Protocolo Abreviado Guiado Digital: Técnicas de Marcadores Tisulares, Silicona de Registro y CBCT con Sonrisa / Digitally Guided Abbreviated Protocol: Tissue Marker Techniques, Recording Silicone and CBCT with Smile

Establecer un protocolo de cirugía guiada estática con técnicas referenciales para ser realizado de manera predecible, repetible y simple, en todos los tipos de casos. El protocolo abreviado guiado digital para cirugía guiada estática para implantes se centra en diseñar computacionalmente una guía quirúrgica que se apoye en el tejido remanente del paciente, siendo un protocolo digital versátil para la cirugía y rehabilitación implanto protésica, basada en registros clínicos, principalmente la línea de la sonrisa y la captación de ésta en tomografía de haz cónico (CBCT), además de establecer dimensión vertical oclusal (DVO). Logrando así, planificación de implantes hasta la inserción inmediata de la prótesis temporal. Se ejemplifica el trabajo con 2 casos clínicos. Se establece un protocolo con la intención de que pueda ser realizado en pacientes desdentados parciales (Técnica de Registro Silicona) o totales (Técnica de Marcadores Tisulares en prótesis), definiendo un flujo de trabajo tridimensional, digital y optimizado, con un consecuente ahorro de tiempo clínico. Como principio del protocolo de cirugía guiada es lograr el objetivo quirúrgico - protésico deseado con alta precisión. La cirugía y rehabilitación de implantes de manera convencional es altamente dependiente del operador por lo que la alternativa de cirugía guiada de manera estática es una herramienta más para mejorar el pronóstico del paciente. Se establece un protocolo digital simple y efectivo, de cirugía guiada, para la rehabilitación implanto protésica basada en la línea de la sonrisa, tomografía de haz cónico (CBCT), dimensión vertical oclusal (DVO). Protocolo predecible y que optimiza los tiempos clínicos, logrando una rehabilitación protésica inmediata acorde e individualizada para cada paciente.

Establish a static guided surgery protocol with referential techniques to be performed in a predictable, repeatable and simple way, in all types of cases. The abbreviated digital guided protocol for static guided surgery for implants focuses on computationally designing a surgical guide that rests on the patient's remaining tissue, being a versatile digital protocol for prosthetic implant surgery and rehabilitation, based on clinical records, mainly the line of the smile and its uptake in cone beam tomography (CBCT), in addition to establishing occlusal vertical dimension (OVD). Thus achieving implant planning until the immediate insertion of the temporary prosthesis. The work is exemplified with 2 clinical cases. A protocol is established with the intention that it can be carried out in partially edentulous patients (Silicone Registration Technique) or total (Tissue Marker Technique in prostheses), defining a three-dimensional, digital and optimized workflow, with a consequent saving of time. clinical. As a principle of the guided surgery protocol, it is to achieve the desired surgical-prosthetic objective with high precision. Conventional implant surgery and rehabilitation is highly dependent on the operator, so the alternative of statically guided surgery is one more tool to improve the patient's prognosis. A simple and effective digital protocol for guided surgery is established for prosthetic implant rehabilitation based on the smile line, cone beam tomography (CBCT), and occlusal vertical dimension (OVD). Predictable protocol that optimizes clinical times, achieving an immediate and individualized prosthetic rehabilitation for each patient.

Current application and limitations of augmented reality in the stomatology / 中华口腔医学杂志

Computer-assisted technology are gradually integrated into dental education and clinical treatment. As a cutting-edge technology in computer-aided medicine, augmented reality can not only be used as an aid to dental education by presenting three-dimensional scenes for teaching demonstration and experimental skills training, but also can superimpose virtual image information of patients onto real lesion areas for real-time feedback and intraoperative navigation. This review explores the current applications and limitations of augmented reality in dentistry to provide a reference for future research.

