RESUMEN
Introducción: Las fracturas complejas de fémur distal AO/AOT tipo 33C3.3 constituyen un reto para los ortopedistas debido a la dificultad de su tratamiento y las complicaciones asociadas. El planeamiento y procedimiento quirúrgicos emplean placas condilares, pero estas se asocian a la pérdida de la fijación y al colapso de la reducción. Objetivo: Describir la planificación preoperatoria de una fractura de fémur distal AO/AOT 33C3.3 con bioimpresión 3D y reconstrucción por computadora. Presentación del caso: Paciente masculino de 34 años con fractura izquierda conminuta del fémur distal, AO/AOT tipo 33C3.3, por un accidente de tránsito. El planeamiento y el tratamiento quirúrgicos se realizaron exitosamente con la impresión y reconstrucción de biomodelos 3D. Basados en las imágenes tomográficas del paciente, se identificaron los principales fragmentos, la secuencia de reducción, la cantidad y la posición de los implantes a utilizar. Conclusiones: La planificación preoperatoria resulta una etapa de vital importancia en el manejo de fracturas complejas. Las técnicas convencionales pueden optimizarse con la cirugía asistida por computadora y reconstrucción con biomodelos 3D impresos. Esta novedosa propuesta permitirá el adecuado uso de materiales, una óptima secuencia de reducción, mejor estabilidad de la fractura y menor riesgo de complicaciones quirúrgicas(AU)
Introduction: Complex distal femur fractures AO/AOT type 33C3.3 constitute a challenge for orthopedists due to the difficulty of their treatment and associated complications. The surgical planning and procedure use condylar plates; but these are associated with loss of fixation and collapse of the reduction. Objective: To describe preoperative planning for an AO/AOT 33C3.3 distal femur fracture with 3D bioprinting and computer reconstruction. Case report: The case of a 34-year-old male patient is reported. He has comminuted left fracture of the distal femur, AO/AOT type 33C3.3, due to a traffic accident. Surgical planning and treatment were successfully performed with 3D biomodel printing and reconstruction. Based on the patient's tomographic images, the main fragments, the reduction sequence, the number and position of the implants to be used were identified. Conclusions: Preoperative planning is a critically important stage in managing complex fractures. Conventional techniques can be optimized with computer-assisted surgery and reconstruction with 3D printed biomodels. This novel proposal will allow the appropriate use of materials, optimal reduction sequence, better stability of the fracture and lower risk of surgical complications(AU)
Asunto(s)
Humanos , Masculino , Adulto , Accidentes de Tránsito , Cirugía Asistida por Computador/instrumentación , Fracturas del Fémur/cirugía , Bioimpresión/métodos , PlanificaciónRESUMEN
Abstract Purpose To present new endoscopic robotic devices in the context of minimally invasive procedures with high precision and automation. Methods Review of the literature by December 2018 on robotic endoscopy. Results We present the studies and investments for robotic implementation and flexible endoscopy evolution. We divided them into forceps manipulation platforms, active endoscopy and endoscopic capsule. They try to improve forceps handling and stability and to promote active movement. Conclusion The implementation and propagation of robotic models depend on doing what the endoscopist is unable to. The new devices are moving forward in this direction.
Asunto(s)
Endoscopía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Instrumentos Quirúrgicos , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Endoscopios/clasificación , Modelos Animales , Cirugía Asistida por Computador/instrumentación , Diseño de Equipo , Procedimientos Quirúrgicos Robotizados/instrumentación , Resección Endoscópica de la Mucosa/instrumentación , Resección Endoscópica de la Mucosa/métodosRESUMEN
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.
Asunto(s)
Humanos , Femenino , Anciano , Diseño Asistido por Computadora , Implantación Dental , Prótesis Dental de Soporte Implantado , Cirugía Asistida por Computador/instrumentación , Cirugía Asistida por Computador/métodos , Tecnología OdontológicaRESUMEN
O planejamento é fundamental na Implantodontia. Com um correto planejamento, tornam-se muito maiores as chances de obtenção do sucesso clínico, que hoje vai muito além de somente alcançar a osseointegração dos implantes, mas sim, de posicionar o implante idealmente para a confecção de uma prótese que venha a contemplar saúde, função e estética. O objetivo desse artigo foi de reforçar a importância das etapas de planejamento e da utilização de meios para transferir as informações obtidas para a situação clínica através do uso de guias. A busca pelas publicações foi realizada nas bases de dados Pubmed (Medline) e Periódicos CAPES, durante o segundo semestre de 2013. Também foi realizada busca manual de referências. A seleção final após a leitura de títulos, abstracts e textos completos chegou a 30 artigos. Concluiu-se que os guias auxiliam em todas as fases do tratamento e permitem maior previsibilidade dos resultados, aumentando substancialmente a qualidade e longevidade das reabilitações protéticas implantossuportadas.
Planning is essential in oral Implantology. With correct planning there are greater chances of obtaining clinical success, which currently means more than the osseointegration of implants, and includes ideal positioning of the implant for making a prosthesis that contemplates health, function and aesthetics. The aim of this article was to reinforce the importance of planning steps and the use of means to transfer the information obtained to the clinical situation using the guides. The search was conducted in the databases Pubmed (Medline) and CAPES journals during the second half of 2013. It was also performed manual search of references. The final selection after reading titles, abstracts and full texts reached 30 articles. It can be concluded that the guides help at all stages of treatment and allow greater predictability of the results, thereby greatly enhancing the quality and longevity of the prosthetic implant restorations.
Asunto(s)
Humanos , Cirugía Asistida por Computador/instrumentación , Implantación Dental , Diseño de Prótesis Dental/métodos , Brasil , Radiografía Dental/instrumentación , Tomografía Computarizada por Rayos X/instrumentaciónRESUMEN
Introduction: Intra-operative ultrasound provides low cost real time imaging that is simple and rapid to use. In recent years there has been a signifi cant improvement in the quality of ultrasound imaging. Ultrasound integrated neuronavigation can be used to optimize the approach, and achieving safe maximal resection, thereby improving outcomes for patients with diff erent localization and histology of brain tumors, vascular patology, spontaneous intra-cerebral hemorrhage. Material and Methods: Since 2007 till 2010, in the Institute of Neurology and Neurosurgery, 130 operations with application of 2D iUS have been performed. Starting from March till May 2012, 17 patients went under surgical treatment using the intraoperative ultrasound integrated neuronavigation system. Results: We applied ultrasound neuronavigation system in 17 cases on patients with diverse pathologies, including brain tumors (craniopharyngeoma, corpus callosum and intracerebral glioblastoma, intraaxial glioma), vascular patology (arteriovenous malformations, aneurysms), spontaneous intracerebral hemorrhage. Application of ultrasound neuronavigation system aids in improving postoperative outcomes for these patients. Conclusions: Th e integration of 3D US with neuronavigation technology created an effi cient and inexpensive tool for intraoperative imaging in neurosurgery. Th e technology has been applied to optimize surgery of brain tumors, but it has also been found to be useful in other procedures such as operations for aneurysms or arteriovenous malformations. iUS is easy to use and has a rapid learning curve which makes it a useful tool to the neurosurgeons intraoperative armamentarium.
Asunto(s)
Neoplasias Encefálicas/cirugía , Neoplasias Encefálicas/diagnóstico por imagen , Humanos , Imagenología Tridimensional/instrumentación , Neuronavegación/métodos , Neurocirugia/métodos , Procedimientos Neuroquirúrgicos/métodos , Cirugía Asistida por Computador/instrumentación , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/estadística & datos numéricos , Ultrasonografía/instrumentación , Ultrasonografía/métodos , Ultrasonografía/estadística & datos numéricosRESUMEN
Resection of retroperitoneal tumors is usually perfomed using the anterior retroperitoneal approach. Our report presents an innovative method utilizing a robotic surgical system. A 50-yr-old male patient visited our hospital due to a known paravertebral mass. Magnetic resonance imaging showed a well-encapsulated mass slightly abutting the abdominal aorta and left psoas muscle at the L4-L5 level. The tumor seemed to be originated from the prevertebral sympathetic plexus or lumbosacral trunk and contained traversing vessels around the tumor capsule. A full-time robotic transperitoneal tumor resection was performed. Three trocars were used for the robotic camera and working arms. The da Vinci Surgical System(R) provided delicate dissection in the small space and the tumor was completely removed without damage to the surrounding organs and great vessels. This case demonstrates the feasibility of robotic resection in retroperitoneal space. Robotic surgery offered less invasiveness in contrast to conventional open surgery.
