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Lin J, Li Y, Feng X, Zhang Y, Wang J, Liao W, Li H, Yi X, Gan W, Yuan Z, Liu F, Shi L, Zeng B, Diao D. Impact of three-dimensional-printing technology guidance on surgical outcomes for retroperitoneal sarcoma: A propensity score-matched study. Cancer 2024. [PMID: 38959293 DOI: 10.1002/cncr.35452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND The surgical treatment of retroperitoneal sarcoma (RPS) is highly challenging because of its complex anatomy. In this study, the authors compared the surgical outcomes of patients with RPS who underwent surgical resection guided by three-dimensional (3D) printing technology versus traditional imaging. METHODS This retrospective study included 251 patients who underwent RPS resection guided by 3D-printing technology or traditional imaging from January 2019 to December 2022. The main outcome measures were operative time, intraoperative blood loss, postoperative complications, and hospital stay. RESULTS In total, 251 patients were enrolled in the study: 46 received 3D-printed navigation, and 205 underwent traditional surgical methods. Propensity score matching yielded 44 patients in the 3D group and 82 patients in the control group. The patients' demographics and tumor characteristics were comparable in the matched cohorts. The 3D group had significantly shorter operative time (median, 186.5 minutes [interquartile range (IQR), 130.0-251.3 minutes] vs. 210.0 minutes [IQR, 150.8-277.3 minutes]; p = .04), less intraoperative blood loss (median, 300.0 mL [IQR, 100.0-575.0 mL] vs. 375.0 mL [IQR, 200.0-925.0 mL]; p = .02), shorter postoperative hospital stays (median, 11.0 days [IQR, 9.0-13.0 days] vs. 14.0 days [IQR, 10.8-18.3 days]; p = .02), and lower incidence rate of overall postoperative complications than the control group (18.1% vs. 36.6%; p = .03). There were no differences with regard to the intraoperative blood transfusion rate, the R0/R1 resection rate, 30-day mortality, or overall survival. CONCLUSIONS Patients in the 3D group had favorable surgical outcomes compared with those in the control group. These results suggest that 3D-printing technology might overcome challenges in RPS surgical treatment. PLAIN LANGUAGE SUMMARY The surgical treatment of retroperitoneal sarcoma (RPS) is highly challenging because of its complex anatomy. The purpose of this study was to investigate whether three-dimensional (3D) printing technology offers advantages over traditional two-dimensional imaging (such as computed tomography and magnetic resonance imaging) for guiding the surgical treatment of RPS. In a group of patients who had RPS, surgery guided by 3D-printing technology was associated with better surgical outcomes, including shorter operative time, decreased blood loss, shorter hospital stays, and fewer postoperative complications. These findings suggested that 3D-printing technology could help surgeons overcome challenges in the surgical treatment of RPS. 3D-printing technology has important prospects in the surgical treatment of RPS.
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Affiliation(s)
- Jiaxin Lin
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Yingru Li
- Department of General Surgery, Hernia and Abdominal Wall Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaochuang Feng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yu Zhang
- Department of Pathology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jiahao Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Weilin Liao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Hongming Li
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaojiang Yi
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wenchang Gan
- Department of General Surgery, Hernia and Abdominal Wall Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhilong Yuan
- Department of General Surgery, Hernia and Abdominal Wall Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fuheng Liu
- Department of General Surgery, Hernia and Abdominal Wall Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lishuo Shi
- Clinical Research Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bing Zeng
- Department of General Surgery, Hernia and Abdominal Wall Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Dechang Diao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
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Tetsworth KD, Welyczko ZH, Quinnan SM. Indications for Nonbiological Reconstruction of Posttraumatic Bone Defects About the Knee. J Orthop Trauma 2024; 38:S23-S29. [PMID: 38502600 DOI: 10.1097/bot.0000000000002764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 03/21/2024]
Abstract
SUMMARY 3D printing and modeling has continued to grow in popularity over the past decade because the technology has matured and become more affordable and widely available. The main indications for nonbiological reconstruction of large bone defects are principally those patients where the candidate is unlikely to be successful if reconstructed by other means. Bespoke, custom, patient-specific implants can be designed to very effectively address bone loss, incorporating design elements that are particular to the needs of any given unique clinical condition. These implants are generally designed as titanium scaffolds that encourage bony incorporation at the host implant junction both proximal and distal. These scaffolds are typically considered a cellular solid, with high porosity that also promotes bone ingrowth directly into the substance of the body of the implant. Titanium scaffolds of this type have become a useful treatment alternative for large segmental bone defects around the knee, especially distal femoral defects. These are often adult patients with local or systemic compromise, or instead they may be too young to be considered candidates for reconstruction using a megaprosthesis. The process requires careful evaluation of individual patients, then matching that patient with the best treatment option, while recognizing the expectations and demands specific to that particular patient. Several cases are presented here to illustrate the variety of indications that can be successfully addressed with this technology, highlighting the quality of the clinical outcome that can be achieved despite the complexity of the pathology encountered.