Application of a new point contact pedicle navigation template as an auxiliary screw implant in scoliosis correction surgery / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of a new point contact pedicle navigation template (referred to as "new navigation template" for simplicity) in assisting screw implantation in scoliosis correction surgery.@*METHODS@#Twenty-five patients with scoliosis, who met the selection criteria between February 2020 and February 2023, were selected as the trial group. During the scoliosis correction surgery, the three-dimensional printed new navigation template was used to assist in screw implantation. Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group. There was no significant difference between the two groups ( P>0.05) in terms of gender, age, disease duration, Cobb angle on the coronal plane of the main curve, Cobb angle at the Bending position of the main curve, the position of the apical vertebrae of the main curve, and the number of vertebrae with the pedicle diameter lower than 50%/75% of the national average, and the number of patients whose apical vertebrae rotation exceeded 40°. The number of fused vertebrae, the number of pedicle screws, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were compared between the two groups. The occurrence of implant complications was observed. Based on the X-ray films at 2 weeks after operation, the pedicle screw grading was recorded, the accuracy of the implant and the main curvature correction rate were calculated.@*RESULTS@#Both groups successfully completed the surgeries. Among them, the trial group implanted 267 screws and fused 177 vertebrae; the control group implanted 523 screws and fused 358 vertebrae. There was no significant difference between the two groups ( P>0.05) in terms of the number of fused vertebrae, the number of pedicle screws, the pedicle screw grading and accuracy, and the main curvature correction rate. However, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were significantly lower in trial group than in control group ( P<0.05). There was no complications related to screws implantation during or after operation in the two groups.@*CONCLUSION@#The new navigation template is suitable for all kinds of deformed vertebral lamina and articular process, which not only improves the accuracy of screw implantation, but also reduces the difficulty of operation, shortens the operation time, and reduces intraoperative bleeding.

Multiresolution discrete optimization registration method of ultrasound and magnetic resonance images based on key points / 生物医学工程学杂志

The registration of preoperative magnetic resonance (MR) images and intraoperative ultrasound (US) images is very important in the planning of brain tumor surgery and during surgery. Considering that the two-modality images have different intensity range and resolution, and the US images are degraded by lots of speckle noises, a self-similarity context (SSC) descriptor based on local neighborhood information was adopted to define the similarity measure. The ultrasound images were considered as the reference, the corners were extracted as the key points using three-dimensional differential operators, and the dense displacement sampling discrete optimization algorithm was adopted for registration. The whole registration process was divided into two stages including the affine registration and the elastic registration. In the affine registration stage, the image was decomposed using multi-resolution scheme, and in the elastic registration stage, the displacement vectors of key points were regularized using the minimum convolution and mean field reasoning strategies. The registration experiment was performed on the preoperative MR images and intraoperative US images of 22 patients. The overall error after affine registration was (1.57 ± 0.30) mm, and the average computation time of each pair of images was only 1.36 s; while the overall error after elastic registration was further reduced to (1.40 ± 0.28) mm, and the average registration time was 1.53 s. The experimental results show that the proposed method has prominent registration accuracy and high computational efficiency.

Current application and prospect of accurate navigation technology in orthopaedic trauma / 中华外科杂志

In the past decades,a dramatic development of navigation technology in orthopaedic surgery has been witnessed. By assisting the localization of surgical region,verification of target bony structure,preoperative planning of fixation,intraoperative identification of planned entry point and direction of instruments or even automated insertion of implants,its ability and potential to reduce operation time,intraoperative radiation,surgical trauma,and improve accuracy has been proved. However,in contrast to the widespread use of navigation technology in arthroplasty,orthopaedic tumor,and spine surgery,its application in orthopaedic trauma is relatively less. In this manuscript,the main purpose is to introduce the technical principles of navigation devices,outline the current clinical application of navigation systems in orthopaedic trauma,analyze the current challenges confronting its further application in clinical practice and its prospect in the future.

Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as '5-ALA free' or '5-ALA residual'. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the '5-ALA free' resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease.

Determinación de la Longitud de Trabajo Mediante Localizador Electrónico de Foramen Apical y CBCT a Través del Software 3D Endo de Dentsply Sirona: Estudio Comparativo in vitro / Determination of Working Length Using Electronic Locator for Apex and CBCT with 3D Endo Dentsply Sirona Software: Comparative in vitro Study

