scholarly journals 3D-Imaging navigation in posterior pelvic iliosacral screwing using the Surgivisio® system.

10.29007/trs2 ◽  
2020 ◽  
Author(s):  
Mehdi Boudissa ◽  
Delphine Carmagnac ◽  
Gael Kerschbaumer ◽  
Jérôme Tonetti
Keyword(s):  
Radiation Exposure ◽  
3D Imaging ◽  
Operative Time ◽  
Screw Placement ◽  
Iliosacral Screw ◽  
Navigation Systems ◽  
Intraoperative 3D Imaging ◽  
Dose Area Product ◽  
Iliosacral Screws ◽  
The Mean

The recent studies about iliosacral screws performed with navigation systems show promising results. The Surgivisio system is a new generation of intraoperative 3D imaging technique used in our institution since two years. The aim of this prospective study was to evaluate the accuracy of iliosacral screw placement and radiation exposure with the Surgivisio® system.Between January 2018 and December 2019, every patient operated for percutaneous iliosacral screwing using the Surgivisio® system were included in this prospective single center study. Accuracy of screw placement was assessed with post-operative high- resolution CT-scan. Operative time, radiation exposure and complications were assessed.A total of 32 patients were included with 49 iliosacral screws. Using the modified Gras classification, 2% (1/49) were rated as misplaced and 2% (1/49) were repositioned. The mean operative time was 26 min for the whole procedure. The mean dose area product was 7.98 Gy.cm2. Two complications were recorded (neurological pain treated by removal of the misplaced screw, an asymptomatic cement leakage with one augmented iliosacral screw).The Surgivisio® system is an efficient navigation tool for iliosacral screwing in minimal invasive surgery. It improves the accuracy of screw placement with an acceptable radiation exposure and operative time.

scholarly journals A useful intraoperative technique for transiliac-transsacral screws: a point-to-point coaxial guide apparatus

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ze-hang Zheng ◽  
Fei Xu ◽  
Zheng-qiang Luo ◽  
Ye Ren ◽  
Tao Fu ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Pelvic Fracture ◽  
Operative Time ◽  
Screw Placement ◽  
Screw Insertion ◽  
Average Operative Time ◽  
Free Hand Technique ◽  
Point To Point ◽  
Postoperative Fracture

Abstract Background The transiliac-transsacral screw placement is a clinical challenge for surgeons. This study explored a point-to-point coaxial guide apparatus assisting the transiliac-transsacral screw insertion and aimed to investigate the feasibility and accuracy of the guide apparatus in the treatment of posterior ring unstable pelvic fracture compared with a free-hand technique. Methods A retrospective study was performed to evaluate patients treated with transiliac-transsacral screws assisted by the point-to-point coaxial guide apparatus or free-hand technique. The intraoperative data of operative time and radiation exposure times were recorded. Postoperative radiographs and CT scans were performed to scrutinize the accuracy of screws position. The quality of the postoperative fracture reduction was assessed according to Matta radiology criteria. The pelvic function was assessed according to the Majeed scoring criteria at 6 months postoperatively. Results From July 2017 to December 2019, a total of 38 patients were included in this study, 20 from the point-to-point guide apparatus group and 18 from the free-hand group. There were no significant differences between the two groups in gender, age, injury causes, pelvic fracture type, screws level, and follow-up time (P > 0.05). The average operative time of the guide apparatus group for each screw was significantly less than that in the free-hand group (25.8 ± 4.7 min vs 40.5 ± 5.1, P < 0.001). The radiation exposure times were significantly lower in the guide apparatus group than that in the free-hand group (24.4 ± 6.0 vs 51.6 ± 8.4, P < 0.001). The intraosseous and juxtacortical rate of screw placement (100%) higher than in the free-hand group (94.4%). Conclusion The point-to-point coaxial guide apparatus is feasible for assisting the transiliac-transsacral screw in the treatment of posterior unstable pelvic fractures. It has the advantages of simple operation, reasonable design and no need for expensive equipment, and provides an additional surgical strategy for the insertion of the transiliac-transsacral screw.

scholarly journals Navigated iliac screw placement may reduce radiation and OR time in lumbopelvic fixation of unstable complex sacral fractures

2021 ◽  
Author(s):  
M. F. Hoffmann ◽  
E. Yilmaz ◽  
D. C. Norvel ◽  
T. A. Schildhauer
Keyword(s):  
Radiation Exposure ◽  
Operative Time ◽  
Pelvic Ring ◽  
Screw Placement ◽  
Fluoroscopy Time ◽  
Complication Rates ◽  
Lumbopelvic Fixation ◽  
Navigation Group ◽  
Iliac Screws ◽  
Iliac Screw

