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2.
World Neurosurg ; 131: 220-226, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31415891

RESUMO

OBJECTIVE: Extent of resection of glioblastoma is an important predictor for overall survival, and 5-aminolevulinic acid fluorescence-guided surgery can improve outcomes. However, the technique requires the installation of a blue light module on operative microscopes and may be cost prohibitive. A novel and economical blue light-emitting headlamp was designed, and its clinical utility was explored. METHODS: A remote-controlled dual light emitting diode headlamp system was constructed with 1 diode emitting white light and the other blue. Spectrographic analysis of the blue light emitted from a commercial operative microscope and the headlamp was performed. A comparative evaluation of the 2 illumination systems was conducted for 3 patients who underwent craniotomy for glioblastoma resection. Histologic examination of the fluorescing tissue detected by the headlamp was performed, and the extent of resection was assessed by postoperative day 1 magnetic resonance imaging. RESULTS: Spectrography of blue light emitted from the headlamp system was wavelength specific with a single emission peak at 416 nm and a linewidth of 35 nm. In contrast, blue light from the microscope (peak: 426 nm) had a wider linewidth of 54 nm and was not wavelength specific with additional infrared radiation detected. Gross or near-total resection of contrast-enhancing glioblastoma was performed for all 3 patients. Intraoperatively, comparable tumor fluorescence was observed under microscope and headlamp blue light illumination. Histologic examination of tissue fluorescing under headlamp blue light confirmed the presence of glioblastoma. CONCLUSIONS: This novel proof-of-concept blue light-emitting headlamp device may offer an opportunity for institutions with limited resources to implement 5-aminolevulinic acid fluorescence-guided glioblastoma resections.


Assuntos
Neoplasias Encefálicas/cirurgia , Glioblastoma/cirurgia , Ácidos Levulínicos , Fármacos Fotossensibilizantes , Cor , Craniotomia/instrumentação , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espectrometria de Fluorescência , Cirurgia Assistida por Computador/instrumentação , Instrumentos Cirúrgicos
3.
Arch Orthop Trauma Surg ; 139(11): 1579-1586, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31278509

RESUMO

INTRODUCTION: When locking intramedullary nails, inserting the distal interlocking screw accurately and quickly with less radiation exposure is very important. The purpose of this randomized control study was to compare radiation exposure and accuracy of distal locking screws between free-hand fluoroscopic guidance and the use of a distal targeting system (DTS). MATERIALS AND METHODS: Inclusion criteria of this study were patients older than 60 years who need an intramedullary nailing due to unstable intertrochanteric and subtrochanteric fracture. The primary outcome was the attempt numbers of image intensifier during the insertion of distal locking screws. Secondary outcomes were operative time and angles between distal locking screws and nail. RESULTS: A total of 36 patients participated in the study. Eighteen patients using free-hand fluoroscopic guidance were assigned to Group I while 18 patients using DTS were assigned to Group II. The number of attempts of image intensifier during distal screw insertion (57.3 ± 31.42 vs. 11.5 ± 7.41, p < 0.001), ratio of attempt number for distal screws to the total attempts (0.33 ± 0.21 vs. 0.12 ± 0.08, p = 0.001), the number of hand exposure to image intensifier directly (75.0 ± 29.55 vs. 13.5 ± 19.07, p < 0.001), and the time of radiation exposure during distal screws insertion (42.57 ± 2.42 s vs. 12.72 ± 8.10 s, p < 0.001) were significantly lower in Group II compared to those in Group I. And, operation time (96.3 min ± 18.94 vs. 76.1 min ± 14.10, p < 0.001) was also statistically significantly lower in Group II. Both distal locking screws were significantly closer to perpendicular direction to the nail in Group II. CONCLUSION: The attempt number of image intensifier during the insertion of two distal locking screws was significantly reduced with DTS compared with that with free hand fluoroscopic guidance. Angle between distal locking screws and nail was also more accurate using DTS.