RESUMEN: En la historia de la Endodoncia, se han utilizado distintos métodos para determinar la longitud de los canales radiculares, como sensación táctil y radiografías. Últimamente, han adquirido gran importancia los localizadores apicales electrónicos, por su gran precisión. Actualmente se ha incorporado el uso de imagenología con Cone Beam. Debido a que existen muchas formas de medir dicha longitud, es necesario ponerlos a prueba y ver si se asemejan a la técnica gold estándar definida en la literatura como el localizador electrónico de foramen apical. El propósito de esta investigación es determinar si existen diferencias estadísticamente significativas en la medida de la longitud de trabajo entre el localizador electrónico de foramen apical, y el uso de Cone Beam procesado con el software 3D endo de Dentsply Sirona. Para esto, se seleccionaron 30 premolares extraídos; se les tomó un Cone Beam para ser analizados con el software 3D endo y medir la longitud de trabajo. Una vez hecho esto, se realizó manualmente cavidad de acceso y se preparó el tercio cervical con fresas Gates Glidden 1 y 2; luego, los dientes fueron colocados en un modelo Pro Train, que asemejó las propiedades de los dientes en la cavidad oral, para permitir el uso del localizador electrónico de foramen y determinar la longitud de trabajo. Una vez obtenidos los datos, fueron comparados a través del Test de Proporciones (p=0.05 hipotético), dando como resultado p=0,2 lo que indica que no existen diferencias estadísticamente significativas en la medida de la longitud de trabajo entre ambos métodos.

ABSTRACT: Various methods have been used in the history of endodontics, to determine the length of the root canals (working length), such as tactile sensation and X-rays. Recently, apical locators have acquired importance, due to their precision. The use of Cone Beam has now also been incorporated. Because there are many ways to measure this length, it is necessary to test them and see if they resemble the standard gold measurement technique defined in the literature as the electronic apex locators. The purpose of this research is to determine whether there are statistically significant differences in the working length between the electronic apex locators, and the use of Cone Beam processed with the Software 3D Endo by Dentsply Sirona. For this, 30 extracted pre-molars were selected, for Cone Beam tomography and 3D endo Software analysis, to measure the working length. Once this was carried out, cavity preparation was performed manually, and the cervical third approached with gates glidden drills 1 and 2. Subsequently, the teeth were placed in a Pro Train model, which resembled the properties of the teeth in the oral cavity, to allow the use of the electronic apex locators to determine the working length.Once the data were obtained, they were compared through the proportions Test (p = 0.05 hypothetical), resulting in p = 0.2, indicating that there are no statistically significant differences in the working length between the two methods.

Cirugía laparoscópica con imagen 3D: indicaciones, resultados y evaluación subjetiva y objetiva de cirujanos participantes / Laparoscopic surgery with 3D image: indications, results and subjective and objective evaluation of participating surgeons

Resumen Introducción El uso del sistema de visión 3D en cirugía laparoscópica puede significar una mejor performance de los procedimientos quirúrgicos de mayor complejidad. Objetivo Reportar las indicaciones, los resultados y la valoración de un grupo de cirujanos de diferentes especialidades en el uso de visión 3D. Materiales y Método: Se analizan las indicaciones quirúrgicas y los resultados subjetivos y objetivos del uso del sistema óptico 3D (n = 155 pacientes) en cirugía laparoscópica compleja. Para evaluación subjetiva se aplicó a una encuesta de percepción cualitativa a los cirujanos participantes tipo Likert. Para la evaluación objetiva, se registran los tiempos quirúrgicos empleados en los diferentes procedimientos efectuados y las complicaciones postoperatorias y se comparan con los pacientes operados con sistema 2D (n = 783 pacientes) en el mismo periodo. Resultados el 70,6% concuerda tener mejor imagen con la técnica 3D, el 64,7% de los cirujanos refieren que se puede reducir el tiempo operatorio, el 58,8% considera que se puede reducir el error quirúrgico, el 92% y 100% respectivamente afirman que el confort del cirujano es mejor con el uso de óptica 3D y que esta técnica es recomendable para los procedimientos complejos. El tiempo operatorio se redujo en algunos procedimientos, especialmente urológicos. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a complicaciones postoperatorias. En la 3D no se encontró mortalidad postoperatoria, probablemente por el menor número de pacientes de ese grupo. Conclusión La laparoscopia 3D posee una buena valoración por los cirujanos que la emplearon, principalmente en calidad de imagen, reducción del tiempo operatorio y confort del cirujano en comparación con la laparoscopía 2D convencional. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a tiempo operatorio ni complicaciones postoperatorias.

