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PURPOSE: To compare the two most used digital alignment systems regarding precision, repeatability and loss of track. METHODS: 15 eyes of 15 patients older than 21 years with cataracts were included in this prospective study. The two systems were intraoperatively superimposed and recorded, and the alignment of the two displayed alignment axes was analysed regarding precision, repeatability and loss of track. RESULTS: There was a significant difference in precision and repeatability between the two digital alignment systems regarding the projected alignment axis. The deviation from the actual target axis was significantly different, with a mean of 0.34°±0.75° for the Zeiss system and 1.60°±1.08° for the Alcon system (p=0.03, n=14). The within-subject SD was significantly lower with 0.21° for the Zeiss system and 0.34° for the Alcon system (p=0.03, n=14). CONCLUSIONS: The Zeiss Callisto system showed a significantly lower deviation from the target axis, higher stability with eye movements and less need for microscope illumination than the Alcon system. Both systems showed high precision when compared with manual marking methods. TRIAL REGISTRATION NUMBER: NCT05220683.
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Implantación de Lentes Intraoculares , Humanos , Estudios Prospectivos , Femenino , Masculino , Implantación de Lentes Intraoculares/métodos , Implantación de Lentes Intraoculares/instrumentación , Persona de Mediana Edad , Anciano , Lentes Intraoculares , Reproducibilidad de los Resultados , Astigmatismo/cirugía , Adulto , Facoemulsificación/métodos , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentación , Agudeza Visual/fisiología , CatarataRESUMEN
Electromagnetic tracking (EMT) can benefit image-guided interventions in cases where line of sight is unavailable. However, EMT can suffer from electromagnetic distortion in the presence of metal instruments. Metal instruments are widely used in laparoscopic surgery, ENT surgery, arthroscopy and many other clinical applications. In this work, we investigate the feasibility of tracking such metal instruments by placing the inductive sensor within the instrument shaft. We propose a magnetostatic model of the field within the instrument, and verify the results experimentally for frequencies from 6 kHz to 60 kHz. The impact of the instrument's dimensions, conductivity and transmitting field frequency is quantified for ranges representative of typical metal instruments used in image-guided interventions. We then performed tracking using the open-source Anser EMT system and quantify the error caused by the presence of the rod as a function of the frequency of the eight emitting coils for the system. The work clearly demonstrates why smaller tool diameters (less than 8 mm) are less susceptible to distortion, as well as identifying optimal frequencies (1 kHz to 2 kHz) for transmitter design to minimise for distortion in larger instruments.
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Metales , Metales/química , Humanos , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentación , Magnetismo/instrumentación , Diseño de Equipo , Campos ElectromagnéticosRESUMEN
BACKGROUND: Operation with a 3D exoscope has recently been introduced in clinical practice. The exoscope consists of two cameras placed in front of the operative field. Images are shown on a large 3D screen with high resolution. The system can be used to enhance precise dissection and provides new possibilities for improved ergonomics, fluorescence, and other optical-guided modalities. METHODS: Initial experience with the ultra-high-definition (4K) 3D exoscope in thyroid and parathyroid operations. The exoscope (OrbEyeTM) was mounted on a holding system (Olympus). RESULTS: We used the exoscope in parathyroidectomy (N = 6) and thyroidectomy (N = 6). Immediate advantages and disadvantages were discussed and recorded. The learning curve for use of the exoscope may be shorter for surgeons with training in endoscopic or robotic procedures. There may be improved ergonomics compared with normal open-neck operations. Further, the optical guided operations can be used with fluorescence and have potential for different on-lay techniques in the future. The 4 K 3D image quality is state-of-art and is highly appreciated during fine surgical dissection and eliminates the need for loupes. CONCLUSION: In several ways, using the ORBEYE™ in thyroid and parathyroid surgery provides the surgical team with a new and enhanced experience. This includes improved possibility for teaching, surgical ergonomics, and a 4K 3D camera with a powerful magnification system. However, it is not clear if utilization of these features would improve surgical outcomes. Furthermore, the ORBEYE™ lacks incorporation of parathyroid autofluorescence, and the current costs for the system do not facilitate general access to exoscope assisted operations.
