Navigation-assisted surgery for bone and soft tissue tumors with bony extension.
BACKGROUND
The navigation system was introduced to orthopaedic surgery in the 1990s. More recently, CT-based navigation systems have been used more commonly in spine and joint replacement surgery because of their precision.


OBJECTIVE
The aim of our study was to evaluate the accuracy and efficacy of navigation-assisted excision of bone and soft tissue tumors.


METHODS
From 2006 to 2009, we performed navigation-assisted surgery in 16 patients, 11 males and five females, with a mean age of 39 years (range, 13-70 years). We diagnosed nine benign bone tumors and seven malignant bone and soft tissue tumors. In two patients, the malignant soft tissue tumors infiltrated the adjacent bones. Nine excisional biopsies for benign tumors and seven en bloc excisions for malignant tumors were performed. In all cases, the point registration method was performed using 10 skin markers, which were placed around the tumor. Each excisional difference between the preoperative and postoperative plans was evaluated histologically or by postoperative CT.


RESULTS
The mean accuracy of this system, which was determined using skin markers, was 0.93 mm (range, 0.6-1.2 mm). All biopsy and excision samples were evaluated by pathologic examination and postoperative CT imaging. The mean difference between the planned margin and postoperative CT or excised histologic specimen was 0 mm to 4 mm. The mean followup was 34 months (range, 10-54 months). There were no local recurrences, except for excision of skip metastases in a patient with a chordoma.


CONCLUSIONS
We report our experience with navigation-assisted surgery for bone and soft tissue tumors. Navigation-assisted surgery could be indicated for sufficiently reliable, accurate, and minimally invasive resections.
Department of Orthopedic Surgery, Yodogawa Christian Hospital, 2-9-26 Awaji, Higashiyodogawa-Ku, Osaka 533-0021, Japan. ieguchi@med.osaka-cu.ac.jp
Makoto
M
Ieguchi
Manabu
M
Hoshi
Jun
J
Takada
Noriaki
N
Hidaka
Hiroaki
H
Nakamura
D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods* / Q000401:mortality; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult