[Integrated navigation. Preclinical evaluation and initial clinical experience].
BACKGROUND
Computer navigation systems have increasingly become part of the surgical routine due to the improvements of intraoperative visualization procedures. Because of limited space in the operating room and insufficient workflow, the project of integrated navigation had been started.


METHODS
As the first step, the navigation system VectorVision2 and the second-generation fluoroscopic C-arm system Orbic 3D were integrated into one common trolley. In an experimental study the integrated navigation system was used to drill 160 pedicle screws. Afterwards the system was clinically evaluated in 11 surgical procedures.


RESULTS
During the whole experimental study the system could be used for all 160 drilling procedures without any technical faults, causing a failure rate of 4.2%. For clinical evaluation the integrated navigation system was used in seven patients with navigated dorsal spine instrumentation, in three cases sacroiliac screws were placed, and in one case supra-acetabular screw osteosynthesis was performed for an acetabular fracture. In all cases the positioning of the screws was correct and no system failure occurred.


CONCLUSIONS
The combination of the navigation system and the C-arm system in one common trolley is a major improvement of the surgical workflow. In the experimental study and the clinical trials the system worked extremely reliably and with high precision.
Stöckle
U
U
Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin. ulrich.stoeckle@charite.de
Schäffler
A
A
König
B
B
Haas
N P
NP
D000077:Acetabulum / Q000293:injuries / Q000601:surgery; D001863:Bone Screws; D004867:Equipment Design; D005471:Fluoroscopy / Q000295:instrumentation*; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D021621:Imaging, Three-Dimensional / Q000295:instrumentation*; D010384:Pelvic Bones / Q000293:injuries / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D014947:Wounds and Injuries / Q000601:surgery*