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Affiliation(s)
- Kevin D Tetsworth
- Department of Orthopaedic Surgery, The Royal Brisbane and Women's Hospital, Brisbane, Australia
- Orthopaedic Research Centre of Australia, Brisbane, Australia
- Herston Biofabrication Institute, Brisbane, Australia
| | - Zhenya H Welyczko
- Department of Orthopaedic Surgery, The Royal Brisbane and Women's Hospital, Brisbane, Australia
- Department of Orthopaedic Surgery, The Princess Alexandra Hospital, Brisbane, Australia; and
| | - Stephen M Quinnan
- The Paley Orthopedic and Spine Institute, St. Mary's Medical Center, West Palm Beach, FL
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van der Zee JM, Fitski M, van de Sande MAJ, Buser MAD, Hiep MAJ, Terwisscha van Scheltinga CEJ, Hulsker CCC, van den Bosch CH, van de Ven CP, van der Heijden L, Bökkerink GMJ, Wijnen MHWA, Siepel FJ, van der Steeg AFW. Tracked ultrasound registration for intraoperative navigation during pediatric bone tumor resections with soft tissue components: a porcine cadaver study. Int J Comput Assist Radiol Surg 2024; 19:297-302. [PMID: 37924438 PMCID: PMC10838821 DOI: 10.1007/s11548-023-03021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/12/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Resection of pediatric osteosarcoma in the extremities with soft tissue involvement presents surgical challenges due to difficult visualization and palpation of the tumor. Therefore, an adequate image-guided surgery (IGS) system is required for more accurate tumor resection. The use of a 3D model in combination with intraoperative tracked ultrasound (iUS) may enhance surgical decision making. This study evaluates the clinical feasibility of iUS as a surgical tool using a porcine cadaver model. METHODS First, a 3D model of the porcine lower limb was created based on preoperative scans. Second, the bone surface of the tibia was automatically detected with an iUS by a sweep on the skin. The bone surface of the preoperative 3D model was then matched with the bone surface detected by the iUS. Ten artificial targets were used to calculate the target registration error (TRE). Intraoperative performance of iUS IGS was evaluated by six pediatric surgeons and two pediatric oncologic orthopedists. Finally, user experience was assessed with a post-procedural questionnaire. RESULTS Eight registration procedures were performed with a mean TRE of 6.78 ± 1.33 mm. The surgeons agreed about the willingness for clinical implementation in their current clinical practice. They mentioned the additional clinical value of iUS in combination with the 3D model for the localization of the soft tissue components of the tumor. The concept of the proposed IGS system is considered feasible by the clinical panel, but the large TRE and degree of automation need to be addressed in further work. CONCLUSION The participating pediatric surgeons and orthopedists were convinced of the clinical value of the interaction between the iUS and the 3D model. Further research is required to improve the surgical accuracy and degree of automation of iUS-based registration systems for the surgical management of pediatric osteosarcoma.
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Affiliation(s)
- J M van der Zee
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
- Technical Medicine, TechMed Centre, University of Twente, Enschede, The Netherlands.
| | - M Fitski
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M A J van de Sande
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - M A D Buser
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M A J Hiep
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - C C C Hulsker
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C H van den Bosch
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C P van de Ven
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - L van der Heijden
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - G M J Bökkerink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M H W A Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - F J Siepel
- Robotics and Mechatronics, TechMed Centre, University of Twente, Enschede, The Netherlands
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Walker K, Simister SK, Carr-Ascher J, Monument MJ, Thorpe SW, Randall RL. Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas. J Surg Oncol 2024; 129:97-111. [PMID: 38010997 DOI: 10.1002/jso.27526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
In this special edition update on soft tissue sarcomas (STS), we cover classifications, emerging technologies, prognostic tools, radiation schemas, and treatment disparities in extremity and truncal STS. We discuss the importance of enhancing local control and reducing complications, including the role of innovative imaging, surgical guidance, and hypofractionated radiation. We review advancements in systemic and immunotherapeutic treatments and introduce disparities seen in this vulnerable population that must be considered to improve overall patient care.