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Imagenología Tridimensional , Paratiroidectomía , Tiroidectomía , Humanos , Tiroidectomía/instrumentación , Tiroidectomía/métodos , Paratiroidectomía/instrumentación , Paratiroidectomía/métodos , Imagenología Tridimensional/instrumentación , Imagenología Tridimensional/métodos , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentación , Glándulas Paratiroides/cirugía , Glándulas Paratiroides/diagnóstico por imagen , Glándula Tiroides/cirugía , Diseño de Equipo , Femenino , MasculinoRESUMEN
BACKGROUND AND OBJECTIVE: During open surgeries, telementoring serves as a valuable tool for transferring surgical knowledge from a specialist surgeon (mentor) to an operating surgeon (mentee). Depicting the intended movements of the surgical instruments over the operative field improves the understanding of the required tool-tissue interaction. The objective of this work is to develop a telementoring system tailored for open surgeries, enabling the mentor to remotely demonstrate the necessary motions of surgical instruments to the mentee. METHODS: A remote telementoring system for open surgery was implemented. The system generates visual cues in the form of virtual surgical instrument motion augmented onto the live view of the operative field. These cues can be rendered on both conventional screens in the operating room and as dynamic holograms on a head mounted display device worn by the mentee. The technical performance of the system was evaluated, where the operating room and remote location were geographically separated and connected via the Internet. Additionally, user studies were conducted to assess the effectiveness of the system as a mentoring tool. RESULTS: The system took 307 ± 12 ms to transmit an operative field view of 1920 × 1080 resolution, along with depth information spanning 36 cm, from the operating room to the remote location. Conversely, it took 145 ± 14 ms to receive the motion of virtual surgical instruments from the remote location back to the operating room. Furthermore, the user studies demonstrated: (a) mentor's capability to annotate the operative field with an accuracy of 3.92 ± 2.1 mm, (b) mentee's ability to comprehend and replicate the motion of surgical instruments in real-time with an average deviation of 12.8 ± 3 mm, (c) efficacy of the rendered dynamic holograms in conveying information intended for surgical instrument motion. CONCLUSIONS: The study demonstrates the feasibility of transmitting information over the Internet from the mentor to the mentee in the form of virtual surgical instruments' motion and projecting it as holograms onto the live view of the operative field. This holds potential to enhance real-time collaborative capabilities between the mentor and the mentee during an open surgery.
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Holografía , Tutoría , Instrumentos Quirúrgicos , Humanos , Cirugía Asistida por Computador/instrumentación , Telemedicina , Interfaz Usuario-Computador , Quirófanos , Sistemas de ComputaciónRESUMEN
BACKGROUND: Millions of patients suffering from eye disease cannot receive proper treatment due to the lack of qualified surgeons. Medical robots have the potential to solve this problem and have attracted significant attention in the research community. METHOD: This paper proposes a novel parallel robot with a remote centre of motion for minimally invasive eye surgery. Kinematics models, singularity and workspace analyses, and dimension optimisation are conducted. A prototype was developed, and experiments were conducted to test its mobility, accuracy, precision and stiffness. RESULTS: The prototype robot can successfully perform the required motions, and has a precision ranging from 7 ± 2 µm to 30 ± 8 µm, accuracy from 21 ± 10 µm to 568 ± 374 µm, and stiffness ranging from 1.22 ± 0.39 N/mm to 10.53 ± 5.18 N/mm. CONCLUSION: The prototype robot has a great potential for performing the minimally invasive surgery. Its stiffness meets the design requirement, but its accuracy and precision need to be further improved.