Assuntos
Fluoroscopia , Fixação Intramedular de Fraturas , Exposição à Radiação/estatística & dados numéricos , Cirurgia Assistida por Computador , Fluoroscopia/instrumentação , Fluoroscopia/métodos , Fluoroscopia/estatística & dados numéricos , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Fixação Intramedular de Fraturas/estatística & dados numéricos , Humanos , Período Intraoperatório , Pessoa de Meia-Idade , Duração da Cirurgia , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Cirurgia Assistida por Computador/estatística & dados numéricos
4.
J Urol ; 202(6): 1263-1269, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31347954

RESUMO

PURPOSE: Urinary stone treatment has been strongly influenced by advances in technology. Nevertheless, the photonic characteristics of stones as the treatment target have been neglected. Monitoring fluorescence spectra is sufficient for automatic target differentiation and laser feedback control as previously described. We investigated the characteristics of fluorescence signals and the clinical practicability of real-time laser feedback control during lithotripsy. MATERIALS AND METHODS: Fluorescence excitation light was superimposed on a holmium laser beam into the treatment fiber. Spectra were recorded and signal amplitude changes were analyzed during increases in distance between the fiber tip and the stone to identify the optimal threshold level for stone recognition. Ho:YAG lithotripsy was performed under in vitro surgical conditions in porcine tissue while our feedback system autonomously controlled the laser impulse release during lithotripsy. The tissue was then endoscopically and macroscopically examined for laser induced lesions. RESULTS: Mean ± SD autofluorescence signal amplitudes from urinary stone samples varied between 142 ± 29 and 1,521 ± 152 ADU while tissue and endoscope coating emission was negligible. Signal amplitude decreased rapidly at distances larger than 1 to 2 mm. Clinically reliable threshold values for target recognition could be set to prevent laser pulse emission if the stone was out of range or urothelial tissue might be harmed by laser irradiation. We observed no incorrectly released laser pulse or injury to tissue during autonomously controlled holmium laser lithotripsy. CONCLUSIONS: Our laboratory study strengthens the evidence that tracking real-time autofluorescence spectra during endoscopic stone surgery via automatic feedback control of the laser impulse release may become a potentially useful clinical tool for surgeons who navigate in the upper urinary tract.


Assuntos
Litotripsia a Laser/métodos , Imagem Óptica/métodos , Cirurgia Assistida por Computador/métodos , Ureteroscopia/métodos , Cálculos Urinários/cirurgia , Animais , Modelos Animais de Doenças , Estudos de Viabilidade , Retroalimentação , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Lasers de Estado Sólido , Litotripsia a Laser/instrumentação , Imagem Óptica/instrumentação , Reprodutibilidade dos Testes , Cirurgia Assistida por Computador/instrumentação , Suínos , Resultado do Tratamento , Ureteroscópios , Ureteroscopia/instrumentação , Cálculos Urinários/diagnóstico por imagem
5.
Expert Rev Med Devices ; 16(7): 555-567, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31154870

RESUMO

INTRODUCTION: Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic procedures. During the past decade, patient-specific instrumentation (PSI) has been commercially introduced in order to simplify and make TKA surgery more effective, precise and efficient than conventional mechanical instrumentation (CI) and computer-assisted surgery (CAS). Nevertheless, there are critical arguments against PSI for routine use. The aim of the current manuscript is to describe advantages and limitations of PSI for primary TKA. AREAS COVERED: By means of a description of the available literature different aspects are discussed (accuracy, clinical and functional outcomes, operative time, blood loss, efficiency and costs). EXPERT OPINION: Most publications do not claim a significant increase in PSI accuracy over CI, but they also do not postulate PSIs accuracy is worse either. Regarding clinical aspects, PSI did not appear to give any advantage over standard techniques although, equally, it did not appear to show any disadvantages. PSI seems to reduce operative time, could reduce perioperative blood loss and provides logistical benefits in the operation room. Further studies will be required to more thoroughly assess all the advantages and disadvantages of this promising technology as an alternative to CI and CAS.


Assuntos
Artroplastia do Joelho/instrumentação , Articulação do Joelho/cirurgia , Artroplastia do Joelho/economia , Custos e Análise de Custo , Humanos , Articulação do Joelho/diagnóstico por imagem , Duração da Cirurgia , Cirurgia Assistida por Computador/economia , Cirurgia Assistida por Computador/instrumentação , Resultado do Tratamento
6.
Phys Med ; 63: 63-69, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31221410

RESUMO

INTRODUCTION: Bone density can interfere with fluoroscopy-guided tumor tracking in radiotherapy. To improve markerless tumor tracking accuracy, we developed a dual energy subtraction (DES) mechanical image mask to use with a single x-ray exposure. METHODS: The DES mask consists of 2-mm-thick stainless-steel with 128 pairs of slits (0.388 mm width and openings), designed to match the dynamic flat panel detector (DFPD) pixel size. This was set on the front of the DFPD. This results in a DFPD image with one containing the exposed pixels and one containing the masked pixels. The masked pixel columns were interpolated from adjacent pixels and a subtraction image was generated from the interpolated images to make a bone suppression (BS) image. A chest phantom was set on the commercially available moving table (CIRS DYNAMIC PLATFORM 008PL) and DFPD images were acquired. A reference BS image was generated by double-exposure DES with and without a 2-mm-thick stainless-steel plate. Image quality and markerless tumor tracking accuracy were then evaluated. RESULTS: The DES mask decreased most of the visible bone densities from the chest phantom image acquired with a single exposure for a peak-signal-to-noise-ratio/structural similarity index measure (PSNR/SSIM) of 25.3 db/0.685). The tracking positional error, originally 12.6 mm, was improved to 0.2 mm. CONCLUSIONS: The DES mask can aid in BS image on fluoroscopic imaging and may be useful in markerless tumor tracking.