Introduction The use of the 3D vision system in laparoscopic surgery can mean better performance in more complex surgical procedures. Aim Report the indications, results and assessment of a group of surgeons of different specialties in the use of 3D vision. Materials and Method Surgical indications and subjective and objective results of the use of 3D optical system in patients (n = 155) submitted to complex laparoscopic surgery are analyzed. Subjective evaluation based on a survey of qualitative perception (Likert) was applied to the participating surgeons. For objective evaluation, the operatory times and postoperative complications were recorded and compared with the results observed with the use of the 2D system (783 patients) in the same period. Results 70.6% agree to have a better image with the 3D technique, 64.7% of surgeons report that the operative time can be reduced, 58.8% consider that it can be reduced the surgical error, 92% and 100% respectively considered that the comfort of the surgeon is better with the use of 3D optics and that this technique is recommended for complex procedures. No substantial differences were found when comparing the results with the use of 3D versus 2D system by the same surgical teams in terms of operative times and postoperative complications. In 3D, postoperative mortality was probably not found due to the lower number of patients in this group. Conclusion 3D laparoscopy has a good evaluation by the surgeons who used it, mainly in image quality, reduction of operative time and comfort of the surgeon compared to conventional 2D laparoscopy. No substantial differences were found when comparing the results with the use of 3D versus 2D system in terms of operative times or postoperative complications.

Facial asymmetry: virtual planning to optimize treatment predictability and aesthetic results

Abstract Facial asymmetry is a condition that compromises function and social interactions and, consequently, the quality of life. Orthodontic-surgical treatment may be indicated to achieve a stable occlusion and significant improvement in facial aesthetics. The virtual planning of the maxillary, mandibular and chin movements can be done prior to surgery. These movements can be successfully performed with the use of prototyped guides obtained from virtual planning. The aim of this article is to show the state of the art of treatments of facial asymmetries, and emphasize how important is the multi-disciplinary approach to achieve predictable aesthetic and functionally stable results in a patient with facial asymmetry and chin protrusion.

Resumo A assimetria facial é uma condição capaz de comprometer a função oclusal e as interações sociais e, consequentemente, a qualidade de vida dos indivíduos. Nessas condições, para se obter oclusão estável e melhora significativa na estética facial, o tratamento ortodôntico-cirúrgico pode estar indicado. A simulação virtual da cirurgia permite planejar de forma adequada, e antecipada, os movimentos cirúrgicos a serem efetuados na maxila, mandíbula e mento. Esses movimentos são, então, realizados com sucesso graças ao uso de guias prototipados obtidos a partir do planejamento virtual. Assim, os objetivos do presente artigo consistem em relatar o estado da arte no planejamento virtual do tratamento de um paciente com assimetria facial e protrusão do mento, e enfatizar a importância da abordagem multidisciplinar para se atingir resultados estéticos previsíveis e funcionalmente estáveis.

New trends in translational microsurgery

Abstract Technological advances such as optical instruments and surgical tools have enabled the considerable contributions of microsurgery to surgical therapies. Accordingly, surgical therapeutics has provided the latest information across a wide range of medical specialties, including immunology and pharmacology, despite specialization according to organs and organ systems. The International Society for Experimental Microsurgery, an academic organization, has utilized experimental microsurgery technology in the identification of curative concepts for diseases that remain difficult to treat. For this publication to mark the 32nd anniversary of the Brazilian Surgical Society, I introduced the following types of technology related to the further development of microsurgical technological innovations in the future: high-resolution three-dimensional (3D) video and touch-sensitive microsurgery robots.

Vertebroplastia percutánea guiada por tomografía para el manejo del dolor en pacientes con fractura del cuerpo vertebral / CT-guided Vertebroplasty for Painful Vertebral Fractures

Objetivo Describir la técnica y resultados en cuanto a la mejoría del dolor y complicaciones al realizar este procedimiento mediante guía por tomografía computada. Materiales y Métodos Estudio observacional descriptivo de una serie de 108 pacientes a quienes se les realizó vertebroplastia percutánea guiada por tomografía computada realizadas en dos hospitales universitarios, entre mayo 2007 y mayo 2017. Todos los procedimientos se realizaron de forma ambulatoria con anestesia local y se valoró el dolor mediante la escala visual análoga. Resultados Se realizaron 125 vertebroplastias, en el 87,9% de los pacientes (n = 95) se realizó el procedimiento en un cuerpo vertebral, en el 8,3% (n = 9) y 3,7% (n = 4) de los pacientes se cementaron 2 y 3 vertebras respectivamente. El rango de dolor según la escala visual análoga (EVA) previo al tratamiento varió entre 5 y 10, donde un 94% (n = 102) de los pacientes manifestaban una intensidad 10/10. En el postratamiento el rango de dolor varió entre 0a7dondeel 98% de la población reportó un valor menor o igual a 3. Se presentaron 3 complicaciones: tromboembolismo pulmonar por metil-metacrilato, extravasación al plexo de Batson y extravasación al espacio interdiscal, cada una en tres pacientes diferentes. Conclusión La vertebroplastia percutánea guiada por TC ofrece una indiscutible mejora inmediata del dolor en pacientes con fractura de uno o más cuerpos vertebrales, con una baja tasa de complicaciones.