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Diseño de Equipo , Procedimientos Quirúrgicos Mínimamente Invasivos , Movimiento (Física) , Procedimientos Quirúrgicos Robotizados , Humanos , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Fenómenos Biomecánicos , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Oftalmológicos/instrumentación , Procedimientos Quirúrgicos Oftalmológicos/métodos , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentación , Reproducibilidad de los Resultados , Algoritmos , Robótica/instrumentación , Robótica/métodosRESUMEN
OBJECTIVES: The aim of this study was to assess the accuracy of surgical guides manufactured with four different 3D printers.. METHODS: Forty-eight surgical guides (BlueSky Plan, BlueSky Bio) were produced using four different 3D printers, with strict adherence to each manufacturer's instructions. The printers used were three digital light processing (DLP) printers (SolFlex170, VC; Nextdent5100, ND, and D30+Rapidshape, RS) and one stereolithographic (SLA) printer (Formlabs3B+, FL). The study evaluated the trueness and precision of the overall surface, the region of interest (RoI) (occlusal and guide zone), the repeatability in several batches, and the guide hole's diameter and xyz axes. The printed guides were digitized and compared with the CAD design control specimen (Control X, Geomagic). Descriptive statistics and Kruskal-Wallis tests with post-hoc Mann-Whitney tests were performed (α=0.05). RESULTS: Differences in trueness and precision were found between groups in the overall zone and RoI (p = 0.00). The ND group demonstrated the highest repeatability. Only the RS group exhibited a comparable guide hole diameter to the master specimen (5.27±2.12 mm; p = 0.104). No statistical differences were observed between groups in the x and z axes. However, in the y-axis, the VC group displayed statistically significant differences (p = 0.01). CONCLUSIONS: The results showed that the DLP groups had better overall accuracy, while the SLA group had the best results in the RoI. The manufacturer's workflows demonstrated a high reproducibility between batches in the RoI. The RS group had values most similar values to the guide hole diameter of the master specimen, with minimal deviations in guide hole orientation. CLINICAL SIGNIFICANCE: Implant position can be affected by the accuracy of the 3D printed surgical guide. Therefore, it is critical to analyze the final dimensions and the direction of the guide hole using available printing technologies.
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Diseño Asistido por Computadora , Impresión Tridimensional , Cirugía Asistida por Computador , Humanos , Reproducibilidad de los Resultados , Cirugía Asistida por Computador/instrumentación , Cirugía Asistida por Computador/métodos , Estereolitografía , Imagenología Tridimensional , Modelos Dentales , Diseño de EquipoRESUMEN
PURPOSE: Surgical robots effectively improve the accuracy and safety of surgical procedures. Current optical-navigated oral surgical robots are typically developed based on binocular vision positioning systems, which are susceptible to factors including obscured visibility, limited workplace, and ambient light interference. Hence, the purpose of this study was to develop a lightweight robotic platform based on monocular vision for oral surgery that enhances the precision and efficiency of surgical procedures. METHODS: A monocular optical positioning system (MOPS) was applied to oral surgical robots, and a semi-autonomous robotic platform was developed utilizing monocular vision. A series of vitro experiments were designed to simulate dental implant procedures to evaluate the performance of optical positioning systems and assess the robotic system accuracy. The singular configuration detection and avoidance test, the collision detection and processing test, and the drilling test under slight movement were conducted to validate the safety of the robotic system. RESULTS: The position error and rotation error of MOPS were 0.0906 ± 0.0762 mm and 0.0158 ± 0.0069 degrees, respectively. The attitude angle of robotic arms calculated by the forward and inverse solutions was accurate. Additionally, the robot's surgical calibration point exhibited an average error of 0.42 mm, with a maximum error of 0.57 mm. Meanwhile, the robot system was capable of effectively avoiding singularities and demonstrating robust safety measures in the presence of minor patient movements and collisions during vitro experiment procedures. CONCLUSION: The results of this in vitro study demonstrate that the accuracy of MOPS meets clinical requirements, making it a promising alternative in the field of oral surgical robots. Further studies will be planned to make the monocular vision oral robot suitable for clinical application.