Assuntos
Imagens de Fantasmas , Técnica de Subtração , Cirurgia Assistida por Computador/instrumentação , Movimento (Física) , Tórax/diagnóstico por imagem , Fatores de Tempo
7.
Int J Med Robot ; 15(4): e2005, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31039278

RESUMO

BACKGROUND: The integration of computer-aided design/computer-aided manufacturing (CAD/CAM) tools and medicine is rapidly developing for designing medical devices. A novel design for a 3D-printed patient-specific surgical template for thoracic pedicle screw insertion, using a procedure based on reverse engineering, is presented. METHODS: The surgeon chooses the entry point on the vertebra. The optimal insertion direction and the size of the screws are defined via an algorithm on the basis of a patient-specific vertebra CAD model. The template features an innovative shape for a comfortable and univocal placement and a novel disengaging device. RESULTS: Three spinal fusions were performed to test the template. Excellent results were achieved in terms of the accuracy of the screw positioning, reduction in surgery duration, and number of X-rays. CONCLUSIONS: A novel design for a customized, 3D-printed surgical template for thoracic spinal arthrodesis was presented, and improvements in terms of precision, duration, and safety were achieved without changing the standard procedure.


Assuntos
Parafusos Pediculares , Impressão Tridimensional , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Algoritmos , Vértebras Cervicais/cirurgia , Humanos , Imagem Tridimensional/métodos , Radiografia , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X
8.
J Appl Clin Med Phys ; 20(6): 91-98, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31095866

RESUMO

PURPOSE: To evaluate the accuracy of monitoring intrafraction motion during stereotactic radiotherapy with the optical surface monitoring system. Prior studies showing a false increase in the magnitude of translational offsets at non-coplanar couch positions prompted the vendor to implement software changes. This study evaluated two software improvements intended to address false offsets. METHODS: The vendor implemented two software improvements: a volumetric (ACO) rather than planar calibration and, approximately 6 months later, an improved calibration workflow (CIB) designed to better compensate for thermal drift. Offsets relative to the reference position, obtained at table angle 0 following image-guided setup, were recorded before beam-on at each table position and at the end of treatment the table returned to 0° for patients receiving SRT. RESULTS: Prior to ACO, between ACO and CIB, and after CIB, 223, 155, and 436 fractions were observed respectively. The median magnitude of translational offsets at the end of treatment was similar for all three intervals: 0.29, 0.33, and 0.27 mm. Prior to ACO, the offset magnitude for non-zero table positions had a median of 0.79 mm and was found to increase with increasing distance from isocenter to the anterior patient surface. After ACO, the median magnitude was 0.74 mm, but the dependence on surface-to-isocenter distance was eliminated. After CIB, the median magnitude for non-zero table positions was reduced to 0.57 mm. CONCLUSION: Ongoing improvements in software and calibration procedures have decreased reporting of false offsets at non-zero table angles. However, the median magnitude for non-zero table angles is larger than that observed at the end of treatment, indicating that accuracy remains better when the table is not rotated.


Assuntos
Neoplasias Encefálicas/cirurgia , Posicionamento do Paciente , Imagens de Fantasmas , Radiocirurgia/instrumentação , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Cirurgia Assistida por Computador/instrumentação , Neoplasias Encefálicas/patologia , Humanos , Imobilização , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Software
9.
Arch Orthop Trauma Surg ; 139(8): 1133-1139, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31134372