Objetive Describe the technique, results in terms of pain improvement and complications to perform this procedure by computed tomography. Materials and Methods A descriptive observational study of a 108 cases series of percutaneous vertebroplasty guided by computed tomography performed in two university hospitals between May 2007 and May 2017. All procedures were performed with local anesthesia on an outpatient basis, pain was assessed by means of the Visual analogue scale (VAS). Results A total of 125vertebroplasties were performed. In 87.9% (n = 95) of the patients, the procedure was performed in one vertebral body, in 8.3% (n = 9) and 3.7% (n = 4) of the patientshad two or three vertebrae cemented respectively. The range of pain according to VAS prior to treatment varied between 5 and 10, where 94% (n = 102) of the patients manifested a 10/10 intensity; after treatment, the range of pain varied between 0 to 7 where 98% of the population reported a value less than or equal to 3. Three complications were reported, one pulmonary thromboembolism due to methylmethacrylate, one extravasation in to the Batson plexus and one extravasation of cement to the interdiscal space. Conclusion CT-guided percutaneous vertebroplasty offers an undeniable immediate improvement of pain in patients with fracture of one or more vertebral bodies, with a low rate of complications.

Implantología digital con guías quirúrgicas 3D / Digital implantology with 3D surgical guides

Se utilizaron métodos digitales de fabricación para guías quirúrgicas de restricción absoluta, para la colocación asistida de implantes dentales que facilitaron la predicción y planificación de la rehabilitación protética virtual a través de protocolos de CAD-CAM con impresoras 3D de escritorio, aditivas, de bajo costo-eficiencia, obteniendo exactitud controlada y alta precisión, lo que permitió reproducibilidad y predecibilidad implantológica. Con el fin de universalizar, promover y difundir el uso de la tecnología 3D como herramienta facilitadora que la práctica dental actual requiere, se investigó la desviación entre la posición planeada y la final encontrada de los implantes colocados bajo asistencia guiada, dando como resultado una discrepancia clínicamente insignificante que sugiere que la guía quirúrgica en impresoras 3D puede ser utilizada como herramienta clínica para posicionar adecuadamente los implantes dentales.

Fluxo de trabalho para aplicação da técnica de cirurgia guiada em reabilitação total de maxila / Workflow for guided implant surgery (GIS) in full arch maxillary rehabilitation

A aplicação de um fluxo digital é um recurso cada vez mais utilizado na Implantodontia. A técnica de cirurgia guiada tem evoluído constantemente, acompanhando os avanços de hardwares e softwares aplicados na Odontologia, resultando no aumento da indicação e precisão dos guias cirúrgicos obtidos. O objetivo deste trabalho foi, através de um relato de caso clínico, demonstrar o fluxo de trabalho utilizado para aplicação da técnica de cirurgia guiada em reabilitação total de maxila, utilizando o software coDiagnostiX (Dental Wings, Chemnitz, Alemanha). Após as etapas de preparo pré-tomográfico, obtenção da digitalização de superfície, aquisições tomográficas e planejamento virtual, foram instalados seis implantes cone-morse (Neodent, Curitiba, Brasil), com a utilização de um guia cirúrgico obtido por impressão 3D. Após o período de osseointegração, foi instalada uma prótese fixa implantossuportada. O planejamento virtual em software específico, através da digitalização de superfície associada à tomografia computadorizada de feixe cônico (TCFC), propõe um diagnóstico previsível, seguro e a possibilidade de oferecer maior segurança e precisão nas reabilitações com implantes osseointegrados.

The application of a digital workflow is an increasingly used resource in Implantology. The guided implant surgery (GIS) has constantly evolved, following the advances of hardware and software applied in Dentistry, resulting in an increase in the indication and precision of the surgical guides. The objective of this article is, through a clinical case report, to demonstrate a workflow used to apply guided surgery technique in full-arch maxillary rehabilitation using the coDiagnostiX software (Dental Wings, Chemnitz, Germany). After the pre-tomographic preparation, surface scanning, tomographic acquisitions and virtual planning, six morse taper implants (Neodent, Curitiba, Brazil) were placed using a surgical guide obtained by 3D printing. After a period of osseointegration, a implant supported fixed prosthesis was placed. The virtual planning in specific software, through surface scanning associated with cone beam computed tomography (CBCT), proposes a predictable, safe diagnosis and the possibility of offering greater safety and precision in the rehabilitations with osseointegrated implants.