Abstract Purpose Instability of the posterior pelvic ring may be stabilized by lumbopelvic fixation. The optimal osseous corridor for iliac screw placement from the posterior superior iliac spine to the anterior inferior iliac spine requires multiple ap- and lateral-views with additional obturator-outlet and -inlet views. The purpose of this study was to determine if navigated iliac screw placement for lumbopelvic fixation influences surgical time, fluoroscopy time, radiation exposure, and complication rates. Methods Bilateral lumbopelvic fixation was performed in 63 patients. Implants were inserted as previously described by Schildhauer. A passive optoelectronic navigation system with surface matching on L4 was utilized for navigated iliac screw placement. To compare groups, demographics were assessed. Operative time, fluoroscopic time, and radiation were delineated. Results Conventional fluoroscopic imaging for lumbopelvic fixation was performed in 32 patients and 31 patients underwent the procedure with navigated iliac screw placement. No differences were found between the groups regarding demographics, comorbidities, or additional surgical procedures. Utilization of navigation led to fluoroscopy time reduction of more than 50% (3.2 vs. 8.6 min.; p < 0.001) resulting in reduced radiation (2004.5 vs. 5130.8 Gy*cm2; p < 0.001). Operative time was reduced in the navigation group (176.7 vs. 227.4 min; p = 0.002) despite the necessity of additional surface referencing. Conclusion For iliac screws, identifying the correct entry point and angle of implantation requires detailed anatomic knowledge and multiple radiographic views. In our study, additional navigation reduced operative time and fluoroscopy time resulting in a significant reduction of radiation exposure for patients and OR personnel.

A prospective case control comparison of the ZeroGravity system versus a standard lead apron as radiation protection strategy in neuroendovascular procedures

2015 ◽  
Vol 8 (10) ◽  
pp. 1052-1055 ◽  
Author(s):  
Diogo C Haussen ◽  
Imramsjah Martijn John Van Der Bom ◽  
Raul G Nogueira
Keyword(s):  
Radiation Exposure ◽  
Radiation Protection ◽  
Protection System ◽  
Skin Dose ◽  
Lead Apron ◽  
Dose Area Product ◽  
Primary Operator ◽  
The Mean ◽  
Area Product ◽  
Peak Skin Dose

Background and purposeWe aimed to compare the performance of the ZeroGravity (ZG) system (radiation protection system composed by a suspended lead suit) against the use of standard protection (lead apron (LA), thyroid shield, lead eyeglasses, table skirts, and ceiling suspended shield) in neuroangiography procedures.Materials and methodsRadiation exposure data were prospectively collected in consecutive neuroendovascular procedures between December 2014 and February 2015. Operator No 1 was assigned to the use of an LA (plus lead glasses, thyroid shield, and a 1 mm hanging shield at the groin) while operator No 2 utilized the ZG system. Dosimeters were used to measure peak skin dose for the head, thyroid, and left foot.ResultsThe two operators performed a total of 122 procedures during the study period. The ZG operator was more commonly the primary operator compared with the LA operator (85% vs 71%; p=0.04). The mean anterior-posterior (AP), lateral, and cumulative dose area product (DAP) radiation exposure as well as the mean fluoroscopy time were not statistically different between the operators’ cases. The peak skin dose to the head of the operator with LA was 2.1 times higher (3380 vs 1600 μSv), while the thyroid was 13.9 (4460 vs 320 μSv), the mediastinum infinitely (520 vs 0 μSv), and the foot 3.3 times higher (4870 vs 1470 μSv) compared with the ZG operator, leading to an overall accumulated dose 4 times higher. The ratio of cumulative operator received dose/total cumulative DAP was 2.5 higher on the LA operator.ConclusionsThe ZG radiation protection system leads to substantially lower radiation exposure to the operator in neurointerventional procedures. However, substantial exposure may still occur at the level of the lens and thyroid to justify additional protection.

Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial

2019 ◽  
Vol 30 (5) ◽  
pp. 615-622 ◽  
Author(s):  
Xiaoguang Han ◽  
Wei Tian ◽  
Yajun Liu ◽  
Bo Liu ◽  
Da He ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Radiation Exposure ◽  
Pedicle Screw ◽  
Spinal Surgery ◽  
Facet Joint ◽  
Postoperative Hospital Stay ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
The Mean

OBJECTIVEThe object of this study was to compare the safety and accuracy of pedicle screw placement using the TiRobot system versus conventional fluoroscopy in thoracolumbar spinal surgery.METHODSPatients with degenerative or traumatic thoracolumbar spinal disorders requiring spinal instrumentation were randomly assigned to either the TiRobot-assisted group (RG) or the freehand fluoroscopy-assisted group (FG) at a 1:1 ratio. The primary outcome measure was the accuracy of screw placement according to the Gertzbein-Robbins scale; grades A and B (pedicle breach < 2 mm) were considered clinically acceptable. In the RG, discrepancies between the planned and actual screw placements were measured by merging postoperative CT images with the trajectory planning images. Secondary outcome parameters included proximal facet joint violation, duration of surgery, intraoperative blood loss, conversion to freehand approach in the RG, postoperative hospital stay, and radiation exposure.RESULTSA total of 1116 pedicle screws were implanted in 234 patients (119 in the FG, and 115 in the RG). In the RG, 95.3% of the screws were perfectly positioned (grade A); the remaining screws were graded B (3.4%), C (0.9%), and D (0.4%). In the FG, 86.1% screws were perfectly positioned (grade A); the remaining screws were graded B (7.4%), C (4.6%), D (1.4%), and E (0.5%). The proportion of clinically acceptable screws was significantly greater in the RG than in the FG (p < 0.01). In the RG, the mean deviation was 1.5 ± 0.8 mm for each screw. The most common direction of screw deviation was lateral in the RG and medial in the FG. Two misplaced screws in the FG required revision surgery, whereas no revision was required in the RG. None of the screws in the RG violated the proximal facet joint, whereas 12 screws (2.1%) in the FG violated the proximal facet joint (p < 0.01). The RG had significantly less blood loss (186.0 ± 255.3 ml) than the FG (217.0 ± 174.3 ml; p < 0.05). There were no significant differences between the two groups in terms of surgical time and postoperative hospital stay. The mean cumulative radiation time was 81.5 ± 38.6 seconds in the RG and 71.5 ± 44.2 seconds in the FG (p = 0.07). Surgeon radiation exposure was significantly less in the RG (21.7 ± 11.5 μSv) than in the FG (70.5 ± 42.0 μSv; p < 0.01).CONCLUSIONSTiRobot-guided pedicle screw placement is safe and useful in thoracolumbar spinal surgery.Clinical trial registration no.: NCT02890043 (clinicaltrials.gov)

When does intraoperative 3D-imaging play a role in transpedicular C2 screw placement?

Injury ◽  
2017 ◽  
Vol 48 (11) ◽  
pp. 2522-2528 ◽  
Author(s):  
Cornelius Jacobs ◽  
Philip P. Roessler ◽  
Sebastian Scheidt ◽  
Milena M. Plöger ◽  
Collin Jacobs ◽  
...  
Keyword(s):  
3D Imaging ◽  
Screw Placement ◽  
Intraoperative 3D Imaging

scholarly journals A Comparison of Radiation Exposure During Endoscopic Retrograde Cholangiopancreatography (ERCP) by Different Fluoroscope Techniques

2020 ◽  
Author(s):  
Saleh A. Alghsoon ◽  
Khaled S. Shaban ◽  
Altaf H. Khan ◽  
Fares M. Almeshal ◽  
Sulaimon O. Balogun ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Gastrointestinal Endoscopy ◽  
Tertiary Care ◽  
Care Hospital ◽  
Endoscopic Retrograde ◽  
Dose Area Product ◽  
The Mean ◽  
Level I ◽  
American Society

ABSTRACT Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is a relatively new endoscopic procedure combined with fluoroscopy that is performed for multiple diagnostic and therapeutic indications. It carries a known risk of radiation exposure to patients and staff. We aimed to examine radiation administration techniques and to measure the radiation dose delivered by these techniques. Methods This was a retrospective analysis of 437 ERCP procedures performed at a tertiary care hospital between April 2015 and April 2017. Results A total of 437 ERCP procedural charts were reviewed: fluoroscopy administration was endoscopist controlled (EC, n = 187, 42.79%) or technician controlled (TC, n = 250, 57.21%). The mean (and SD) fluoroscopy time (FT) was 2.107 ± 2.0 minutes. The mean (and SD) dose–area product (DAP) was 15,227.371 ± 16,784.738 Gy·cm2. The degree of ERCP difficulty was evaluated as recommended by the American Society for Gastrointestinal Endoscopy, and graded 1–4. Level I TC procedures had a mean FT and DAP of 1.600 minutes and 12,644.72 Gy·cm2, respectively. The FT and DAP values for level I EC procedures were 1.514 minutes and 12,966.71 Gy·cm2, respectively, as compared with level IV TC procedures (mean FT, 2.539 minutes; mean DAP, 19,469.94 Gy·cm2) and level IV EC procedures (mean FT, 4.890 minutes; mean DAP, 37,921.00 Gy·cm2). Conclusion DAP and FT are increased significantly in EC ERCP in American Society for Gastrointestinal Endoscopy 4 procedures. Comparison of the different degrees of difficulty indicated that there is a linear correlation between the degree of difficulty and both FT and DAP.

