Cargando…
Advances in stereotactic navigation for pelvic surgery
BACKGROUND: Stereotactic navigation could improve the quality of surgery for rectal cancer. Critical challenges related to soft tissue stereotactic pelvic navigation include the potential difference in patient anatomy between intraoperative lithotomy and preoperative supine position for imaging. The...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5956093/ https://www.ncbi.nlm.nih.gov/pubmed/29214516 http://dx.doi.org/10.1007/s00464-017-5968-0 |
_version_ | 1783323826664243200 |
---|---|
author | Wijsmuller, A. R. Romagnolo, L. G. C. Agnus, V. Giraudeau, C. Melani, A. G. F. Dallemagne, B. Marescaux, J. |
author_facet | Wijsmuller, A. R. Romagnolo, L. G. C. Agnus, V. Giraudeau, C. Melani, A. G. F. Dallemagne, B. Marescaux, J. |
author_sort | Wijsmuller, A. R. |
collection | PubMed |
description | BACKGROUND: Stereotactic navigation could improve the quality of surgery for rectal cancer. Critical challenges related to soft tissue stereotactic pelvic navigation include the potential difference in patient anatomy between intraoperative lithotomy and preoperative supine position for imaging. The objective of this study was to determine the difference in patient anatomy, sacral tilt, and skin fiducial position between these different patient positions and to investigate the feasibility and optimal set-up for stereotactic pelvic navigation. METHODS: Four consecutive human anatomical specimens were submitted to repeated CT-scans in a supine and several degrees of lithotomy position. Patient anatomy, sacral tilt, and skin fiducial position were compared by means of an image computing platform. In two specimens, a 10-degree wedge was introduced to reduce the natural tilt of the sacrum during the shift from supine to lithotomy position. A simulation of laparoscopic and transanal surgical procedures was performed to assess the accuracy of the stereotactic navigation. RESULTS: An up-to-supracentimetric change in patient anatomy was noted between different patient positions. This observation was minimized through the application of a wedge. When switching from supine to another position, sacral retroversion occurred independent of the use of a wedge. There was considerable skin fiducial motion between different positions. Accurate stereotactic navigation was obtained with the least registration error (1.9 mm) when the position of the anatomical specimen was registered in a supine position with straight legs, without pneumoperitoneum, using a conventional CT-scan with an identical specimen positioning. CONCLUSION: The change in patient anatomy is small during the sacral tilt induced by positional changes when using a 10-degree wedge, allowing for an accurate stereotactic surgical navigation. This opens up new promising opportunities to increase the quality of surgery for rectal cancer cases where it is difficult or impossible to identify and dissect along the anatomical planes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00464-017-5968-0) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5956093 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-59560932018-05-18 Advances in stereotactic navigation for pelvic surgery Wijsmuller, A. R. Romagnolo, L. G. C. Agnus, V. Giraudeau, C. Melani, A. G. F. Dallemagne, B. Marescaux, J. Surg Endosc Article BACKGROUND: Stereotactic navigation could improve the quality of surgery for rectal cancer. Critical challenges related to soft tissue stereotactic pelvic navigation include the potential difference in patient anatomy between intraoperative lithotomy and preoperative supine position for imaging. The objective of this study was to determine the difference in patient anatomy, sacral tilt, and skin fiducial position between these different patient positions and to investigate the feasibility and optimal set-up for stereotactic pelvic navigation. METHODS: Four consecutive human anatomical specimens were submitted to repeated CT-scans in a supine and several degrees of lithotomy position. Patient anatomy, sacral tilt, and skin fiducial position were compared by means of an image computing platform. In two specimens, a 10-degree wedge was introduced to reduce the natural tilt of the sacrum during the shift from supine to lithotomy position. A simulation of laparoscopic and transanal surgical procedures was performed to assess the accuracy of the stereotactic navigation. RESULTS: An up-to-supracentimetric change in patient anatomy was noted between different patient positions. This observation was minimized through the application of a wedge. When switching from supine to another position, sacral retroversion occurred independent of the use of a wedge. There was considerable skin fiducial motion between different positions. Accurate stereotactic navigation was obtained with the least registration error (1.9 mm) when the position of the anatomical specimen was registered in a supine position with straight legs, without pneumoperitoneum, using a conventional CT-scan with an identical specimen positioning. CONCLUSION: The change in patient anatomy is small during the sacral tilt induced by positional changes when using a 10-degree wedge, allowing for an accurate stereotactic surgical navigation. This opens up new promising opportunities to increase the quality of surgery for rectal cancer cases where it is difficult or impossible to identify and dissect along the anatomical planes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00464-017-5968-0) contains supplementary material, which is available to authorized users. Springer US 2017-12-06 2018 /pmc/articles/PMC5956093/ /pubmed/29214516 http://dx.doi.org/10.1007/s00464-017-5968-0 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Article Wijsmuller, A. R. Romagnolo, L. G. C. Agnus, V. Giraudeau, C. Melani, A. G. F. Dallemagne, B. Marescaux, J. Advances in stereotactic navigation for pelvic surgery |
title | Advances in stereotactic navigation for pelvic surgery |
title_full | Advances in stereotactic navigation for pelvic surgery |
title_fullStr | Advances in stereotactic navigation for pelvic surgery |
title_full_unstemmed | Advances in stereotactic navigation for pelvic surgery |
title_short | Advances in stereotactic navigation for pelvic surgery |
title_sort | advances in stereotactic navigation for pelvic surgery |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5956093/ https://www.ncbi.nlm.nih.gov/pubmed/29214516 http://dx.doi.org/10.1007/s00464-017-5968-0 |
work_keys_str_mv | AT wijsmullerar advancesinstereotacticnavigationforpelvicsurgery AT romagnololgc advancesinstereotacticnavigationforpelvicsurgery AT agnusv advancesinstereotacticnavigationforpelvicsurgery AT giraudeauc advancesinstereotacticnavigationforpelvicsurgery AT melaniagf advancesinstereotacticnavigationforpelvicsurgery AT dallemagneb advancesinstereotacticnavigationforpelvicsurgery AT marescauxj advancesinstereotacticnavigationforpelvicsurgery |