RESUMO

BACKGROUND: Although sagittal tibial alignment in total knee arthroplasty (TKA) is important, no landmark exists to achieve reproducible slope. It is theoretically demonstrated that the preoperative planned distance between the skin surface and the rod can be a useful guide for the tibial slope in the previous imaging study. We conducted this retrospective study to confirm whether the results of the study are repeatable in an intra-operative situation. METHODS: Fifty-five consecutive TKAs using the distance from the extramedullary cutting guide rod to the skin surface as a reference guide for the tibial slope were performed and tibial component positioning was compared with 55 knees performed using the accelerometer-based portable navigation. The tibial component alignment was evaluated with a computed tomography (CT)-based three-dimensional (3D) software. RESULTS: The absolute mean deviation from the targeted slope in the proposed method was significantly smaller than the portable navigation (1.0° and 1.7°, respectively, p = 0.0025). The outlier rate beyond 3° was 0% in the proposed technique (16.4% in the portable navigation, p = 0.0014). CONCLUSIONS: The preoperative planned distance between the skin surface and the guide rod is a useful technique to provide accurate posterior tibial slope in TKA.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/diagnóstico por imagem , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Idoso , Feminino , Humanos , Imagem Tridimensional , Articulação do Joelho/cirurgia , Prótese do Joelho , Masculino , Cuidados Pré-Operatórios , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
10.
Oral Maxillofac Surg Clin North Am ; 31(3): 513-518, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31103316

RESUMO

Robotic surgery is no longer a fiction and its clinical applications are rapidly developing. Robotic surgery is increasingly used because of its minimal invasiveness. This article provides an overview of robotic surgery and its current applications in oral and maxillofacial surgery and implant dentistry. Robotic surgery is constantly evolving, and its applications are continuously expanding. Recently, robot-assisted surgery has been used for dental implant placement. In the United States, the first robotic dental surgery system was cleared by the Food and Drug Administration for dental implant procedures in 2017. At the end of 2017, the world's first autonomous dental implant placement system was developed by Zhao and colleagues in China. This so-called intelligent robot has a high degree of autonomy, can automatically adjust during intraoperative procedures, and can execute surgical tasks directly on patients without any apparent control by a surgeon.


Assuntos
Implantes Dentários , Procedimentos Cirúrgicos Robóticos , Robótica , Cirurgia Assistida por Computador , Competência Clínica , Humanos , Cirurgia Assistida por Computador/instrumentação , Estados Unidos
11.
Med Phys ; 46(6): 2646-2658, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30994191

RESUMO

PURPOSE: Minimally invasive procedures, such as microwave ablation, are becoming first-line treatment options for early-stage liver cancer due to lower complication rates and shorter recovery times than conventional surgical techniques. Although these procedures are promising, one reason preventing widespread adoption is inadequate local tumor ablation leading to observations of higher local cancer recurrence compared to conventional procedures. Poor ablation coverage has been associated with two-dimensional (2D) ultrasound (US) guidance of the therapy needle applicators and has stimulated investigation into the use of three-dimensional (3D) US imaging for these procedures. We have developed a supervised 3D US needle applicator segmentation algorithm using a single user input to augment the addition of 3D US to the current focal liver tumor ablation workflow with the goals of identifying and improving needle applicator localization efficiency. METHODS: The algorithm is initialized by creating a spherical search space of line segments around a manually chosen seed point that is selected by a user on the needle applicator visualized in a 3D US image. The most probable trajectory is chosen by maximizing the count and intensity of threshold voxels along a line segment and is filtered using the Otsu method to determine the tip location. Homogeneous tissue mimicking phantom images containing needle applicators were used to optimize the parameters of the algorithm prior to a four-user investigation on retrospective 3D US images of patients who underwent microwave ablation for liver cancer. Trajectory, axis localization, and tip errors were computed based on comparisons to manual segmentations in 3D US images. RESULTS: Segmentation of needle applicators in ten phantom 3D US images was optimized to median (Q1, Q3) trajectory, axis, and tip errors of 2.1 (1.1, 3.6)°, 1.3 (0.8, 2.1) mm, and 1.3 (0.7, 2.5) mm, respectively, with a mean ± SD segmentation computation time of 0.246 ± 0.007 s. Use of the segmentation method with a 16 in vivo 3D US patient dataset resulted in median (Q1, Q3) trajectory, axis, and tip errors of 4.5 (2.4, 5.2)°, 1.9 (1.7, 2.1) mm, and 5.1 (2.2, 5.9) mm based on all users. CONCLUSIONS: Segmentation of needle applicators in 3D US images during minimally invasive liver cancer therapeutic procedures could provide a utility that enables enhanced needle applicator guidance, placement verification, and improved clinical workflow. A semi-automated 3D US needle applicator segmentation algorithm used in vivo demonstrated localization of the visualized trajectory and tip with less than 5° and 5.2 mm errors, respectively, in less than 0.31 s. This offers the ability to assess and adjust needle applicator placements intraoperatively to potentially decrease the observed liver cancer recurrence rates associated with current ablation procedures. Although optimized for deep and oblique angle needle applicator insertions, this proposed workflow has the potential to be altered for a variety of image-guided minimally invasive procedures to improve localization and verification of therapy needle applicators intraoperatively.