scholarly journals Pedicle Screw Placement Using Augmented Reality Surgical Navigation With Intraoperative 3D Imaging

Spine ◽  
2019 ◽  
Vol 44 (7) ◽  
pp. 517-525 ◽  
Author(s):  
Adrian Elmi-Terander ◽  
Gustav Burström ◽  
Rami Nachabe ◽  
Halldor Skulason ◽  
Kyrre Pedersen ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Pedicle Screw ◽  
3D Imaging ◽  
Surgical Navigation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Intraoperative 3D Imaging

scholarly journals Application of 3D laparoscopic colectomy for colon cancer

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Như Hiệp Phạm ◽  
Đình Quốc Dũng Phan
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Colectomy ◽  
3D Imaging ◽  
Operative Time ◽  
Female Ratio ◽  
Colon Cancers ◽  
Laparoscopic Colon ◽  
The Mean ◽  
Clinical Characteristic

Tóm tắt Đặt vấn đề: Đánh giá kết quả sớm việc ứng dụng nội soi 3D trong phẫu thuật cắt đại tràng do ung thư. Phương pháp nghiên cứu: Gồm 30 người bệnh (NB) được chẩn đoán ung thư đại tràng và được cắt đại tràng ứng dụng nội soi 3D từ tháng 01/2018 đến tháng 6/2019 tại Bệnh viện Trung ương Huế. Nghiên cứu một số đặc điểm chung, đặc điểm lâm sàng, cận lâm sàng và kết quả sớm cũng như theo dõi ngắn hạn người bệnh được phẫu thuật. Kết quả: Tỉ lệ nam (56,7%), nữ (43,3%), tuổi trung bình của người bệnh là 59,6 tuổi. Tỉ lệ cắt đại tràng phải, ngang, trái, sigma lần lượt là: 40%; 3,3%; 20%; 36,7%, không có tai biến trong mổ, biến chứng sau mổ là 10% với 2 trường hợp nhiễm khuẩn vết mổ, một trường hợp rò miệng nối sớm sau mổ. Thời gian phẫu thuật trung bình là 149,7 phút, lượng mất máu trong mổ là ít hơn 100 ml chiếm tỉ lệ 76,7%, thời gian nằm viện trung bình là 9,4 ngày. Số hạch vét được là 450 hạch. Kết quả sau mổ 03 tháng có 24/30 người bệnh tái khám và không có trường hợp nào tử vong, chưa phát hiện tái phát tại chỗ hay di căn trong các trường hợp tái khám. Kết luận: Nội soi 3D ứng dụng trong phẫu thuật cắt đại tràng do ung thư là an toàn và hiệu quả với những ưu điểm vượt trội về chiều sâu không gian của hình ảnh ba chiều, nên được ứng dụng rộng rãi và đây là bước đệm cho kĩ thuật mổ robot trong tương lai. Abstract Introduction: This study aims to evaluate the early outcomes of application of 3D in laparoscopic colectomy for colon cancer. Materials and Methods: 30 patients diagnosed the colon cancer were treated by 3D in laparoscopic colectomy from January 2018 to June 2019, at Hue Central hospital. The database on general as well as clinical and para-clinical characteristic aspects and early outcomes, short follow up were collected. Results: Male and female ratio was 1,3/1, average age was 59,6 years old. Rate of right, transverse, left and sigma colectomy was 40%; 3,3%; 20%; 36,7%, no complication occurred during the operation. The post-operative complication observed in 2 cases (10%) including one surgical site infection and one early anastomotic leak. The mean operative time was 149,7 minutes. Average blood loss lower than 100ml was in 76,7%. The mean hospitalization was 9.4 days. Total lympho node harvested 450. Follow up in 3 months after the operation for 24/30 patients, no death and local recurrence or metastasis were found. Conclusion: Three dimenssional (3D) imaging in laparoscopic colectomy for colon cancer were safe and effective, has remarkable advantages in the depth holograms of 3D, it should be widely applied as a step for future robotic surgery. Keywords: Three- dimenssional laparoscopic, colon cancers

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