Haptic robot-assisted surgery improves accuracy of wide resection of bone tumors: a pilot study.
BACKGROUND
Accurate reproduction of the preoperative plan at the time of surgery is critical for wide resection of primary bone tumors. Robotic technology can potentially help the surgeon reproduce a given preoperative plan, but yielding control of cutting instruments to a robot introduces potentially serious complications. We developed a novel passive ("haptics") robot-assisted resection technique for primary bone sarcomas that takes advantage of robotic accuracy while still leaving control of the cutting instrument in the hands of the surgeon.


OBJECTIVE
We asked whether this technique would enable a preoperative resection plan to be reproduced more accurately than a standard manual technique.


METHODS
A joint-sparing hemimetaphyseal resection was precisely outlined on the three-dimensionally reconstructed image of a representative Sawbones femur. The indicated resection was performed on 12 Sawbones specimens using the standard manual technique on six specimens and the haptic robotic technique on six specimens. Postresection images were quantitatively analyzed to determine the accuracy of the resections compared to the preoperative plan, which included measuring the maximum linear deviation of the cuts from the preoperative plan and the angular deviation of the resection planes from the target planes.


RESULTS
Compared with the manual technique, the robotic technique resulted in a mean improvement of 7.8 mm of maximum linear deviation from the preoperative plan and 7.9° improvement in pitch and 4.6° improvement in roll for the angular deviation from the target planes.


CONCLUSIONS
The haptic robot-assisted technique improved the accuracy of simulated wide resections of bone tumors compared with manual techniques.


CONCLUSIONS
Haptic robot-assisted technology has the potential to enhance primary bone tumor resection. Further bench and clinical studies, including comparisons with recently introduced computer navigation technology, are warranted.
Department of Orthopedic Surgery, State University of New York at Stony Brook, Stony Brook, NY, USA. fazelkhan928@yahoo.com
Fazel
F
Khan
Andrew
A
Pearle
Christopher
C
Lightcap
Patrick J
PJ
Boland
John H
JH
Healey
D000293:Adolescent; D003196:Computer Graphics; D003198:Computer Simulation; D005260:Female; D005266:Femoral Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008953:Models, Anatomic; D009048:Motor Skills; D018365:Neoplasm, Residual; D010027:Osteotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010865:Pilot Projects; D012371:Robotics / Q000295:instrumentation; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D012677:Sensation; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000295:instrumentation; D016896:Treatment Outcome