Assuntos
Técnicas de Ablação/instrumentação , Fígado/diagnóstico por imagem , Fígado/cirurgia , Agulhas , Cirurgia Assistida por Computador/instrumentação , Humanos , Imagens de Fantasmas , Ultrassonografia
12.
Int J Comput Assist Radiol Surg ; 14(8): 1431-1438, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30997635

RESUMO

PURPOSE: The combination of data visualization and auditory display (e.g., sonification) has been shown to increase accuracy, and reduce perceived difficulty, within 3D navigation tasks. While accuracy within such tasks can be measured in real time, subjective impressions about the difficulty of a task are more elusive to obtain. Prior work utilizing electrophysiology (EEG) has found robust support that cognitive load and working memory can be monitored in real time using EEG data. METHODS: In this study, we replicated a 3D navigation task (within the context of image-guided surgery) while recording data pertaining to participants' cognitive load through the use of EEG relative alpha-band weighting data. Specifically, 13 subjects navigated a tracked surgical tool to randomly placed 3D virtual locations on a CT cerebral angiography volume while being aided by visual, aural, or both visual and aural feedback. During the study EEG data were captured from the participants, and after the study a NASA TLX questionnaire was filled out by the subjects. In addition to replicating an existing experimental design on auditory display within image-guided neurosurgery, our primary aim sought to determine whether EEG-based markers of cognitive load mirrored subjective ratings of task difficulty RESULTS : Similar to existing literature, our study found evidence consistent with the hypothesis that auditory display can increase the accuracy of navigating to a specified target. We also found significant differences in cognitive working load across different feedback modalities, but none of which supported the experiments hypotheses. Finally, we found mixed results regarding the relationship between real-time measurements of cognitive workload and a posteriori subjective impressions of task difficulty. CONCLUSIONS: Although we did not find a significant correlation between the subjective and physiological measurements, differences in cognitive working load were found. As well, our study further supports the use of auditory display in image-guided surgery.


Assuntos
Cognição , Eletroencefalografia , Procedimentos Neurocirúrgicos/métodos , Cirurgiões , Cirurgia Assistida por Computador/métodos , Sistemas de Computação , Tomografia Computadorizada de Feixe Cônico , Desenho de Equipamento , Feminino , Humanos , Masculino , Memória de Curto Prazo , Procedimentos Neurocirúrgicos/instrumentação , Reprodutibilidade dos Testes , Cirurgia Assistida por Computador/instrumentação , Inquéritos e Questionários , Interface Usuário-Computador , Carga de Trabalho
13.
Surg Technol Int ; 34: 23-29, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31034576

RESUMO

To circumvent the drawbacks of currently available platforms for natural orifice transluminal endoscopic surgery (NOTES) and monoport surgery (MPS), we developed a patient-specific, disposable, surgical soft robotic system. The system (Single-Port Overtube; SPOT) is designed as an overtube for standard surgical equipment. The platform body and the manipulators can be quickly adapted to transmural (monoport), NOTES and endoluminal (endoscopic) applications, and 3D-printed overnight as an individualized system. In addition, practical considerations, such as the predicted "ideal" dimensions of the platform, were evaluated. As a result, we found that preoperatively available biometric data currently provide little support for tailored instrument design. Further work is required to provide engineers / developers with more useful preoperative information.


Assuntos
Cirurgia Endoscópica por Orifício Natural/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Humanos , Cirurgia Endoscópica por Orifício Natural/métodos , Modelagem Computacional Específica para o Paciente , Impressão Tridimensional , Procedimentos Cirúrgicos Robóticos/métodos , Robótica/instrumentação , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos
14.
J Bone Joint Surg Am ; 101(8): 710-721, 2019 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-30994589