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Diseño de Equipo , Procedimientos Quirúrgicos Robotizados , Humanos , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Visión Monocular/fisiología , Procedimientos Quirúrgicos Orales/instrumentación , Procedimientos Quirúrgicos Orales/métodos , Técnicas In Vitro , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentaciónRESUMEN
BACKGROUND: The method of stem cell transfer to narrow cochlear canals in vivo to generate hair cells is still an unclear operation. Thus, the development of any possible method that will ensure the usage of medical microrobots in small cochlear workspaces is a challenging procedure. METHODS: The current study tries to introduce a macro-micro manipulator system composed of a 6-DoF industrial serial manipulator as a macro manipulator and a proposed 5-DoF parallel manipulator with dual end effectors as a micro manipulator carrying permanent magnets for tetherless microrobot actuation inside the cochlea. RESULTS: Throughout the study, structural synthesis and kinematic analysis of the proposed micro manipulator were introduced. A prototype of the manipulator was manufactured and its hardware verification procedures were carried out using motion capture cameras and surgical navigation registration methodologies. CONCLUSIONS: Following motion training, the assembled macro-micro manipulator was successfully utilised to actuate a microrobot placed inside a manufactured cochlea mockup model.
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Cóclea , Diseño de Equipo , Procedimientos Quirúrgicos Robotizados , Cóclea/cirugía , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Humanos , Movimiento (Física) , Implantación Coclear/métodos , Implantación Coclear/instrumentación , Cirugía Asistida por Computador/instrumentación , Cirugía Asistida por Computador/métodos , Fenómenos BiomecánicosRESUMEN
BACKGROUND: Endoscope retrograde cholangiopancreatography is a standard surgical treatment for gallbladder and pancreatic diseases. However, surgeons is at high risk and require sufficient surgical experience and skills. METHODS: (1) The simultaneous localisation and mapping technique to reconstruct the surgical environment. (2) The preoperative 3D model is transformed into the intraoperative video environment to implement the multi-modal fusion. (3) A framework for virtual-to-real projection based on hand-eye alignment. For the purpose of projecting the 3D model onto the imaging plane of the camera, it uses position data from electromagnetic sensors. RESULTS: Our AR-assisted navigation system can accurately guide physicians, which means a distance of registration error to be restricted to under 5 mm and a projection error of 5.76 ± 2.13, and the intubation procedure is done at 30 frames per second. CONCLUSIONS: Coupled with clinical validation and user studies, both the quantitative and qualitative results indicate that our navigation system has the potential to be highly useful in clinical practice.
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Realidad Aumentada , Colangiopancreatografia Retrógrada Endoscópica , Fantasmas de Imagen , Cirugía Asistida por Computador , Humanos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentación , Imagenología Tridimensional/métodos , Sistemas de Navegación Quirúrgica , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/instrumentación , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: The purpose of this study was to examine the effects of intraoperative technology use on the rate of using polyethylene liners 15 mm or greater during primary total knee arthroplasty (TKA). METHODS: There were 103,295 implants from 16,386 primary unilateral TKAs performed on 14,253 patients at a single institution between 1 January 2018, and 30 June 2022, included in the current study. Robotic assistance and navigation guidance were used in 1274 (8%) and 8345 (51%) procedures, respectively. The remaining 6767 TKAs (41%) were performed manually. Polyethylene liners were manually identified and further subcategorised by implant thickness. Patients who underwent robotic-assisted TKA were younger (p < 0.001) and more likely to be male (p < 0.001) compared to patients who underwent navigation-guided or manual TKAs. RESULTS: Average polyethylene liner thickness was similar between groups (10.5 ± 1.5 mm for robotic-assisted TKAs, 10.9 ± 1.8 mm for navigation-guided TKAs and 10.8 ± 1.8 mm for manual TKAs). The proportions of polyethylene liners 15 mm or greater used were 4.9%, 3.8% and 1.9% for navigation-guided, manual and robotic-assisted procedures, respectively (p < 0.001). Multivariate regression analyses demonstrated that navigation-guided (odds ratio [OR]: 2.6, 95% confidence Interval [CI]: [1.75-4.07], p < 0.001) and manual (OR: 2.0, 95% CI: [1.34-3.20], p = 0.001) procedures were associated with an increased use of polyethylene liners 15 mm or greater. CONCLUSION: Robotic-assisted TKA was associated with a lower proportion of polyethylene liners 15 mm or greater used compared to navigation-guided and manual TKA. These findings suggest that robotic assistance can reduce human error via a more precise cutting system, limit over-resection of the tibia and flexion-extension gap mismatch and ultimately allow for more appropriately sized implants. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