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Affiliation(s)
- Kyle Walker
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - Samuel K Simister
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - Janai Carr-Ascher
- Department of Hematology and Oncology, University of California, Davis, Sacramento, California, USA
| | - Michael J Monument
- Department of Surgery, The University of Calgary, Calgary, Alberta, Canada
| | - Steven W Thorpe
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - R Lor Randall
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
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5
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Segal O, Benady A, Pickholz E, Ovadia JE, Druckmann I, Dadia S, Rath E, Albagli A, Efrima B. MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 cases. BMC Musculoskelet Disord 2023; 24:969. [PMID: 38102608 PMCID: PMC10722811 DOI: 10.1186/s12891-023-07074-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Precision surgery is becoming increasingly important in the field of Orthopaedic Oncology. Image-guided percutaneous cryosurgery (CRA) has emerged as a valid treatment modality for extra-abdominal desmoid tumors (EDTs). To date, most CRA procedures use CT-based guidance which fails to properly characterize tumor segments. Computer-guided MRI navigation can address this issue however, the lack of a fixed landmark for registration remains a challenge. Successful CRA correlates directly with precision approaches facilitated by intraoperative imaging guidance. This is the first study that attempts to assess the feasibility and efficacy of a novel approach of using skin fiducial markers to overcome the challenge of a MRI-based navigation CRA for symptomatic or progressive EDTs. METHODS In this retrospective study conducted between 2018 and 2020, 11 patients at a single center with symptomatic or progressive EDTs were treated with CRA using intraoperative MRI navigation. Fifteen cryosurgery procedures were performed, each adhering to a personalized pre-operative plan. Total tumor size, viable and non-viable portions pre- and post-operation, and SF-36 questionnaire evaluating subjective health were recorded. RESULTS All CRAs demonstrated 100% adherence to the predetermined plan. Overall, tumor size decreased Median= -56.9% [-25.6, -72.4]) with a reduction in viable tissue, (Median= -80.4% [-53.3, -95.2]). Four patients required additional CRAs. Only one patient's tumor did not reduce in size. One patient suffered from local muscle necrosis. Pre-operation, the average physical and mental scores 41.6 [29.4, 43] and 26.3 [17.6, 40.9] respectively. Post-operation, the average physical and mental scores were 53.4[38, 59.7] and 38 [31.2, 52.7] respectively. CONCLUSION These findings provide an early indication of the feasibility and efficacy of performing percutaneous cryosurgery using skin fiducial marker registration for MRI-computed navigation to treat EDTs safely. Larger cohorts and multicenter evaluations are needed to determine the efficacy of this technique.
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Affiliation(s)
- Ortal Segal
- National Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Benady
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eliana Pickholz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua E Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Druckmann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Solomon Dadia
- National Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Albagli
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Efrima
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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6
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Deng Z, Zhang Q, Hao L, Ding Y, Niu X, Liu W. Accuracy of bony resection under computer-assisted navigation for bone sarcomas around the knee. World J Surg Oncol 2023; 21:187. [PMID: 37344874 DOI: 10.1186/s12957-023-03071-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Computer-assisted navigation has made bone sarcoma resections more precise. However, further clinical studies involving accuracy analyses under navigation are still warranted. METHODS A retrospective study for analysis of computer-assisted navigation accuracy was carried out. Between September 2008 and November 2017, 39 cases of bone sarcomas around the knee joint were resected under computer-assisted navigation. The control group comprised 117 cases of bone sarcomas around the knee treated by limb salvage surgery wherein bony cutting was achieved freehand. The length difference (LD) was defined as the specimen length minus the planned resection length. The LDs were detected in both groups and compared. The margin accuracy (MA) was defined as the achieved margin minus the desired margin at the bone cutting site and was detected in the navigation group. RESULTS The LDs between the postoperative specimen length and the preoperative planned length were compared. In the navigation group, the LD was 0.5 ± 2.5 mm (range, - 5 to 5 mm), while in the freehand group, the LD was 3.4 ± 9.6 mm (range, - 20 to 29 mm), with a significant difference (P < 0.01). In the absolute value analysis, the LD absolute value was 2.0 ± 1.6 mm in the navigation group and 8.3 ± 6.0 mm in the freehand group, with a significant difference (P < 0.01). In the navigation group, the MA was 0.3 ± 1.5 mm (range, - 3 to 3 mm) and the MA absolute value was 1.1 ± 1.0 mm. CONCLUSIONS Better accuracy can be achieved when computer-assisted navigation is conducted for bone sarcoma resection around the knee. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Zhiping Deng
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Qing Zhang
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Lin Hao
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yi Ding
- Department of Pathology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Xiaohui Niu
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Weifeng Liu
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China.
