Three-dimensional printed surgical guides for keratoma removal in horses using computed tomography or magnetic resonance imaging-based segmentation.

OBJECTIVE: To report the technique, surgical approach, and postoperative features in horses treated via a 3-dimensional (3D) printed guide-assisted keratoma resection created using computed tomography (CT) or magnetic resonance imaging (MRI)-based segmentation. ANIMALS: Five client-owned horses. STUDY DESIGN: Short case series. METHODS: Horses were placed under general anesthesia for imaging (CT and MRI) and underwent a second anesthesia for surgery. Two horses had guides created from CT-based imaging, 3 horses had guides created from MRI. Various sized nonarbored hole saws were used to create accurate and precise portals for keratoma removal. Surgical sites were managed until keratinized granulation tissue had formed and the defect was sealed with an artificial hoof wall patch. RESULTS: All keratomas were successfully removed as a single piece either intact with the hoof wall or easily extracted after the hoof wall portal was created in a surgical time between 20 and 90 min. All CT created guides fitted without issue; MRI-created guides required minor adjustments with a rotary device for proper fit. All cases had minor debridement adjacent to P3 and circumferential lamellar tissue. All horses returned to previous level of performance 2 to 4 months postoperatively. CONCLUSION: Use of 3D printed guides led to accurate targeting of keratomas with small surgical portals and short surgical times. Due to challenges with MRI-based segmentation, CT is preferred.

Three-dimensional printed guides for screw placement in equine navicular bones.

OBJECTIVE: To determine the influence of a custom 3D-printed guide for placement of cortical bone screws in the equine navicular bone. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Eight pairs of normal adult equine forelimbs. METHODS: A 3.5 × 55 mm cortical screw was placed in the longitudinal axis of each intact navicular bone. Screws were placed with a 3D-printed guide (3D) in one bone and with a traditional aiming device (AD) in the contralateral bone within each pair. Duration of surgery and the number of fluoroscopy images were compared between techniques. Screw placement was subjectively evaluated by gross examination and scored by three boarded veterinary surgeons. RESULTS: The use of a 3D-printed guide reduced the duration of surgery by 6.6 min (±1.5 min) compared to traditional screw placement (20.7 min ± 4.8 min, p < .01). Fewer peri-operative fluoroscopic images were obtained when the 3D guide was used (18 images ± 2.6 images vs. 40 images ± 5.1, p < .01). No difference was detected in navicular screw placement. CONCLUSION: The use of a 3D guide decreased the time required to place screws and the number of intraoperative images taken without affecting screw placement in intact navicular bones. CLINICAL RELEVANCE: 3D-printed guides can aid in the study, practice, and execution of surgical procedures reducing surgical time and radiation exposure throughout the operative period achieving similar results to those obtained with a conventional approach.

Use of Hausdorff Distance and Computer Modelling to Evaluate Virtual Surgical Plans with Three-Dimensional Printed Guides against Freehand Techniques for Navicular Bone Repair in Equine Orthopaedics.

OBJECTIVE: The aim of this study was to evaluate the surgical execution of a virtual surgical plan (VSP) with three-dimensional (3D) guides against a freehand approach in the equine navicular bone using an automated in silico computer analysis technique. STUDY DESIGN: Eight pairs of cadaveric forelimb specimens of adult horses were used in an ex vivo experimental study design with in silico modelling. Limbs received either a 3.5 mm cortical screw according to a VSP or using an aiming device. Using computed tomography and computer segmentation, a comparison was made between the executed screw and the planned screw using the Hausdorff distance (HD). RESULTS: Navicular bone mean HD registration error was -0.06 ± 0.29 mm. The VSP with 3D printing demonstrated significantly superior accuracy with a mean deviation of 1.19 ± 0.42 mm compared with aiming device group (3.53 ± 1.24 mm, p = 0.0018). The VSP group was 5.0 times more likely to result in a mean aberration of less than 1.0 mm (95% confidence interval, 0.62-33.4). A 3.5 mm screw with an optimal entry point can have a maximum deviation angle of 3.23 ± 0.07, 2.70 ± 0.06 and 2.37 ± 0.10 degrees in a proximal, dorsal and palmar direction respectively, prior to violating one of the cortical surfaces. CONCLUSION: Procedures performed using the 3D guides have a high degree of accuracy, with minimal mean deviations (<1 mm and <1 degree) of a VSP compared with those using the conventional aiming device. The use of VSP and the HD for evaluation of orthopaedic surgeries and outcome measures shows promise for simplifying and improving surgical accuracy.

Endoscopic Laser Ablation of a Midline Cyst of the Colliculus Seminalis as a Treatment for Anejaculation in a Stallion.

An 18-year-old Appaloosa stallion presented with a history of ejaculatory dysfunction, which had recently progressed to an inability to ejaculate (anejaculation). Transrectal ultrasound evaluation revealed the presence of a prominent midline cyst of the colliculus seminalis, which was compressing the most terminal parts of the deferent ducts. Both ducts were enlarged and filled with hyperechoic content. The stallion was diagnosed with a complete occlusion of the deferent ducts because of the compression from the midline cyst of the colliculus seminalis. To date, there are no established treatments for this condition in stallions, although several procedures have been successfully used in men affected by similar problems. Therefore, we proposed performing one of these procedures-a laser ablation of the cyst to collapse it and to open the ejaculatory path. The stallion was placed under general anesthesia, and an endoscopic ultrasound-guided laser ablation of the cyst was performed. No immediate or long-term complications were observed. After the expulsion of accumulated material, the stallion produced normal semen and successfully impregnated mares during the next breeding season.