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Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Polietileno , Procedimientos Quirúrgicos Robotizados , Cirugía Asistida por Computador , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Artroplastia de Reemplazo de Rodilla/instrumentación , Masculino , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/instrumentación , Anciano , Femenino , Persona de Mediana Edad , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentación , Estudios Retrospectivos , Diseño de PrótesisRESUMEN
BACKGROUND: The use of portable navigation systems (PNS) in total hip arthroplasty (THA) has become increasingly prevalent, with second-generation PNS (sPNS) demonstrating superior accuracy in the lateral decubitus position compared to first-generation PNS. However, few studies have compared different types of sPNS. This study retrospectively compares the accuracy and clinical outcomes of two different types of sPNS instruments in patients undergoing THA. METHODS: A total of 158 eligible patients who underwent THA at a single institution between 2019 and 2022 were enrolled in the study, including 89 who used an accelerometer-based PNS with handheld infrared stereo cameras in the Naviswiss group (group N) and 69 who used an augmented reality (AR)-based PNS in the AR-Hip group (group A). Accuracy error, navigation error, clinical outcomes, and preparation time were compared between the two groups. RESULTS: Accuracy errors for Inclination were comparable between group N (3.5° ± 3.0°) and group A (3.5° ± 3.1°) (p = 0.92). Accuracy errors for anteversion were comparable between group N (4.1° ± 3.1°) and group A (4.5° ± 4.0°) (p = 0.57). The navigation errors for inclination (group N: 2.9° ± 2.7°, group A: 3.0° ± 3.2°) and anteversion (group N: 4.3° ± 3.5°, group A: 4.3° ± 4.1°) were comparable between the groups (p = 0.86 and 0.94, respectively). The preparation time was shorter in group A than in group N (p = 0.036). There were no significant differences in operative time (p = 0.255), intraoperative blood loss (p = 0.387), or complications (p = 0.248) between the two groups. CONCLUSION: An Accelerometer-based PNS using handheld infrared stereo cameras and AR-based PNS provide similar accuracy during THA in the lateral decubitus position, with a mean error of 3°-4° for both inclination and anteversion, though the AR-based PNS required a shorter preparation time.
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Artroplastia de Reemplazo de Cadera , Realidad Aumentada , Cirugía Asistida por Computador , Sistemas de Navegación Quirúrgica , Humanos , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Estudios Retrospectivos , Femenino , Masculino , Anciano , Persona de Mediana Edad , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentación , Rayos InfrarrojosRESUMEN
INTRODUCTION: The accuracy of acetabular cup placement using conventional portable imageless navigation systems in total hip arthroplasty (THA) in the lateral decubitus position remains challenging. Several novel portable imageless navigation systems have been developed recently to improve cup placement accuracy in THA. This study compared the accuracy of acetabular cup placement using a conventional accelerometer-based portable navigation (c-APN) system and a novel accelerometer-based portable navigation (n-APN) system during THA in the lateral decubitus position. MATERIALS AND METHODS: This retrospective cohort study compared 45 THAs using the c-APN and 45 THAs using the n-APN system. The primary outcomes were the absolute errors between the intraoperative and postoperative values of acetabular cup radiographic inclination and anteversion angles and the percentage of cases with absolute errors within 5°. Intraoperative values were shown on navigation systems, and postoperative measurements were conducted using computed tomography images. RESULTS: The median absolute errors of the cup inclination angles were significantly smaller in the n-APN group than in the c-APN group (3.9° [interquartile range 2.2°-6.0°] versus 2.2° [interquartile range 1.0°-3.3°]; P = 0.002). Additionally, the median absolute errors of the cup anteversion angles were significantly smaller in the n-APN group than in the c-APN group (4.4° [interquartile range 2.4°-6.5°] versus 1.9° [interquartile range 0.8°-2.7°]; P < 0.001). Significant differences were observed in the percentage of cases with absolute errors within 5° of inclination (c-APN group 67% versus n-APN group 84%; P = 0.049) and anteversion angles (c-APN group 62% versus n-APN group 91%; P = 0.001). CONCLUSIONS: The n-APN system improved the accuracy of the cup placement compared to the c-APN system for THA in the lateral decubitus position.