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Bartelstein MK, Boland PJ. Fifty years of bone tumors. J Surg Oncol 2022; 126:906-912. [PMID: 36087079 PMCID: PMC9524618 DOI: 10.1002/jso.27027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/03/2022] [Indexed: 11/10/2022]
Abstract
There have been enormous advances in the treatment of bone tumors over the past half-century. The most notable of these has been the transition from amputation as the standard of care to limb salvage surgery. This transition is the result of advances in imaging techniques, accurate diagnosis, systemic therapies (including chemotherapy), and prosthetic design for the reconstruction of musculoskeletal defects. Advances have also been made in the management of benign and metastatic bone tumors.
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Affiliation(s)
- Meredith K. Bartelstein
- Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patrick J. Boland
- Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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8
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Park JW, Kang HG. Application of 3-dimensional printing implants for bone tumors. Clin Exp Pediatr 2022; 65:476-482. [PMID: 34942688 PMCID: PMC9561186 DOI: 10.3345/cep.2021.01326] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022] Open
Abstract
Three-dimensional (3D) additive manufacturing has recently been used in various medical fields. Among them, orthopedic oncology is one that utilizes it most actively. Bone and tumor modeling for surgical planning, personalized surgical instrument fabrication, and implant fabrication are typical applications. The 3D-printed metal implants using titanium alloy powder have created a revolutionary change in bone reconstruction that can be customized to all body areas; however, bioprinting remains experimental and under active study. This review explores the practical applications of 3D printing in orthopedic oncology and presents a representative case. The 3D-printed implant can replace the conventional tumor prosthesis and auto/allobone graft, thereby personalizing bone reconstruction. Biologic bone reconstruction using biodegradable or bioprinted materials beyond metal may be possible in the future.
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Affiliation(s)
- Jong Woong Park
- Orthopaedic Oncology Clinic, National Cancer Center, Goyang, Korea.,Division of Convergence Technology, National Cancer Center, Goyang, Korea
| | - Hyun Guy Kang
- Orthopaedic Oncology Clinic, National Cancer Center, Goyang, Korea.,Division of Convergence Technology, National Cancer Center, Goyang, Korea
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9
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Hrouda A, Capek L, Hradil J, Horak Z. Biomechanics optimisation of the laminoplasty groove size and position: A numerical study. J Clin Neurosci 2022; 105:45-50. [PMID: 36084565 DOI: 10.1016/j.jocn.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/18/2022] [Accepted: 08/28/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study is focused on the opening technique of the cervical vertebrae during laminoplasty which serves to substantially reduce the most severe adverse effects of the simple resection of posterior vertebral elements. This computational study aims to clarify by an optimisation approach what shape and position upon the lamina the groove should have. METHODS The computational model was developed in the computational software COMSOL Multiphysics 5.6a based on a computer tomography data obtained from the C4 vertebra. For finding the optimal minimum or maximum of a function (surface), optimisation algorithms are developed following the Nelder-Mead algorithm. RESULTS The reaction-opening force increases with a decreasing groove radius and an increasing position from the vertebra body. The created area increases with a decreasing groove radius and a decreasing position. As the opening happens mostly only above the groove, the opening area increases only in this location. Moreover, the von Mises stress peak value is almost twice as large as in the case of maximization of the opening area, which might result in breaking of the lamina as the thickness of the lamina would be reduced to its minimum. CONCLUSION The groove radius and position can affect the opening force and the opening area in case of double door laminoplasty. The opening force is highly influenced by the groove position and radius. The best position for placing the groove is in the middle of the lamina and the radius of the groove should be as large as possible.
