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Uribe Rivera AK, Seeliger B, Goffin L, García-Vázquez A, Mutter D, Giménez ME. Robotic Assistance in Percutaneous Liver Ablation Therapies: A Systematic Review and Meta-Analysis. ANNALS OF SURGERY OPEN 2024; 5:e406. [PMID: 38911657 PMCID: PMC11191991 DOI: 10.1097/as9.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/19/2024] [Indexed: 06/25/2024] Open
Abstract
Objective The aim of this systematic review and meta-analysis is to identify current robotic assistance systems for percutaneous liver ablations, compare approaches, and determine how to achieve standardization of procedural concepts for optimized ablation outcomes. Background Image-guided surgical approaches are increasingly common. Assistance by navigation and robotic systems allows to optimize procedural accuracy, with the aim to consistently obtain adequate ablation volumes. Methods Several databases (PubMed/MEDLINE, ProQuest, Science Direct, Research Rabbit, and IEEE Xplore) were systematically searched for robotic preclinical and clinical percutaneous liver ablation studies, and relevant original manuscripts were included according to the Preferred Reporting items for Systematic Reviews and Meta-Analyses guidelines. The endpoints were the type of device, insertion technique (freehand or robotic), planning, execution, and confirmation of the procedure. A meta-analysis was performed, including comparative studies of freehand and robotic techniques in terms of radiation dose, accuracy, and Euclidean error. Results The inclusion criteria were met by 33/755 studies. There were 24 robotic devices reported for percutaneous liver surgery. The most used were the MAXIO robot (8/33; 24.2%), Zerobot, and AcuBot (each 2/33, 6.1%). The most common tracking system was optical (25/33, 75.8%). In the meta-analysis, the robotic approach was superior to the freehand technique in terms of individual radiation (0.5582, 95% confidence interval [CI] = 0.0167-1.0996, dose-length product range 79-2216 mGy.cm), accuracy (0.6260, 95% CI = 0.1423-1.1097), and Euclidean error (0.8189, 95% CI = -0.1020 to 1.7399). Conclusions Robotic assistance in percutaneous ablation for liver tumors achieves superior results and reduces errors compared with manual applicator insertion. Standardization of concepts and reporting is necessary and suggested to facilitate the comparison of the different parameters used to measure liver ablation results. The increasing use of image-guided surgery has encouraged robotic assistance for percutaneous liver ablations. This systematic review analyzed 33 studies and identified 24 robotic devices, with optical tracking prevailing. The meta-analysis favored robotic assessment, showing increased accuracy and reduced errors compared with freehand technique, emphasizing the need for conceptual standardization.
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Affiliation(s)
- Ana K Uribe Rivera
- From the IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Barbara Seeliger
- From the IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Department of Visceral and Digestive Surgery, University Hospitals of Strasbourg, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube, UMR 7357 CNRS, INSERM U1328 RODIN, University of Strasbourg, Strasbourg, France
- Inserm U1110, Institute for Viral and Liver Diseases, Strasbourg. France
- Trustworthy AI Lab, Centre National de la Recherche Scientifique (CNRS), France
| | - Laurent Goffin
- ICube, UMR 7357 CNRS, INSERM U1328 RODIN, University of Strasbourg, Strasbourg, France
- Trustworthy AI Lab, Centre National de la Recherche Scientifique (CNRS), France
- Computational Surgery SAS, Schiltigheim, France
| | | | - Didier Mutter
- From the IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Department of Visceral and Digestive Surgery, University Hospitals of Strasbourg, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Mariano E Giménez
- From the IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- DAICIM Foundation (Training, Research and Clinical Activity in Minimally Invasive Surgery), Buenos Aires, Argentina
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Lin MS, Huang CW, Tsou HK, Tzeng CY, Kao TH, Lin RH, Chen TY, Li CR, Lee CY. Advances in surgical treatment for atlantoaxial instability focusing on rheumatoid arthritis: Analysis of a series of 67 patients. Int J Rheum Dis 2023; 26:1996-2006. [PMID: 37565304 DOI: 10.1111/1756-185x.14855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