RESUMO

BACKGROUND: Medical image processing has facilitated simulation of 3-dimensional (3-D) corrective osteotomy, and 3-D rapid prototyping technology has further enabled the manufacturing of patient-matched surgical guides and implants (patient-matched instruments, or PMIs). However, 3-D corrective osteotomy using these technologies has not been the standard procedure. We aimed to prospectively verify the efficacy and safety of PMIs in corrective osteotomy for deformities of the upper extremity. METHODS: We enrolled 16 patients with a total of 17 bone deformities in the upper extremity. Eight patients had distal radial malunion; 5, distal humeral malunion; and 3, forearm diaphyseal malunion. All cases underwent 3-D corrective osteotomy with PMIs. The primary end point was the residual maximum deformity angle (MDA), which was calculated from 2 deformity angles-1 on the anteroposterior and 1 on the lateral postoperative radiograph. Secondary end points included the deformity angle on radiographs, 3-D error between the preoperative planning model and the postoperative result, range of motion, grip strength, pain measured with a visual analog scale (VAS), patient satisfaction, and Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: The average MDA significantly improved from 25.5° preoperatively to 3.3° at the final follow-up (p < 0.001). The angular deformity was within 5° in all cases, except for 1 with distal radial malunion who had a higher angle on the anteroposterior radiograph. The error between the correction seen on the postoperative 3-D bone model and the planned correction was <1° and <1 mm. Flexion and extension of the wrist and pronation of the forearm of the patients treated for distal radial malunion improved significantly, and pronation improved for those treated for forearm diaphyseal malunion. The average VAS score, grip strength, and DASH score significantly improved as well. Of the 16 patients, 15 were very satisfied or satisfied with the outcomes. CONCLUSIONS: Corrective osteotomy using PMIs achieved accurate correction and good functional recovery in the upper extremity. Although our study was limited to cases without any deformity on the contralateral side, 3-D corrective osteotomy using PMIs resolved treatment challenges for complex deformities in upper extremities. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Ossos do Braço/lesões , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Fraturas Mal-Unidas/cirurgia , Osteotomia/instrumentação , Cirurgia Assistida por Computador/instrumentação , Adolescente , Adulto , Idoso , Ossos do Braço/diagnóstico por imagem , Criança , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Mal-Unidas/diagnóstico por imagem , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Estudos Prospectivos , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Resultado do Tratamento , Adulto Jovem
15.
J Bone Joint Surg Am ; 101(7): 580-588, 2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30946191

RESUMO

BACKGROUND: Computer navigation and image-derived instrumentation (IDI) are technology-based methods developed to improve outcomes and potentially reduce revision total knee arthroplasty (TKA). IDI refers to the use of manufactured, patient-specific surgical jigs. Conflicting reports exist on IDI-associated improvements in outcomes. The primary aim of the current study was to compare the rates of revision among TKA cases in which components were initially implanted with use of IDI, computer navigation, or neither of these methods ("other" TKA). The secondary aim was to determine whether the outcomes of IDI differed for specific subgroups. METHODS: Data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) for the 3 TKA groups: IDI, computer-navigated, and other TKA. The study period was from the first IDI procedure recorded by the AOANJRR (April 2010) to December 31, 2016. The analysis was restricted to primary TKA cases undertaken for osteoarthritis and involving patellar resurfacing and the use of a cross-linked polyethylene insert. Subanalyses were performed to evaluate the effects of age, sex, implantation method, IDI manufacturer, prosthetic design, and prosthesis type on the rates of revision. Kaplan-Meier estimates of survivorship described the time to first revision. Hazard ratios (HRs, Cox proportional hazards models) with adjustment for age and sex were used to compare revision rates. RESULTS: IDI was used in 5,486 primary TKA procedures. There was no significant difference among the groups in the cumulative percent revision (CPR) at 5 years: 3.3% (95% confidence interval [CI], 2.4% to 4.6%) for IDI, 2.4% (95% CI, 2.2% to 2.7%) for the computer-navigated group, and 2.5% (95% CI, 2.3% to 2.7%) for other TKA. Posterior-stabilized TKA with use of the IDI method had a significantly higher rate of revision at >3 months (HR, 1.45 [95% CI, 1.02 to 2.04]; p = 0.036), as did IDI TKA in the ≤65-year-old patient cohort (HR, 1.52 [95% CI, 1.10 to 2.09]; p = 0.010), compared with computer-navigated TKA. Patellar revision was significantly more likely in the IDI group. CONCLUSIONS: IDI TKA demonstrated no overall difference in early to mid-term revision rates compared with standard implantation methods. However, elevated rates of revision were seen with posterior-stabilized TKA, in patients ≤65 years of age, and for patellar revision, meaning that this method should be used with some caution and requires further study. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artroplastia do Joelho/instrumentação , Osteoartrite do Joelho/cirurgia , Reoperação/instrumentação , Cirurgia Assistida por Computador/instrumentação , Idoso , Austrália , Feminino , Humanos , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Resultado do Tratamento
16.
Breast Cancer Res Treat ; 176(1): 87-94, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30953256