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Affiliation(s)
- Ales Hrouda
- KU Leuven, Department of Mechanical Engineering, Belgium; Technical University of Liberec, Studentska 2, 46117 Liberec, Czech, Czech Republic
| | - Lukas Capek
- Regional Hospital in Liberec, Husova 10, 46001 Liberec, Czech Republic; Technical University of Liberec, Studentska 2, 46117 Liberec, Czech, Czech Republic.
| | - Jan Hradil
- Regional Hospital in Liberec, Husova 10, 46001 Liberec, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Ruska 2411/87, 100 00 Praha 10 Vinohrady, Czech Republic
| | - Zdenek Horak
- Third Faculty of Medicine, Charles University, Prague, Ruska 2411/87, 100 00 Praha 10 Vinohrady, Czech Republic; Colleague of Polytechnics Jihlava, Tolsteho 1556, 58601 Jihlava, Czech Republic
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10
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[Application of three-dimensional printing technology in treatment of limb bone tumors]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:790-795. [PMID: 35848172 PMCID: PMC9288913 DOI: 10.7507/1002-1892.202203006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
With the developing of three-dimensional (3D) printing technology, it is widely used in the treatment of bone tumors in the clinical orthopedics. Because of the great individual differences in the location of bone tumor, resection and reconstruction are difficult. Based on 3D printing technology, the 3D models can be prepared to show the anatomical part of the disease, so that the surgeons can create a patient-specific operational plans based on better understand the local conditions. At the same time, preoperative simulation can also be carried out for complex operations and patient-specific prostheses can be further designed and prepared according to the location and size of tumor, which may have more advantages in adaptability. In this paper, the domestic and international research progress of 3D printing technology in the treatment of limb bone tumors in recent years were reviewed and summarized.
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Clinical applications and prospects of 3D printing guide templates in orthopaedics. J Orthop Translat 2022; 34:22-41. [PMID: 35615638 PMCID: PMC9117878 DOI: 10.1016/j.jot.2022.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/05/2022] Open
Abstract
Background With increasing requirements for medical effects, and huge differences among individuals, traditional surgical instruments are difficult to meet the patients' growing medical demands. 3D printing is increasingly mature, which connects to medical services critically as well. The patient specific surgical guide plate provides the condition for precision medicine in orthopaedics. Methods In this paper, a systematic review of the orthopedic guide template is presented, where the history of 3D-printing-guided technology, the process of guides, and basic clinical applications of orthopedic guide templates are described. Finally, the limitations of the template and possible future directions are discussed. Results The technology of 3D printing surgical templates is increasingly mature, standard, and intelligent. With the help of guide templates, the surgeon can easily determine the direction and depth of the screw path, and choose the angle and range of osteotomy, increasing the precision, safety, and reliability of the procedure in various types of surgeries. It simplifies the difficult surgical steps and accelerates the growth of young and mid-career physicians. But some problems such as cost, materials, and equipment limit its development. Conclusions In different fields of orthopedics, the use of guide templates can significantly improve surgical accuracy, shorten the surgical time, and reduce intraoperative bleeding and radiation. With the development of 3D printing, the guide template will be standardized and simplified from design to production and use. 3D printing guides will be further sublimated in the application of orthopedics and better serve the patients. The translational potential of this paper Precision, intelligence, and individuation are the future development direction of orthopedics. It is more and more popular as the price of printers falls and materials are developed. In addition, the technology of meta-universe, digital twin, and artificial intelligence have made revolutionary effects on template guides. We aim to summarize recent developments and applications of 3D printing guide templates for engineers and surgeons to develop more accurate and efficient templates.