AIM An estimated 88% of rheumatoid arthritis (RA) patients experience various degrees of cervical spine involvement. The excessive movement of the atlantoaxial joint, which connects the occiput to the upper cervical spine, results in atlantoaxial instability (AAI). AAI stabilization is usually achieved by C1 lateral mass-to-C2 pedicle screw-rod fixation (LC1-PC2 fixation), which is technically challenging in RA patients who often show destructive changes in anatomical structures. This study aimed to analyze the clinical results and operative experiences of C1-C2 surgery, with emphasis on the advancement of image-guided surgery and augmented reality (AR) assisted navigation. METHODS We presented our two decades of experience in the surgical management of AAI from April 2004 to November 2022. RESULTS We have performed surgery on 67 patients with AAI, including 21 traumatic odontoid fractures, 20 degenerative osteoarthritis, 11 inflammatory diseases of RA, 5 congenital anomalies of the os odontoideum, 2 unknown etiologies, 2 movement disorders, 2 previous implant failures, 2 osteomyelitis, 1 ankylosing spondylitis, and 1 tumor. Beginning in 2007, we performed LC1-PC2 fixation under C-arm fluoroscopy. As part of the progress in spinal surgery, since 2011 we used surgical navigation from presurgical planning to intraoperative navigation, using the preoperative computed tomography (CT) -based image-guided BrainLab navigation system. In 2021, we began using intraoperative CT scan and microscope-based AR navigation. CONCLUSION The technical complexities of C1-C2 surgery can be mitigated by CT-based image-guided surgery and microscope-based AR navigation, to improve accuracy in screw placement and overall clinical outcomes, particularly in RA patients with AAI.
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Affiliation(s)
- Mao-Shih Lin
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chih-Wei Huang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Houlong, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
- College of Health, National Taichung University of Science and Technology, Taichung, Taiwan, ROC
| | - Chung-Yuh Tzeng
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Houlong, Taiwan, ROC
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Medicinal Botanicals and Foods on Health Applications, Da-Yeh University, Changhua, Taiwan, ROC
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Ting-Hsien Kao
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Ruei-Hong Lin
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Tse-Yu Chen
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Chi-Ruei Li
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Cheng-Ying Lee
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
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Sommer F, Hussain I, Kirnaz S, Goldberg JL, Navarro-Ramirez R, McGrath Jr LB, Schmidt FA, Medary B, Gadjradj PS, Härtl R. Augmented Reality to Improve Surgical Workflow in Minimally Invasive Transforaminal Lumbar Interbody Fusion - A Feasibility Study With Case Series. Neurospine 2022; 19:574-585. [PMID: 36203284 PMCID: PMC9537847 DOI: 10.14245/ns.2244134.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/28/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a highly reproducible procedure for the fusion of spinal segments. We recently introduced the concept of "total navigation" to improve workflow and eliminate fluoroscopy. Imageguided surgery incorporating augmented reality (AR) may further facilitate workflow. In this study, we developed and evaluated a protocol to integrate AR into the workflow of MISTLIF. METHODS A case series of 10 patients was the basis for the evaluation of a protocol to facilitate tubular MIS-TLIF by the application of AR. Surgical TLIF landmarks were marked on a preoperative computed tomography (CT)-scan using dedicated software. This marked CT scan was fused intraoperatively with the low-dose navigation CT scan using elastic image fusion, and the markers were transferred to the intraoperative scan. Our experience with this workflow and the surgical outcomes were collected. RESULTS Our AR protocol was safely implemented in all cases. The TLIF landmarks could be preoperatively planned and transferred to the intraoperative imaging. Of the 10 cases, 1 case had additionally a synovial cyst resection and in 2 cases an additional bony decompression was performed due to central stenosis. The average procedure time was 160.6 ± 31.9 minutes. The AR implementation added 1.72 ± 0.37 minutes to the overall procedure time. No complications occurred. CONCLUSION Our findings support the idea that total navigation with AR may further facilitate the workflow, especially in cases with more complex anatomy and for teaching and training purposes. More work is needed to simplify the software and make AR integration more user-friendly.
