The international journal of medical robotics + computer assisted surgery : MRCAS
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Malrotation after femoral nailing is a common problem, yet estimation of the correct rotation during nailing remains a technical challenge. In the current study, a novel technique was developed for determining femoral antetorsion, the anterior cortical angle (ACA) method. The ACA is the angle between a line along the anterior aspect of the femoral neck and the posterior condylar line of the distal femur. The principal advantage of this method is that it facilitates intra-operative assessment of femoral antetorsion by utilizing the positional technology integrated in smartphones. This measurement is directly comparable to measurements made using computed tomography (CT) scans. The objective of the current study was to investigate the possibility and to validate the feasibility and accuracy of the new method and compare the results obtained with the traditional methods of antetorsion estimation via CT and surgical navigation technology. ⋯ The ACA method generated acceptable results and could contribute to improving the results of femoral nailing. The use of this device in a real clinical setting is necessary to truly elucidate its utility.
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Comparative Study
Personalized image-based templates for iliosacral screw insertions: a pilot study.
Stabilization of rare unstable pelvic fractures in the case of sacral fractures and iliosacral joint dislocations can be tricky. 3D reconstruction and reverse engineering templates may be used to increase the accuracy of screw placement. ⋯ Personalized image-based templates for iliosacral screw insertions can increase the sacral lag screw placement accuracy, reduce radiation exposure, and shorten surgery time compared with traditional fluoroscopic methods.
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Radiation exposure to the surgeon is a concern in spinal surgery, especially with the increasing popularity of minimally invasive spinal surgery techniques. Three-dimensional (3D) image guidance used in conjunction with cone beam computed tomography (cbCT) has a theoretical advantage of decreased radiation exposure to the surgeon and operating room (OR) staff. Radiation scatter to the environment immediately surrounding a CT scanner during acquisition of a CT scan is a known entity. This in vivo study measures the radiation exposure to the surgeon when using cbCT registration in 3D image-guided spinal surgery. ⋯ Our study demonstrates that no radiation exposure to the surgeon occurs in cbCT-based, 3D image-guided spinal surgery procedures. Additionally, radiation scatter does not result in surgeon radiation exposure during patient registration if the surgeon stands behind a lead shield 10 feet from the cbCT device and not in direct line with the opening of the cbCT tube.
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Robotic-assisted transaxillary thyroidectomy is a minimally invasive approach for the removal of the thyroid through the axilla. This technique eliminates a visible scar and affords excellent optics of the cervical anatomy. We sought to describe the technique and outcome for transaxillary gasless subtotal thyroidectomy in the paediatric population. ⋯ This initial experience demonstrates that this technique can be a feasible, safe and effective method for subtotal thyroidectomy in the paediatric population. The use of robotic technology for endoscopic thyroid surgery could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid disease.
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In contemporary surgical clinical practice, spinal instability is often treated with mechanical stabilization techniques in order to protect the spinal cord and nerve roots. These techniques involve placing screws in defined regions of the vertebrae, typically the pedicle, where the strongest bone is found. The challenge for the surgeon is the accurate placement of screws for good mechanical purchase and to avoid damage to surrounding vital anatomical structures. This is especially critical in the cervical region, where the target bone mass is smaller and the spinal cord, nerve roots and vertebral arteries are all at risk. A robotic system enabling the surgeon to precisely place implants into the vertebrae should enhance safety and may potentially improve surgical results. ⋯ These results confirm the utility and applicability of the system. It is currently in redesign to improve accuracy and to render it compatible with on-line planning.