more extensive removing of the greater sphenoid wing as well as the posterior medial wall where it joins the lateral wall of the sphenoid sinus. As shown by MSCT, lateral rectus muscle dislocation into the created bone window was more significant in navigated procedures. This preliminary data convincingly shows advantages and potentials of the use of electromagnetic navigation in orbital decompression surgery, especially, for optic neuropathy in thyroid eye disease patients.

The Insertion of Intramedullary Nail Locking Screws Without Fluoroscopy

This study was designed to compare the accuracy, time, and radiation exposure during the insertion of intramedullary nail locking screws using either standard fluoroscopic assistance or an electromagnetic (EM)-based navigational system without fluoroscopy. Prospective. Level I academic trauma center. Patients were divided into 2 groups: group 1 (fluoroscopic assistance), consisted of standard freehand fluoroscopically assisted insertion of locking screws (OEC 9900; G.E. HealthCare, Waukesha, WI), whereas group 2 (EM), consisted of EM navigationally assisted insertion without fluoroscopy (SureShot; Smith & Nephew, Memphis, TN). Technician arrival time, setup (SU) time, screw insertion (SI) time (seconds), fluoroscopy time (seconds), radiation exposure (mrads), and accuracy (hit or miss) were recorded for each screw. For group 1, the SU time was recorded as the time and radiation required to obtain "perfect circles" before insertion, and for group 2, the SU time was recorded as the time required to set up the navigational EM unit. Data collected regarding SI were then compared using standard analysis of variance. Forty-one locking screws were inserted in group 1, whereas 60 screws were inserted in group 2. Accuracy was 100% for both groups. For group 1, mean technician wait time was 77 seconds plus a mean perfect circle SU time of 105 seconds (9.2 mrads and 10 seconds of fluoroscopy). Mean SU time for group 2 was 94 seconds (no fluoroscopy). Mean insertion time was 342 seconds per screw for group 1 (32.9 mrads and 18 seconds of fluoroscopy) compared with 234 seconds per screw for group 2 (no fluoroscopy). These differences were statistically significant (P = 0.006). The use of EM navigation (SureShot; Smith & Nephew) for the insertion of intramedullary nail locking screws demonstrated accuracy similar to conventional fluoroscopic-guided insertion. However, EM-guided locking SI resulted in a significantly shorter total procedural time and completely eliminated radiation exposure. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Effect of Electromagnetic Navigated Ventriculoperitoneal Shunt Placement on Failure Rates

ObjectiveTo evaluate the effect of electromagnetic (EM) navigation system on ventriculoperitoneal (VP) shunt failure rate through comparing the result of standard shunt placement.MethodsAll patients undergoing VP shunt from October 2007 to September 2010 were included in this retrospective study. The first group received shunt surgery using EM navigation. The second group had catheters inserted using manual method with anatomical landmark. The relationship between proximal catheter position and shunt revision rate was evaluated using postoperative computed tomography by a 3-point scale. 1) Grade I; optimal position free-floating in cerebrospinal fluid, 2) Grade II; touching choroid or ventricular wall, 3) Grade III; tip within parenchyma.ResultsA total of 72 patients were participated, 27 with EM navigated shunts and 45 with standard shunts. Grade I was found in 25 patients from group 1 and 32 patients from group 2. Only 2 patients without use of navigation belonged to grade III. Proximal obstruction took place 7% in grade I, 15% in grade II and 100% in grade III. Shunt revision occurred in 11% of group 1 and 31% of group 2. Compared in terms of proximal catheter position, there was growing trend of revision rate according to increase of grade on each group. Although infection rate was similar between both groups, the result had no statistical meaning (p=0.905, chi-square test).ConclusionThe use of EM navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates.

Preliminary Experience With the Use of Electromagnetic Navigation for the Diagnosis of Peripheral Pulmonary Nodules and Enlarged Mediastinal Lymph Nodes

Electromagnetic navigation is a new technique that can be used with bronchoscopy to obtain samples of small peripheral nodular lesions and enlarged mediastinal lymph nodes. It is very versatile in that it enables both transbronchial biopsies and fine-needle aspiration to be performed. We describe 2 cases in which navigation with the superDimension/Bronchus system combined with traditional diagnostic techniques facilitated a definitive diagnosis by bronchoscopy. Electromagnetic navigation can obviate the need for more invasive diagnostic procedures such as surgery, thus saving time and money and avoiding complications.

Needle Biopsy of Anatomically Unfavorable Liver Lesions with an Electromagnetic Navigation Assist Device in a Computed Tomography Environment

Emerging interventional radiology assistance systems that incorporate electromagnetic navigation (EMN) can help the operator guide a needle or other instrument toward a target along preplanned oblique trajectories while avoiding critical structures. A proof-of-concept study was conducted to assess the use of EMN, and EMN was compared with the standard computed tomographic (CT) fluoroscopy guidance technique. A total of 14 needle passes, seven each with EMN and CT fluoroscopy guidance, were performed into an artificially created liver lesion of a single swine. The accuracy of needle placement for each pass was verified with a confirmatory CT scan. The total radiation dose and time of procedure was compared between the EMN and conventional CT fluoroscopy methods. All needle passes were successful, and all passes conducted with EMN were completed with a single insertion, whereas multiple passes (mean, 2.9) with needle repositioning were required with CT fluoroscopic guidance. Statistically significant reduction in procedure time and overall radiation dose for EMN punctures was shown. Accuracy of needle placement was statistically equivalent for the two methods. This proof-of-concept study shows that EMN guidance has equivalent accuracy of needle placement to conventional CT fluoroscopy-guided methods in swine. EMN is also associated with favorable radiation-dose and time-of-procedure profiles for biopsy of liver lesions. Clinical studies are needed to evaluate the safety and efficacy of this technology in the biopsy of lesions in anatomically challenging locations that require steep angles of needle insertion.