Augmented reality–mediated stereotactic navigation for execution of en bloc lumbar spondylectomy osteotomies

En bloc spinal tumor resections are technically demanding procedures with high morbidity because of the conventionally large exposure area and aggressive resection goals. Stereotactic surgical navigation presents an opportunity to perform the smallest possible resection plan while still achieving an en bloc resection. Augmented reality (AR)–mediated spine surgery (ARMSS) via a mounted display with an integrated tracking camera is a novel FDA-approved technology for intraoperative “heads up” neuronavigation, with the proposed advantages of increased precision, workflow efficiency, and cost-effectiveness. As surgical experience and capability with this technology grow, the potential for more technically demanding surgical applications arises. Here, the authors describe the use of ARMSS for guidance in a unique osteotomy execution to achieve an en bloc wide marginal resection of an L1 chordoma through a posterior-only approach while avoiding a tumor capsule breach. A technique is described to simultaneously visualize the navigational guidance provided by the contralateral surgeon’s tracked pointer and the progress of the BoneScalpel aligned in parallel with the tracked instrument, providing maximum precision and safety. The procedure was completed by reconstruction performed with a quad-rod and cabled fibular strut allograft construct, and the patient did well postoperatively. Finally, the authors review the technical aspects of the approach, as well as the applications and limitations of this new technology.

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Longitudinal quality of life (QOL) and sexual functioning in women undergoing pelvic exenteration for gynecologic malignancies.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.5608 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 5608-5608 ◽

Cited By ~ 1

Author(s):

Pamela T. Soliman ◽

Charlotte C. Sun ◽

Shannon Neville Westin ◽

Lois M. Ramondetta ◽

Diane C. Bodurka ◽

...

Keyword(s):

Social Support ◽

Body Image ◽

Functional Status ◽

Sexual Functioning ◽

Pelvic Exenteration ◽

En Bloc Resection ◽

Bloc Resection ◽

High Morbidity ◽

En Bloc ◽

Reconstruction Methods

5608 Background: Pelvic exenteration (PE) is en bloc resection of the pelvic organs including bladder, vagina, and rectum to treat central recurrence of a gynecologic malignancy. While this procedure has high morbidity, it is the only option for cure in some patients. The goal of this study was to assess QOL and sexual functioning in women who underwent PE with vaginal and/or bladder reconstruction. Methods: All patients were enrolled prior to PE. Surveys included the SF-12 (functional status), BIS (body image), SAQ (sexual functioning), SWD (satisfaction with decision), CES-D (depression), Stoma QOL, and DUFSS completed preoperatively (preop) and post-operatively at 4-6 wks, 6 mo, 1 yr, and 2 yrs. Descriptive statistics, chi-square, Mann-Whitney, and Kruskal Wallis tests were used to evaluate the data. Results: Between 2008 and 2012, 39 women participated. Median age was 56.7 yrs. Mean physical functional status scores (SF-12) declined through 6 mo postop, with improvements at 1 and 2 yrs (p=.002) but did not reach preop levels. SF-12 mental functioning scores declined immediately postop but returned to baseline by 6 mo. BIS was significantly worse at 1ys (p=0.02) and 2 yrs (p=0.025). Mean depression (CES-D) scores decrease but remained above the clinical cutoff of 17 at 6 mo. Poor sexual function was noted preop and did not improve. High scores for social support (DUFSS) remained constant. Stoma QOL improved in the first 2 yrs but not significantly. Pts reported high satisfaction with the decision to undergo PE, which did not change over time. Conclusions: While a majority of women remained satisfied with their decision to undergo PE, the procedure was associated with depression, worsening physical functioning and poor body image despite stable social support. Interventions are currently under development to improve QOL in this patient population. [Table: see text]

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En bloc resection in giant bilobed splenic artery aneurysm

BMJ Case Reports ◽

10.1136/bcr-2021-244319 ◽

2021 ◽

Vol 14 (9) ◽

pp. e244319

Author(s):

Venu Bhargava Mulpuri ◽

Jayanta Samanta ◽

Pankaj Gupta ◽

Vikas Gupta

Keyword(s):

Early Detection ◽

Splenic Artery ◽

Artery Aneurysm ◽

En Bloc Resection ◽

Bloc Resection ◽

Morbidity And Mortality ◽

Splenic Artery Aneurysm ◽

High Morbidity ◽

En Bloc ◽

Distal Pancreas

Giant splenic artery aneurysms are rare and associated with high morbidity and mortality. Early detection is the key to decreasing morbidity and mortality. We present a giant splenic artery aneurysm which was managed by en bloc resection of the spleen, distal pancreas.