Intraoperative near-infrared fluorescent imaging during robotic operations / Sistema de imagem intraoperatória por fluorescência infravermelha durante cirurgias robóticas

ABSTRACT The intraoperative identification of certain anatomical structures because they are small or visually occult may be challenging. The development of minimally invasive surgery brought additional difficulties to identify these structures due to the lack of complete tactile sensitivity. A number of different forms of intraoperative mapping have been tried. Recently, the near-infrared fluorescence imaging technology with indocyanine green has been added to robotic platforms. In addition, this technology has been tested in several types of operations, and has advantages such as safety, low cost and good results. Disadvantages are linked to contrast distribution in certain clinical scenarios. The intraoperative near-infrared fluorescent imaging is new and promising addition to robotic surgery. Several reports show the utility of this technology in several different procedures. The ideal dose, time and site for dye injection are not well defined. No high quality evidence-based comparative studies and long-term follow-up outcomes have been published so far. Initial results, however, are good and safe.

RESUMO A identificação intraoperatória de certas estruturas anatômicas, por seu tamanho ou por elas serem ocultas à visão, pode ser desafiadora. O desenvolvimento da cirurgia minimamente invasiva trouxe dificuldades adicionais, pela falta da sensibilidade tátil completa. Diversas formas de detecção intraoperatória destas estruturas têm sido tentadas. Recentemente, a tecnologia de fluorescência infravermelha com verde de indocianina foi associada às plataformas robóticas. Além disso, essa tecnologia tem sido testada em uma variedade de cirurgias, e suas vantagens parecem estar ligadas a baixo custo, segurança e bons resultados. As desvantagens estão associadas à má distribuição do contraste em determinados cenários. A imagem intraoperatória por fluorescência infravermelha é uma nova e promissora adição à cirurgia robótica. Diversas séries mostram a utilidade da tecnologia em diferentes procedimentos. Dose ideal, local e tempo da injeção do corante ainda não estão bem estabelecidos. Estudos comparativos de alta qualidade epidemiológica baseados em evidência ainda não estão disponíveis. No entanto, os resultados iniciais são bons e seguros.

Neuronavegación en exéresis de linfangioma orbitario / Neuronavigation in exeresis of orbital lymphangioma

El linfangioma es un tumor benigno raro y predominante en la infancia, debido a su crecimiento puede comprometer al órgano donde se desarrolla, se han propuesto varias opciones de trata-miento, sin embargo, la cirugía continúa siendo la primera opción. La neuronavegación permite realizar exéresis con gran precisión y de utilidad en cirugía ocular, por lo que disminuye el riesgo de secuelas después de una exéresis de linfangioma orbitario.

Lymphangioma is a benign tumor predominantly in childhood, due to growth that can compromise the organ where it grows. Several treatment options, have been proposed however,surgery remains the first choice. Neuronavigation allows successful excision and use in eye surgery,which decreases the risk of sequels following excision of orbital lymphangioma.

Accuracy of computer-guided surgery / La precisión de la cirugía guiada por ordenador

Dental implant fixation techniques are widely studied in order to reduce surgical morbidity. Computer-guided flapless surgery has been considered an efficient alternative that presents several advantages and some limitations. This technique allows the virtual planning and simulation of the prosthetic-surgical treatment that can help predict the difficulties and limitations in order to reduce possible errors. In addition to the prosthetic predictability, computer-guided surgery enhances accuracy and reduces surgical morbidity. Thus, the aim of this study was to report on a 7-year follow-up of immediately loaded implants inserted into an edentulous maxilla using virtual planning and flapless surgery.

Las técnicas de fijación del implante dental se estudian ampliamente para reducir la morbilidad quirúrgica. La cirugía sin flapless guiada por ordenador ha sido considerada como una alternativa eficiente con varias ventajas y algunas limitaciones. Esta técnica permite la planificación virtual y simulación del tratamiento protésico quirúrgico con la predicción de las dificultades y limitaciones para reducir posibles errores. Además de la previsibilidad de prótesis, la cirugía guiada por ordenador mejora la precisión y reduce la morbilidad quirúrgica. Por lo tanto, el objetivo de este estudio fue reportar a 5 años de seguimiento de los implantes de carga inmediata insertados en un maxilar desdentado utilizando la planificación virtual y la cirugía sin colgajo. El presente caso prospectivo informó el éxito del tratamiento y destacó la importancia de la planificación, lo que justifica el costo de esta tecnología.