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Wong KC, Sun YE, Kumta SM. Review and Future/Potential Application of Mixed Reality Technology in Orthopaedic Oncology. Orthop Res Rev 2022; 14:169-186. [PMID: 35601186 PMCID: PMC9121991 DOI: 10.2147/orr.s360933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
In orthopaedic oncology, surgical planning and intraoperative execution errors may result in positive tumor resection margins that increase the risk of local recurrence and adversely affect patients’ survival. Computer navigation and 3D-printed resection guides have been reported to address surgical inaccuracy by replicating the surgical plans in complex cases. However, limitations include surgeons’ attention shift from the operative field to view the navigation monitor and expensive navigation facilities in computer navigation surgery. Practical concerns are lacking real-time visual feedback of preoperative images and the lead-time in manufacturing 3D-printed objects. Mixed Reality (MR) is a technology of merging real and virtual worlds to produce new environments with enhanced visualizations, where physical and digital objects coexist and allow users to interact with both in real-time. The unique MR features of enhanced medical images visualization and interaction with holograms allow surgeons real-time and on-demand medical information and remote assistance in their immediate working environment. Early application of MR technology has been reported in surgical procedures. Its role is unclear in orthopaedic oncology. This review aims to provide orthopaedic tumor surgeons with up-to-date knowledge of the emerging MR technology. The paper presents its essential features and clinical workflow, reviews the current literature and potential clinical applications, and discusses the limitations and future development in orthopaedic oncology. The emerging MR technology adds a new dimension to digital assistive tools with a more accessible and less costly alternative in orthopaedic oncology. The MR head-mounted display and hand-free control may achieve clinical point-of-care inside or outside the operating room and improve service efficiency and patient safety. However, lacking an accurate hologram-to-patient matching, an MR platform dedicated to orthopaedic oncology, and clinical results may hinder its wide adoption. Industry-academic partnerships are essential to advance the technology with its clinical role determined through future clinical studies. ![]()
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Affiliation(s)
- Kwok Chuen Wong
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China
- Correspondence: Kwok Chuen Wong, Department of Orthopaedics and Traumatology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China, Email
| | - Yan Edgar Sun
- New Territories, Hong Kong Special Administrative Region, People’s Republic of China
| | - Shekhar Madhukar Kumta
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China
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Abstract
The importance of 3D printing applications in the surgery of musculoskeletal tumors has increased in recent years. Even prior to the era of 3D printing, computer-assisted techniques, such as navigation, have proved their utility. Due to the variable appearance of bone tumors, there is a need for individual solutions. The 3D printing can be used for the development of anatomical demonstration models, the construction of patient-specific instruments and custom-made implants. For these three applications, different regulatory hurdles exist. Especially for the resection of pelvic tumors, 3D printing technologies seem to provide advantages due to the complicated anatomy and the proximity to relevant neurovascular structures. With the introduction of titanium printing, construction of individualized implants that fit exactly into the defect became feasible.
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Goulding KA, Wilke BK, Kiernan HC, Houdek MT, Sherman CE. Skeletal Sarcomas: Diagnosis, Treatment, and Follow-up from the Orthopedic Oncologist Perspective. Radiol Clin North Am 2022; 60:193-203. [DOI: 10.1016/j.rcl.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Moriel-Garceso DJ, González-Quevedo D, García de Quevedo D, Tamimi I. Three-dimensional printed titanium pseudo-prosthesis for the treatment of a tumoral bone defect. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:81-86. [PMID: 37588280 PMCID: PMC10426679 DOI: 10.1016/j.xrrt.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
| | - David González-Quevedo
- Department of Orthopaedic Surgery, Regional University Hospital of Malaga, Malaga, Spain
| | | | - Iskandar Tamimi
- Department of Orthopaedic Surgery, Regional University Hospital of Malaga, Malaga, Spain
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Efrima B, Ovadia J, Drukman I, Khoury A, Rath E, Dadia S, Gortzak Y, Albagli A, Sternheim A, Segal O. Cryo-surgery for symptomatic extra-abdominal desmoids. A proof of concept study. J Surg Oncol 2021; 124:627-634. [PMID: 34043245 DOI: 10.1002/jso.26528] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/05/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Extra abdominal desmoid tumors are rare, highly aggressive, and invasive benign soft tissue tumors. Current treatment modalities show high levels of recurrence and comorbidities. Cryo-surgery as an alternative was subsequently investigated. METHODS In this retrospective, single center study 11 patients showing symptomatic tumors were treated with individualized cryo-surgery. Treatment protocol included preoperative planning using computer rendered 3D models, intraoperative navigation and execution using cone beam guidance, and postoperative magnetic resonance imaging image analysis using a gaussian mixture model software. Subjective outcomes were reported using Short Form Health Survey (SF-36) questionnaires. RESULTS Sixteen ablations were performed, each demonstrating a complete match with the determined preoperative plan and model. A total of 9/11 (82%) of patients showed improvements in symptoms and a reduction in tumor volume while 2/11 (18%) did not. Average reduction in tumor volume and viable segments were 36.7% (p = 0.0397) and 63.3% (p = 0.0477), respectively. Mild complications according to the SIR Adverse Event Classification Guidelines were experienced in 3/16 (19%) ablations. SF-36 scores showed a statistically significant improvement (p = 0.0194) in the mental health category and a nonsignificant (p = 0.8071) improvement in the physical health category. CONCLUSION Cryo-surgery using the three-phase protocol as described may improve the overall outcome of future ablation procedures.
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Affiliation(s)
- Ben Efrima
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Drukman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Gortzak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Assaf Albagli
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Sternheim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ortal Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
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