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En Bloc Resection of Sacral Chordomas Aided by Frameless Stereotactic Image Guidance: A Technical Note

Operative Neurosurgery ◽

10.1227/neu.0b013e31822dd958 ◽

2011 ◽

Vol 70 (suppl_1) ◽

pp. ons82-ons88 ◽

Cited By ~ 2

Author(s):

Hormuzdiyar H. Dasenbrock ◽

Michelle J. Clarke ◽

Ali Bydon ◽

Matthew J. McGirt ◽

Timothy F. Witham ◽

...

Keyword(s):

Image Guidance ◽

En Bloc Resection ◽

Bloc Resection ◽

Surrounding Tissue ◽

Preoperative Imaging ◽

Frameless Stereotaxy ◽

En Bloc ◽

Bony Landmarks ◽

Adjacent Structures ◽

Stereotactic Navigation

Abstract BACKGROUND: The most important predictor of survival for patients with sacral chordomas is an initial en bloc resection with negative margins. However, obtaining negative margins can be technically challenging. Intraoperative navigation may be helpful in attempting an excision with negative margins. OBJECTIVE: This is the first report of partial sacrectomy guided by frameless stereotactic navigation. METHODS: Three patients with a mean age of 58.7 years underwent en bloc resection of sacral chordomas aided by image guidance. Intraoperatively, the reference arc was clamped to the spinous process of L5 and the bony landmarks of S1 were used for registration. Subsequently, the drill was registered, allowing the osteotomy trajectory to be visualized in real time with reference to the patients' anatomy and tumor location. RESULTS: None of the patients had any intraoperative or postoperative complications. Two patients with smaller tumors (5 cm) had negative margins, whereas the third patient with an 11.5 cm tumor had marginal margins. With an average follow-up of 44 months, none of the patients have had a recurrence of the tumor. CONCLUSION: The use of frameless stereotaxy during the en bloc resection of sacral tumors is safe and feasible. Frameless stereotactic navigation was a useful adjunct to preoperative imaging and to the surgeon's anatomic knowledge. Image guidance was used during the osteotomies to decrease the likelihood of injury to vital adjacent structures or violation of the tumor capsule and to increase the likelihood that the appropriate surrounding tissue was resected to attempt a wide or marginal resection.

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Pelvic Exenteration in Gynecologic Cancer: La Paz University Hospital Experience

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000435 ◽

2015 ◽

Vol 25 (6) ◽

pp. 1109-1114 ◽

Cited By ~ 3

Author(s):

Elisa Moreno-Palacios ◽

Maria D. Diestro ◽

Javier De Santiago ◽

Alicia Hernández ◽

Ignacio Zapardiel

Keyword(s):

Pelvic Exenteration ◽

Gynecologic Cancer ◽

Cancer Recurrence ◽

En Bloc Resection ◽

Bloc Resection ◽

University Hospital ◽

High Morbidity ◽

En Bloc ◽

Permanent Colostomy ◽

La Paz

BackgroundPelvic exenteration is an ultraradical surgery involving the en bloc resection of the pelvic organs, including the internal reproductive organs, the distal urinary tract (ureters, bladder, urethra), and/or anorectum. It is mainly applied as a salvage surgery for recurrent gynecologic tumors of any origin (vulva, vagina, cervix, uterine, and also ovary). Our aim was to establish the most favorable cases for this type of surgery by means of a review of our institution experience.MethodsRetrospective analyses of all patients treated with pelvic exenteration for recurrent gynecologic cancer from 2008 to 2014 at La Paz University Hospital.ResultsTen patients underwent pelvic exenteration for recurrent gynecologic cancers including uterine, cervical, vaginal, vulvar, and ovarian cancer. All patients had received prior treatment: surgery, radiotherapy, and/or chemotherapy. Eight patients underwent total pelvic exenteration, one anterior and one posterior pelvic exenteration. Urinary diversions technique consisted of ileal conduits in all cases. Permanent colostomy was performed in all cases. Postoperative complications were related to the urinary diversion in 50% of the cases, to the reconstructive technique in 30%, and to systemic or pelvic infections in 20%.ConclusionsDespite the high morbidity and mortality rates, pelvic exenteration is feasible, and in selected cases of cancer recurrence is the last possible treatment.

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Contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection: a technique for oncological resection of posterolateral spinal tumors

Journal of Neurosurgery Spine ◽

10.3171/2016.8.spine16398 ◽

2017 ◽

Vol 26 (3) ◽

pp. 275-281 ◽

Cited By ~ 2

Author(s):

Viren S. Vasudeva ◽

Alexander E. Ropper ◽

Samuel Rodriguez ◽

Kyle C. Wu ◽

John H. Chi

Keyword(s):