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Affiliation(s)
- Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Jacob L. Goldberg
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Lynn B. McGrath Jr
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Franziska A. Schmidt
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Branden Medary
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Pravesh Shankar Gadjradj
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA,Corresponding Author Roger Härtl Department of Neurological Surgery, New York-Presbyterian Hospital, 525 E 68th Street, Box 99, New York, New York 10065, USA
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Sommer F, Hussain I, Kirnaz S, Goldberg J, McGrath L, Navarro-Ramirez R, Waterkeyn F, Schmidt F, Gadjradj PS, Härtl R. Safety and Feasibility of Augmented Reality Assistance in Minimally Invasive and Open Resection of Benign Intradural Extramedullary Tumors. Neurospine 2022; 19:501-512. [PMID: 36203278 PMCID: PMC9537853 DOI: 10.14245/ns.2244222.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/27/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Surgical resection of benign intradural extramedullary tumors (BIETs) is effective for appropriately selected patients. Minimally invasive surgical (MIS) techniques have been described for successful resection of BIET while minimizing soft tissue injury. Augmented reality (AR) is a promising new technology that can accurately allow for intraoperative localization from skin through the intradural compartment. We present a case series evaluating the timing, steps, and accuracy at which this technology is able to enhance BIET resection. METHODS A protocol for MIS and open AR-guided BIET resection was developed and applied to determine the feasibility. The tumor is marked on diagnostic magnetic resonance imaging (MRI) using AR software. Intraoperatively, the planning MRI is fused with the intraoperative computed tomography. The position and size of the tumor is projected into the surgical microscope and directly into the surgeon's field of view. Intraoperative orientation is performed exclusively via navigation and AR projection. Demographic and perioperative factors were collected. RESULTS Eight patients were enrolled. The average operative time for MIS cases was 128 ± 8 minutes and for open cases 206 ± 55 minutes. The estimated intraoperative blood loss was 97 ± 77 mL in MIS and 240 ± 206 mL in open procedures. AR tumor location and margins were considered sufficiently precise by the surgeon in every case. Neither correction of the approach trajectory nor ultrasound assistance to localize the tumor were necessary in any case. No intraoperative complications were observed. CONCLUSION Current findings suggest that AR may be a feasible technique for tumor localization in the MIS and open resection of benign spinal extramedullary tumors.
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Affiliation(s)
- Fabian Sommer
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Ibrahim Hussain
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Sertac Kirnaz
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Jacob Goldberg
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Lynn McGrath
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Rodrigo Navarro-Ramirez
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Francois Waterkeyn
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Franziska Schmidt
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Pravesh Shankar Gadjradj
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital/Och Spine, New York, NY, USA,Corresponding Author Roger Härtl Department of Neurosurgery, New York-Presbyterian Hospital, 525 E 68th Street, Box 99, New York, New York 10065, USA
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Sommer F, Goldberg JL, McGrath L, Kirnaz S, Medary B, Härtl R. Image Guidance in Spinal Surgery: A Critical Appraisal and Future Directions. Int J Spine Surg 2021; 15:S74-S86. [PMID: 34675032 DOI: 10.14444/8142] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Image-guided spinal surgery (IGSS) underwent rapid development over the past decades. The goal of IGSS is to increase patient safety and improve workflow. We present an overview of the history of IGSS, illustrate its current state, and highlight future developments. Currently, IGSS requires an image set, a tracking system, and a calibration method. IMAGING Two-dimensional images have many disadvantages as a source for navigation. Currently, the most common navigation technique is three-dimensional (3D) navigation based on cross-sectional imaging techniques such as cone-beam computed tomography (CT) or fan-beam CT. TRACKING Electromagnetic tracking uses an electromagnetic field to localize instruments. Optical tracking using infrared cameras has currently become one of the most common tracking methods in IGSS. CALIBRATION The three most common techniques currently used are the point-matching registration technique, the surface-matching registration technique, and the automated registration technique. FUTURE Augmented reality (AR) describes a computer-generated image that can be superimposed onto the real-world environment. Marking pathologies and anatomical landmarks are a few examples of many possible future applications. Additionally, AR offers a wide range of possibilities in surgical training. The latest development in IGSS is robotic-assisted surgery (RAS). The presently available data on RAS are very encouraging, but further improvements of these procedures is expected. CONCLUSION IGSS significantly evolved since its inception and is becoming a routinely used technology. In the future, IGSS will combine the advantages of "active/freehand 3D navigation" with AR and RAS and will one day find its way into all aspects of spinal surgery, not only in instrumented procedures.
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Affiliation(s)
- Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Lynn McGrath
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Branden Medary
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
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