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Acelerometría , Acetábulo , Artroplastia de Reemplazo de Cadera , Sistemas de Navegación Quirúrgica , Humanos , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/instrumentación , Estudios Retrospectivos , Acetábulo/cirugía , Acetábulo/diagnóstico por imagen , Masculino , Femenino , Anciano , Persona de Mediana Edad , Acelerometría/métodos , Acelerometría/instrumentación , Posicionamiento del Paciente/métodos , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentación , Prótesis de Cadera , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: Accurate pedicle screw placement is a challenge with reported misplacement rates of 10% and higher. A handheld navigation device (HND) may provide accuracy equal to CT-based navigation (CT-Nav) but without the cost and complexity. OBJECTIVE: To study the accuracy of a handheld navigation device for pedicle screw placement. STUDY DESIGN: This prospective cross-sectional study with consistently applied reference standard enrolled 20 patients undergoing 92 pedicle screw placements. PATIENTS: Patients who underwent pedicle screw placement between May 2022 and September 2022. OUTCOME MEASURES: Pedicle screw placement accuracy per Gertzbein-Robbins. METHODS: Once the screw pilot hole was established, the proposed trajectory of the HND was compared with that proposed by CT-Nav. Postoperatively, screw accuracy was graded according to Gertzbein-Robbins by a blinded radiologist based on CT scans. Accuracy was compared between the two systems and published control for fluoroscopy assisted and CT-Nav placement using Bayesian posterior distribution. RESULTS: The trajectory proposed by the HND and CT-Nav were in agreement in 98.9% (95% Exact CI; 94.09%-99.97%). The HND accuracy was 98.9% with 91 screws rated "A" and 1 rated "C". Noninferiority to fluoroscopic placement was achieved because the one-sided normal-approximation 95% CI Lower Bound (LB) of 95.3% is greater than the Performance Goal (PG) of 83.4%. Posthoc analysis demonstrated that the probability of superiority of the HND relative to the historical accuracy rate of 91.5% for fluoroscopy assisted procedures is >0.999 and that the HND's accuracy rate is within 4.5% of CT-Nav of 95.5% is >0.999. No adverse events or intra-operative complications associated with HND were observed. There was 1 (1.1%) intra-operative repositioning and no reoperations for any reason. CONCLUSIONS: The accuracy rate of the HND was 98.9%, and the proposed trajectory matched with CT-Nav in 98.9% of the time. This is superior to the historical published accuracy rate for fluoroscopy-assisted procedures and equivalent to the historical published accuracy rate for CT-Nav. CLINICAL TRIAL REGISTRATION NUMBER: Dutch trial register NL74268.058.20.
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Vértebras Lumbares , Tornillos Pediculares , Vértebras Torácicas , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Transversales , Fluoroscopía , Vértebras Lumbares/cirugía , Estudios Prospectivos , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Cirugía Asistida por Computador/instrumentación , Cirugía Asistida por Computador/métodos , Sistemas de Navegación Quirúrgica , Vértebras Torácicas/cirugía , Vértebras Torácicas/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Accurately estimating the 6D pose of snake-like wrist-type surgical instruments is challenging due to their complex kinematics and flexible design. METHODS: We propose ERegPose, a comprehensive strategy for precise 6D pose estimation. The strategy consists of two components: ERegPoseNet, an original deep neural network model designed for explicit regression of the instrument's 6D pose, and an annotated in-house dataset of simulated surgical operations. To capture rotational features, we employ an Single Shot multibox Detector (SSD)-like detector to generate bounding boxes of the instrument tip. RESULTS: ERegPoseNet achieves an error of 1.056 mm in 3D translation, 0.073 rad in 3D rotation, and an average distance (ADD) metric of 3.974 mm, indicating an overall spatial transformation error. The necessity of the SSD-like detector and L1 loss is validated through experiments. CONCLUSIONS: ERegPose outperforms existing approaches, providing accurate 6D pose estimation for snake-like wrist-type surgical instruments. Its practical applications in various surgical tasks hold great promise.