RESUMO

PURPOSE: To develop and evaluate the accuracy of a three-dimensional (3D) US method for assessing unilateral breast reconstruction and discuss the feasibility of breast ultrasound 3D reconstruction of the unilateral breast compared with 3D MRI. METHODS: Sixty-four breast lesions were collected for surgical resection. (1) MRI and US imaging were used to reconstruct the 3D models of the breast neoplasm. The diameters for maximum length, width, and depth of the negative tumor margins were used as the primary standards for comparison. (2) The measurement direction was determined by the largest gravity change between the two body positions. (3) The vertical distance from the midpoint of breast neoplasm to the ipsilateral nipple was calculated via MRI and US reconstruction. RESULTS: (1) Comparison of the measured size and histopathology of the breast neoplasm showed that US, MRI, and histopathology were highly correlated (p < 0.001). (2) When compared with the other two vertical directions, the direction with the largest gravity change had the greatest difference between MRI and US measurements. (3) The vertical distance from the breast neoplasm to the ipsilateral nipple and skin junction was significantly different (p > 0.05). CONCLUSIONS: We have presented a novel US 3D reconstruction method for evaluating tumor size, which can provide a basis for investigated advanced visualization techniques for assessing breast tissue such as holographic presentation of 3D image data. These methods can provide physicians with a novel approach for making accurate surgical plans, for better communication with patients, and for more effective navigating throughout the operation.


Assuntos
Imagem Tridimensional , Mamoplastia , Cirurgia Assistida por Computador , Ultrassonografia Mamária , Neoplasias Unilaterais da Mama/diagnóstico por imagem , Neoplasias Unilaterais da Mama/cirurgia , Adulto , Gerenciamento Clínico , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imagem Tridimensional/instrumentação , Imagem Tridimensional/métodos , Imagem por Ressonância Magnética/métodos , Mamoplastia/instrumentação , Mamoplastia/métodos , Pessoa de Meia-Idade , Pesquisa , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Carga Tumoral , Ultrassonografia Mamária/instrumentação , Ultrassonografia Mamária/métodos , Neoplasias Unilaterais da Mama/patologia , Adulto Jovem
17.
Av. odontoestomatol ; 35(2): 59-68, mar.-abr. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184309

RESUMO

La planificación preoperatoria de la posición de los implantes constituye una parte importante de la coordinación quirúrgica y prostodóncica que se ha ido incrementando para conseguir resultados funcionales y estéticos. La cirugía guiada de implantes ha aumentado su popularidad, particularmente debido a los avances y a la utilización de la tomografia computarizada de haz cónico (CBCT) y a la planificación del tratamiento con implantes mediante programas informáticos 3D que valoran la localización del implante. De hecho, los pacientes edéntulos pueden ser diagnosticados con una CBCT y tratados con varios implantes por cirugía guiada y carga inmediata. La CBCT constituye un método no invasivo para describir las estructuras maxilofaciales evaluando la cantidad y calidad ósea de los rebordes alveolares. La incorporación de softwares específicos de implantología guiada puede mejorar la planificación virtual de la cirugía sin colgajo y los resultados de los implantes colocados con una férula quirúrgica guiada. En muchos casos, la carga inmediata optimiza el éxito de la técnica de cirugía guiada con muchos beneficios como la reducción del tiempo del tratamiento y el confort del paciente


Preoperative planning of the implant position as part of a coordinated prosthetic and surgical concept is becoming increasingly important regarding function and esthetics. Guided implant surgery is increasing in popularity, particularly due to advances and increased usage of cone beam computed tomography (CBCT) and dental implant treatment planning software allowing three-dimensional assessment of the implant site. In fact, edentulous patients can be diagnosed by a CBCT and treated with several implants for rehabilitation with guided surgery and immediate loading. The CBCT provides a noninvasive method to describe maxillofacial structures and assess bone volume and density of alveolar ridges. The introduction of specific softwares of guided implant dentistry can improve the virtual planning of flapless surgery and outcomes of dental implant placed in edentulous alveolar ridges by template guided surgery. In many cases, the immediate-loading protocol maximises the sucess of the guided surgery techniques with many benefits, such as short time and maximum patient comfort


Assuntos
Humanos , Cirurgia Assistida por Computador/instrumentação , Prostodontia/instrumentação , Implantação Dentária/instrumentação , Cirurgia Assistida por Computador , Procedimentos Cirúrgicos Pré-Protéticos Bucais , Tomografia Computadorizada de Feixe Cônico/métodos
18.
J Robot Surg ; 13(3): 363-370, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30847653

