In orthopaedic bone tumour surgery, surgeons perform malignant bone tumour resections with tumour-free margin. The bone defects following the resections have to be reconstructed to restore limb function. An inaccurate resection with positive surgical margin increased the risk of local recurrence and compromised patients’ survival. Conventionally, orthopaedic tumour surgeons analyse two-dimensional (2D) imaging information and mentally integrate to formulate a three-dimensional (3D) surgical plan. It is difficult to translate the surgical plan to the operating room in complex cases.
Computer-assisted tumour surgery (CATS) has been developed in orthopaedic oncology for the last decade. The technique may enable surgeons’ 3D surgical planning and image-guided bone resection as planned. The technique may apply to difficult surgery in pelvic or sacral tumours, limited resection in joint-preserving tumour surgery or bone defect reconstruction using CAD prostheses or allograft.
Early results suggested that the technique may help in safe tumour resection and improve surgical accuracy by replicating the preoperative planning. The improved surgical accuracy may offer clinical benefits.
Surgeons have to be aware of the potential errors of the technique that may result in inaccurate bone resections with possible adverse clinical outcomes. Given that bone sarcoma is rare, the published reports from different tumour centres could only analyse relatively small patient population with the heterogeneous histological diagnosis. Multicentre comparative studies with long-term follow-up are necessary to confirm its clinical efficacy.
This chapter provides an overview of computer navigation in orthopaedic tumour surgery over the past decade. It (1) describes the current workflow, (2) reports the clinical indications and results and (3) discusses its limitations and future development.
Computer navigation Computer-assisted tumour surgery (CATS) Image fusion Pelvic tumour Sacral tumour Joint-preserving surgery Surgical accuracy Orthopaedic oncology Surgical planning Image-guided bone resection
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Conflict of Interest
Kwok-Chuen Wong, Xiaohui Niu, Hairong Xu, Yuan Li and Shekhar Kumta declared no conflict of interest. The Stryker, Materialise and Stanmore Implants Limited and companies did not fund or sponsor this research.
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