Safety and feasibility of radiofrequency ablation for treatment of Bosniak IV renal cysts

ABSTRACT Purpose To describe our initial experience with radiofrequency ablation (RFA) of Bosniak IV renal cysts. Materials and Methods From 2010 to 2014, 154 renal tumor cases were treated with percutaneous thermal ablation, of which 10 cases (6.4%) from nine patients were complex renal cysts and were treated with radiofrequency ablation. Results All complex cysts were classified as Bosniak IV (four women and five men; mean age: 63.6 yrs, range: 33–83 years). One patient had a single kidney. Lesion size ranged from 1.5 to 4.1cm (mean: 2.5cm) and biopsy was performed on four cysts immediately before the procedure, all of which were malignant (two clear cell and two papillary carcinoma). Mean volume reduction of complex cysts was 25% (range: 10–40%). No patients required retreatment with RFA and no immediate or late complications were observed. The follow-up of Bosniak IV cysts had a median of 27 months (interquartile range [IQR], 23 to 38) and no recurrence or significant loss of renal function were observed. Conclusions Mid-term follow-up of the cases in our database suggests that image-guided percutaneous RFA can treat Bosniak IV cysts with very low complication rates and satisfactorily maintain renal function.

Cirugía asistida por computador en tumores óseos: principios generales / Computer assisted surgery in bone tumours: general principles

La mayoría de los tumores óseos primarios pueden ser tratados mediante una resección amplia —muchas veces asociada a terapias adyuvantes— sin comprometer la sobrevida del paciente. La posibilidad de una resección conservadora depende de la localización y tamaño del tumor y de las partes blandas circundantes. Una cuidadosa evaluación de estudios imagenológicos permite al cirujano elaborar un plan quirúrgico que permita una resección con márgenes adecuados, al mismo tiempo que conservar la mayor cantidad de tejido sano, de modo de obtener una extremidad funcional. A veces, la ejecución quirúrgica de lo planeado se hace muy difícil, y la precisión de esta puede resultar afectada. La cirugía guiada por computador se ha constituido en una herramienta útil en estas situaciones. Está basada en la creación de un plan virtual en 3 dimensiones mediante el procesamiento de imágenes de tomografía computada (TC) y resonancia nuclear magnética (RNM). Este plan puede ser reproducido en el escenario quirúrgico mediante la correspondencia entre este escenario virtual y la anatomía real del paciente. Esta tecnología puede permitir una mayor precisión en la ejecución de osteotomías en zonas difíciles como la pelvis, minimizando la resección innecesaria de tejido sano, pero manteniendo un margen oncológico adecuado. Describiremos los principios y el razonamiento que fundamentan el uso de la cirugía guiada por computador en la cirugía de tumores óseos, la cual se ha constituido en una herramienta útil para el manejo de situaciones clínicas específicas...

The majority of primary bone tumours can be effectively treated with wide resection —frequently associated with adjuvant therapy— without compromising the outcome of the patient. The feasibility of limb-sparing surgery in a particular scenario is dependent on the location and size of the tumour, as well as the involvement of the host bone and surrounding soft tissues. Careful evaluation of imaging studies allows the surgeon to plan the resection with adequate margins, while preserving as much normal tissues as possible, in order to achieve a functional limb. At times, the surgical execution of what was planned as resection becomes very difficult, and precision may be less than optimal. Computer-guided surgery has become a useful tool in these situations. It is based on the creation of a three-dimensional virtual plan by means of image processing from computed tomography (CT) and magnetic resonance (MRI) of the clinical situation. This plan is reproduced in the surgical field by means of the interaction between this virtual scenario and the actual anatomy of the patient. This technology could allow better precision in the execution of osteotomies in difficult areas, such as the pelvis, minimising unnecessary resection of normal tissue, while maintaining wide margins. A description is presented of the principles and rationale of computer-guided surgery for bone tumours, which has become a useful tool for the management of selected clinical situations...

Computer-Assisted Rotational Acetabular Osteotomy for Patients with Acetabular Dysplasia

Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in non-navigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system.