RESUMO

A systematic review was undertaken to assess the technology used to create stereovision for human perception. Adverse effects associated with artificial stereoscopic technology were reviewed with an emphasis on the impact of surgical performance in the operating room. MEDLINE/PubMed library databases were used to identify literature published up to Aug 2017. In the past 60 years, four major types of technologies have been used for reconstructing stereo images: anaglyph, polarization, active shutter, and autostereoscopy. As none of them can perfectly duplicate our natural stereoperception, user exposure to this artificial environment for a period of time can lead to a series of psychophysiological responses including nausea, dizziness, and others. The exact mechanism underlying these symptoms is not clear. Neurophysiologic evidences suggest that the visuo-vestibular pathway plays a vital role in coupling unnatural visual inputs to autonomic neural responses. When stereoscopic technology was used in surgical environments, controversial results were reported. Although recent advances in stereoscopy are promising, no definitive evidence has yet been presented to support that stereoscopes can enhance surgical performance in image-guided surgery. Stereoscopic technology has been rapidly introduced to healthcare. Adverse effects to human operators caused by immature technology seem inevitable. The impact on surgeons working with this visualization system needs to be explored and its safety and feasibility need to be addressed.


Assuntos
Imagem Tridimensional , Cirurgiões , Cirurgia Assistida por Computador , Percepção de Profundidade , Humanos , Imagem Tridimensional/efeitos adversos , Imagem Tridimensional/instrumentação , Imagem Tridimensional/métodos , Imagem Tridimensional/tendências , Enjoo devido ao Movimento/etiologia , Procedimentos Cirúrgicos Robóticos , Cirurgiões/psicologia , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Cirurgia Assistida por Computador/tendências
19.
Knee ; 26(3): 787-793, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30885546

RESUMO

BACKGROUND: The region around the knee joint is a common location of malignant bone tumours. Limb salvage procedures, whenever possible, are preferred to amputation. Allograft reconstruction is an accepted procedure to restore large bone defects. Preoperative three-dimensional (3D) planning and patient-specific instruments (PSI) have already been introduced. The purpose of this study was to provide a technical guideline for joint preserving tumour resection and allograft reconstruction around the knee using 3D planning and PSI. MATERIAL AND METHODS: 3D triangular surface models are created based on computed tomography (CT) and magnetic resonance imaging (MRI) data, whereby tumour expansion in the bone and affection of the surrounding structures are assessed. We describe the preoperative 3D analysis and planning in tumours around the knee joint. In addition, we provide a description of different PSI as well as cutting-techniques to enlarge the toolkit and facilitate a broad range of joint preserving tumour resections with allograft reconstruction around the knee. The basic guide serves for the registration of the preoperative plan for the surgery. Reference pins facilitate the application of further guides. Different additional guide designs can be applied, such as "safety guides," "osteotomy guides," and "allograft adjustment guides." DISCUSSION: The use of 3D planning and generation of PSI offers valuable tools in tumour resection and allograft reconstruction around the knee joint. To perform complex osteotomies and to preserve vital structures PSI seems to be helpful tools. A step-by-step guideline is provided for the use of 3D preoperative planning and sequentially applied patient-specific guides.


Assuntos
Neoplasias Ósseas/cirurgia , Imagem Tridimensional , Articulação do Joelho/cirurgia , Cuidados Pré-Operatórios , Cirurgia Assistida por Computador/métodos , Aloenxertos , Neoplasias Ósseas/diagnóstico por imagem , Transplante Ósseo/métodos , Humanos , Articulação do Joelho/diagnóstico por imagem , Salvamento de Membro/métodos , Imagem por Ressonância Magnética , Osteotomia , Cirurgia Assistida por Computador/instrumentação , Tomografia Computadorizada por Raios X
20.
Proc Inst Mech Eng H ; 233(4): 444-463, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30843465

RESUMO

Lung cancer is the leading cause of cancer-related death. According to the American Cancer Society, there were an estimated 222,500 new cases of lung cancer and 155,870 deaths from lung cancer in the United States in 2017. Accurate localization in lung interventions is one of the keys to reducing the death rate from lung cancer. In this study, a total of 217 publications from 2006 to 2017 about designs of medical devices for localization in lung interventions were screened, shortlisted, and categorized by localization principle and reviewed for functionality. Each study was analyzed for engineering characteristics and clinical significance. Research regarding interventional imaging equipment, navigation systems, and surgical devices was reviewed, and both research prototypes and commercial products were discussed. Finally, the future directions and existing challenges were summarized, including real-time intra-procedure guidance, accuracy of localization, clinical application, clinical adoptability, and clinical regulatory issues.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Cirurgia Assistida por Computador/instrumentação , Humanos , Tomografia Computadorizada por Raios X
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