Articles: surgery.
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Minim Invas Neurosur · Oct 2008
ReviewAdvanced computer-aided intraoperative technologies for information-guided surgical management of gliomas: Tokyo Women's Medical University experience.
The availability of the intraoperative MRI and real-time neuronavigation has dramatically changed the principles of surgery for gliomas. Current intraoperative computer-aided technologies permit perfect localization of the neoplasm, precise estimation of its volume, and clear definition of its interrelationships with the eloquent brain structures. ⋯ Therefore, appropriate management of the wide spectrum of the intraoperative medical data and its adequate distribution between members of the surgical team for facilitation of the clinical decision-making is very important for attainment of the best possible outcome. Further progress in advanced neurovisualization, robotics, and comprehensive medical information technology has a great potential to increase the safety of the neurosurgical procedures for parenchymal brain tumors in the eloquent brain areas.
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Knee Surg Sports Traumatol Arthrosc · Oct 2008
Randomized Controlled TrialMinimal invasive and computer assisted total knee replacement compared with the conventional technique: a prospective, randomised trial.
Minimal invasive surgery (MIS) in total knee replacement (TKR) has been favoured by several authors and the industry and is asked for by the patients. Computer assisted surgery (CAS) is proposed to support the surgeon in terms of postoperative leg alignment and implant orientation. To prove the hypothesis that MIS in TKR fastens early rehabilitation compared to the standard approach and that CAS-MIS in TKR improves accuracy in implant position compared to the freehand MIS and freehand standard technique, we performed a prospective, randomised short-term trial which was approved by the local ethic committee. ⋯ The clinical relevance of our results is that the benefit of the minimal invasive approach in TKR is still not proven and navigation improves postoperative accuracy of leg alignment and component orientation. Our study shows that for the group of patients included there is no statistically significant difference in early rehabilitation between MIS and the conventional approach based on the Knee Society and WOMAC Score. Using the CAS technique restoration of leg axis was more accurate.
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Clinical Trial
Mutual-information-based image to patient re-registration using intraoperative ultrasound in image-guided neurosurgery.
An image-based re-registration scheme has been developed and evaluated that uses fiducial registration as a starting point to maximize the normalized mutual information (nMI) between intraoperative ultrasound (iUS) and preoperative magnetic resonance images (pMR). We show that this scheme significantly (p<0.001) reduces tumor boundary misalignment between iUS pre-durotomy and pMR from an average of 2.5 mm to 1.0 mm in six resection surgeries. ⋯ In addition, we report the translational and rotational capture ranges necessary for successful convergence of the nMI registration technique (5.9 mm and 5.2 deg, respectively). The proposed scheme is automatic, sufficiently robust, and computationally efficient (<2 min), and holds promise for routine clinical use in the operating room during image-guided neurosurgical procedures.
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Clinical biomechanics · Oct 2008
Validation of a computer navigation system and a CT method for determination of the orientation of implanted acetabular cup in total hip arthroplasty: a cadaver study.
Successful hip reconstruction to restore the normal hip biomechanics requires precise placement of implants. Computer assisted navigation in total hip arthroplasty has been proposed to have the potential to help achieve a high accuracy in implant placement. The goal of the study was to evaluate the accuracy of an imageless computer navigation system on cadavers and to validate a non-invasive computed tomography method for post-operative determination of acetabular cup orientation. ⋯ While the values for cup orientation determined with imageless computer navigation were comparable to those from direct bone and implant digitization, the measurement for anteversion obtained was not as accurate as that for abduction. The proposed computer tomography-model method has an excellent intra-rater consistency for experienced raters, as well as an excellent overall inter-rater consistency. The study confirms that a non-invasive computed tomography based model analysis can be used in clinical practice as a valid method for post-operatively evaluating the orientation of the acetabular component.
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Comparative Study Controlled Clinical Trial
Comparison between pointer-based and ultrasound-based navigation technique in THA using a minimally invasive approach.
The use of navigation techniques in primary total hip arthroplasty improves the position of endoprosthetic components, especially cup positioning. An intraoperative registration of the anterior pelvic plane is necessary to define the anteversion and inclination angles on the acetabular side. ⋯ Findings show more accurate postoperative radiographic anteversion with ultrasound navigation, although both manual pointer palpation and ultrasound registration techniques show a very small standard deviation in anteversion, inclination, and leg length difference. In conclusion, we recommend navigation as a very reliable tool for the positioning of implants.