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Redes Neurales de la Computación , Instrumentos Quirúrgicos , Muñeca , Humanos , Muñeca/cirugía , Diseño de Equipo , Fenómenos Biomecánicos , Algoritmos , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Imagenología Tridimensional/métodos , Rotación , Reproducibilidad de los Resultados , Cirugía Asistida por Computador/instrumentación , Cirugía Asistida por Computador/métodos , Análisis de RegresiónRESUMEN
BACKGROUND: In the field of orthopaedics, external fixators are commonly employed for treating extremity fractures and deformities. Computer-assisted systems offer a promising and less error-prone treatment alternative to manual fixation by utilising a software to plan treatments based on radiological and clinical data. Nevertheless, existing computer-assisted systems have limitations and constraints. METHODS: This work represents the culmination of a project aimed at developing a new automatised fixation system and a corresponding software to minimise human intervention and associated errors, and the developed system incorporates enhanced functionalities and has fewer constraints compared to existing systems. RESULTS: The automatised fixation system and its graphical user interface (GUI) demonstrate promising results in terms of accuracy, efficiency, and reliability. CONCLUSION: The developed fixation system and its accompanying GUI represent an improvement in computer-assisted fixation systems. Future research may focus on further refining the system and conducting clinical trials.
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Fijadores Externos , Fijación de Fractura , Programas Informáticos , Cirugía Asistida por Computador , Interfaz Usuario-Computador , Humanos , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentación , Fijación de Fractura/instrumentación , Fijación de Fractura/métodos , Reproducibilidad de los Resultados , Diseño de Equipo , Fracturas Óseas/cirugía , Automatización , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/instrumentaciónRESUMEN
BACKGROUND: This paper proposes a haptic guidance system to improve catheter navigation within a simulated environment. METHODS: Three force profiles were constructed to evaluate the system: collision prevention; centreline navigation; and a novel force profile of reinforcement learning (RL). All force profiles were evaluated from the left common iliac to the right atrium. RESULTS: Our findings show that providing haptic feedback improved surgical safety compared to visual-only feedback. If staying inside the vasculature is the priority, RL provides the safest option. It is also shown that the performance of each force profile varies in different anatomical regions. CONCLUSION: The implications of these findings are significant, as they hold the potential to improve how and when haptic feedback is applied for cardiovascular intervention.
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Cirugía Asistida por Computador , Humanos , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentación , Simulación por Computador , Retroalimentación , Catéteres , Diseño de Equipo , Interfaz Usuario-ComputadorRESUMEN
INTRODUCTION: Surgery and biomedical imaging encompass a big share of the medical-device market. The ever-mounting demand for precision surgery has driven the integration of these two into the field of image-guided surgery. A key-question herein is how imaging modalities can guide the surgical decision-making process. Through performance-based design, chemists, engineers, and doctors need to build a bridge between imaging technologies and surgical challenges. AREAS-COVERED: This perspective article highlights the complementary nature between the technological design of an image-guidance modality and the type of procedure performed. The specific roles of the involved professionals, imaging technologies, and surgical indications are addressed. EXPERT-OPINION: Molecular-image-guided surgery has the potential to advance pre-, intra- and post-operative tissue characterization. To achieve this, surgeons need the access to well-designed indication-specific chemical-agents and detection modalities. Hereby, some technologies stimulate exploration ('go'), while others stimulate caution ('stop'). However, failing to adequately address the indication-specific needs rises the risk of incorrect tool employment and sub-optimal surgical performance. Therefore, besides the availability of new technologies, market growth is highly dependent on the practical nature and impact on real-life clinical care. While urology currently takes the lead in the widespread implementation of image-guidance technologies, the topic is generic and its popularity spreads rapidly within surgical oncology.