Spinal Column ◽

Progression Free Survival ◽

En Bloc Resection ◽

Bloc Resection ◽

Spinal Tumors ◽

High Morbidity ◽

Low Grade ◽

En Bloc ◽

Bloc Spondylectomy ◽

Pars Interarticularis

En bloc resection of tumors involving the spinal column is technically challenging and is associated with high morbidity to the patient due to the proximity of critical neurological and vascular structures and the destabilizing nature of this surgery. Nevertheless, evidence has shown improved progression-free survival with en bloc resection for certain low-grade malignant and aggressive benign musculoskeletal tumors. To avoid the morbidity of en bloc spondylectomy in patients with tumors localized to the lateral and posterolateral spinal column, the authors have found that the goals of surgery can be accomplished through a contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection (COPPER). They reviewed their series of 5 patients who underwent successful tumor removal through a COPPER approach. These patients were all found to harbor spinal column tumors involving the posterolateral elements that, based on pathology, would benefit from en bloc resection. Tumor pathology included chondrosarcoma, leiomyosarcoma, osteoblastoma, and liposarcoma. Resections were performed by completing ipsilateral facetectomies above and below the lesion and ipsilateral pedicle osteotomies from a contralateral approach following hemilaminectomy. By disarticulating the posterolateral elements while carefully protecting the thecal sac, the tumors were removed en bloc along with the affected lamina, pedicles, pars interarticularis, and spinous processes, allowing tumor-free margins. This technical report suggests that the COPPER approach is safe and effective for en bloc resection of tumors involving the posterolateral aspect of the spinal column with tumor-free margins and that it eliminates the need for anterior column reconstruction.

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Oncological principles in spinal tumor surgery

Hirurgiâ pozvonočnika ◽

10.14531/ss2021.2.64-72 ◽

2021 ◽

Vol 18 (2) ◽

pp. 64-72

Author(s):

N. S. Zaborovskii ◽

D. A. Ptashnikov ◽

D. A. Mikhaylov ◽

O. A. Smekalenkov ◽

S. V. Masevnin

Keyword(s):

Personal Experience ◽

Resection Margin ◽

Complete Removal ◽

Spinal Tumor ◽

En Bloc Resection ◽

Bloc Resection ◽

Spinal Tumors ◽

En Bloc ◽

Single Block ◽

The Sacrifice

Surgical intervention remains the cornerstone of the treatment of patients with spinal tumors. The presented literature review includes also the authors’ personal experience in the treatment of tumors. Pain relief, local control of a neoplasm growth and preservation of body functions are the main goals of this pathology treatment.Treatment of spinal tumors is based on the biology, location and extent of the neoplasm. If surgical treatment is indicated, en-bloc resection is the preferred method. This operation is based on the complete removal of the tumor in a single block entirely covered by a shell of healthy tissue. This surgical procedure can be challenging due to the proximity of the neural structures. Moreover, achieving clean resection margin around the tumor often requires the sacrifice of adjacent anatomic structures. A more comprehensive approach requires a combination of surgery, systemic therapy and radiotherapy to improve outcomes in patients with advanced spinal tumors.The fulfillment of oncological principles is fundamental to achieving best treatment outcomes for spinal tumors.

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Surgical Navigation, Augmented Reality, and 3D Printing for Hard Palate Adenoid Cystic Carcinoma En-Bloc Resection: Case Report and Literature Review

Frontiers in Oncology ◽

10.3389/fonc.2021.741191 ◽

2022 ◽

Vol 11 ◽

Author(s):

Mónica García-Sevilla ◽

Rafael Moreta-Martinez ◽

David García-Mato ◽

Gema Arenas de Frutos ◽

Santiago Ochandiano ◽

...

Keyword(s):

Augmented Reality ◽

3D Printing ◽

Adenoid Cystic Carcinoma ◽

En Bloc Resection ◽

Bloc Resection ◽

Optical Tracking ◽

Patient Specific ◽

En Bloc ◽

Less Invasive ◽

Adenoid Cystic

Adenoid Cystic Carcinoma is a rare and aggressive tumor representing less than 1% of head and neck cancers. This malignancy often arises from the minor salivary glands, being the palate its most common location. Surgical en-bloc resection with clear margins is the primary treatment. However, this location presents a limited line of sight and a high risk of injuries, making the surgical procedure challenging. In this context, technologies such as intraoperative navigation can become an effective tool, reducing morbidity and improving the safety and accuracy of the procedure. Although their use is extended in fields such as neurosurgery, their application in maxillofacial surgery has not been widely evidenced. One reason is the need to rigidly fixate a navigation reference to the patient, which often entails an invasive setup. In this work, we studied three alternative and less invasive setups using optical tracking, 3D printing and augmented reality. We evaluated their precision in a patient-specific phantom, obtaining errors below 1 mm. The optimum setup was finally applied in a clinical case, where the navigation software was used to guide the tumor resection. Points were collected along the surgical margins after resection and compared with the real ones identified in the postoperative CT. Distances of less than 2 mm were obtained in 90% of the samples. Moreover, the navigation provided confidence to the surgeons, who could then undertake a less invasive and more conservative approach. The postoperative CT scans showed adequate resection margins and confirmed that the patient is free of disease after two years of follow-up.

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