Asunto(s)
Cirugía Asistida por Computador , Humanos , Cirugía Asistida por Computador/instrumentación , Cirugía Asistida por Computador/métodos , Diagnóstico por Imagen/métodos , Diagnóstico por Imagen/instrumentación , Medicina de Precisión/métodos , Medicina de Precisión/instrumentación , Equipos y SuministrosRESUMEN
PURPOSE: The rise of stereolithographic surgical guides and digital workflow, combined with a better knowledge of materials and loading principle, has enabled the placement of the temporary prosthesis at the time of implant placement. This scoping review aimed to assess the current knowledge available on stackable guides. METHODS: The review focused on fully edentulous or requiring total edentulism patients. The procedure studied was the use of stackable guides for edentulous patients in order to place immediate temporary prostheses. The clinical endpoint was immediate placement of the provisional prosthesis after surgery combined with a prior bone reduction using a stackable guide. RESULTS: 12 case reports or case series articles met inclusion criteria, which did not allow an analysis by a systematic review. The included studies were case reports or case series. Most of the articles showed a base stabilized by 3 or 4 bone-pins, anchored in buccal or lingual part. Regarding the accuracy of bone reduction (ranged from 0.0248 mm to 1.98 mm) and implant placement when compared to planned, only 4 articles reported quantitative data. 11 articles showed an immediate loading with the transitional prosthesis after implant placement. CONCLUSIONS: There are as yet no prospective or comparative studies on the efficiency of this technique. In a reliable way, stackable guides seem to be able to guide the practitioner from the flap elevation to the placement of the temporary screw-retained implant supported prosthesis. Given the lack of studies in this specific field of guided surgery, further studies are needed to confirm the clinical relevance of this technique.
Asunto(s)
Implantación Dental Endoósea , Humanos , Implantación Dental Endoósea/métodos , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentación , Carga Inmediata del Implante Dental/métodos , Boca Edéntula/cirugíaRESUMEN
OBJECTIVE: To address the instability in implant surgical guides, this technique proposes an alternative anchoring mechanism in the stackable metal surgical guides utilizing cone-wedge anchors for improved stability. METHODS: Postoperative implant position superimposed onto the preoperatively planned design using Mimics Medical 21.0 and Materialise Magics 24.0 to assess 3D coronal implant deviation, 3D apical implant deviation, and implant angular deviation. RESULTS: Postoperative cone-beam computed tomography (CBCT) revealed a high level of precision in the implant placement, with an average 0.97 mm deviation at implant coronal region, 1.56 mm at implant apexes, and 2.95° angular deviation. CONCLUSION: This technique introduces a novel cone-wedge anchoring mechanism to enhance the stability of stackable metal surgical guide templates, addressing inherent instability issues. The utilization of this approach significantly improves the accuracy of implant placement procedures.
Asunto(s)
Tomografía Computarizada de Haz Cónico , Tomografía Computarizada de Haz Cónico/métodos , Humanos , Implantación Dental Endoósea/métodos , Implantación Dental Endoósea/instrumentación , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/instrumentación , Metales , Imagenología Tridimensional/métodosRESUMEN
OBJECTIVES: To quantify the reproducibility of the drill calibration process in dynamic navigation guided placement of dental implants and to identify the human factors that could affect the precision of this process in order to improve the overall implant placement accuracy. METHODS: A set of six drills and four implants were calibrated by three operators following the standard calibration process of NaviDent® (ClaroNav Inc.). The reproducibility of the position of each tip of a drill or implant was calculated in relation to the pre-planned implants' entry and apex positions. Intra- and inter-operator reliabilities were reported. The effects of the drill length and shape on the reproducibility of the calibration process were also investigated. The outcome measures for reproducibility were expressed in terms of variability range, average and maximum deviations from the mean distance. RESULTS: A satisfactory inter-rater reproducibility was noted. The precision of the calibration of the tip position in terms of variability range was between 0.3 and 3.7 mm. We noted a tendency towards a higher precision of the calibration process with longer drills. More calibration errors were observed when calibrating long zygomatic implants with non-locking adapters than with pointed drills. Flexible long-pointed drills had low calibration precision that was comparable to the non-flexible short-pointed drills. CONCLUSION: The clinicians should be aware of the calibration error associated with the dynamic navigation placement of dental and zygomatic implants. This should be taken in consideration especially for long implants, short drills, and long drills that have some degree of flexibility. CLINICAL SIGNIFICANCE: Dynamic navigation procedures are associated with an inherent drill calibration error. The manual stability during the calibration process is crucial in minimising this error. In addition, the clinician must never ignore the prescribed accuracy checking procedures after each calibration process.