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Humanos , Masculino , Persona de Mediana Edad , Aorta Abdominal , Procesamiento de Imagen Asistido por Computador/instrumentación , Imagen por Resonancia Magnética , Neurilemoma/diagnóstico , Espacio Retroperitoneal , Robótica/instrumentación , Neoplasias de la Columna Vertebral/diagnóstico , Cirugía Asistida por Computador/instrumentaciónRESUMEN
PURPOSE: To design a simple, cost-effective system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: The design consists of a low-cost, light-weight, portable mechanical gantry with a needle guiding device. Using C-arm fluoroscopy, two images of the contrast-filled renal collecting system are obtained: at 0-degrees (perpendicular to the kidney) and 20-degrees. These images are relayed to a laptop computer containing the software and graphic user interface for selecting the targeted calyx. The software provides numerical settings for the 3 axes of the gantry, which are used to position the needle guiding device. The needle is advanced through the guide to the depth calculated by the software, thus puncturing the targeted calyx. Testing of the system was performed on 2 target types: 1) radiolucent plastic tubes the approximate size of a renal calyx (5 or 10 mm in diameter, 30 mm in length); and 2) foam-occluded, contrast-filled porcine kidneys. RESULTS: Tests using target type 1 with 10 mm diameter (n = 14) and 5 mm diameter (n = 7) tubes resulted in a 100 percent targeting success rate, with a mean procedure duration of 10 minutes. Tests using target type 2 (n = 2) were both successful, with accurate puncturing of the selected renal calyx, and a mean procedure duration of 15 minutes. CONCLUSIONS: The mechanical gantry system described in this paper is low-cost, portable, light-weight, and simple to set up and operate. C-arm fluoroscopy is limited to two images, thus reducing radiation exposure significantly. Testing of the system showed an extremely high degree of accuracy in gaining precise access to a targeted renal calyx.
Asunto(s)
Cálices Renales/cirugía , Nefrostomía Percutánea/instrumentación , Cirugía Asistida por Computador/instrumentación , Análisis Costo-Beneficio , Diseño de Equipo , Fluoroscopía , Agujas , Nefrostomía Percutánea/métodos , Reproducibilidad de los Resultados , Robótica/instrumentación , Cirugía Asistida por Computador/métodos , Factores de TiempoRESUMEN
La cirugía mínimamente invasiva y la incorporación de la robótica en este tipo de procedimientos representa grandes ventajas para el paciente, el cirujano y los sistemas de salud. sin embargo, los dispositivos comerciales disponibles en la actualidad no cuentan con realimentación de fuerza y tacto, que faciliten al cirujano la identificación de los tejidos y consecuentemente, la reducción de errores en los procedimientos quirúrgicos; por lo cual, el desarrollo de sistemas que cuenten con este tipo de realimentación se convierte en un tema de interés a nivel mundial. el presente artículo contiene una revisión del estado de la técnica con respecto a los sistemas comerciales y experimentales desarrollados en esta área. también, se presentan algunos sensores y modelos matemáticos utilizados para calcular las fuerzas y torques en cirugía mínimamente invasiva.
Minimally invasive surgery and the adaptation of robotics to these procedures represent many advantages for the patient, the surgeon, and the health program. However, commercial devices used nowadays lack haptic feedback. this fact makes the tissue identification more difficult and increments the injuries risk during the surgical procedure. The development of systems with this kind of feedback has become a topic of interest throughout the world. the present article contains a revision of the state of the art about commercial and experimental systems developed in this area. models for the force and torque propagation, used in minimally invasive surgery, are also presented.
Asunto(s)
Cirugía Asistida por Computador/instrumentación , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/tendencias , Modelos Teóricos , Robótica , Retroalimentación , TorqueRESUMEN
Neurocirurgia guiada por imagem permite ao neurocirurgião navegar dentro do cérebro do paciente, usando imagens préoperatórias como orientação, através do uso de sistemas de rastreamento 3D, durante o procedimento cirúrgico. Seguindo um procedimento de calibração, a posição tridimensional e a orientação dos instrumentos cirúrgicos podem ser transmitidas ao computador. Estas informações espaciais são usadas para acessar a região de interesse nas imagens pré-operatórias com a finalidade de apresentá-las ao cirurgião durante o procedimento cirúrgico. Contudo, quando se faz a craniotomia para a remoção da lesão, o movimento do tecido cerebral pode ser fonte significativa de erro nestes sistemas de navegação. A arquitetura implementada neste trabalho visa o desenvolvimento de um sistema que permite planejamento e orientação cirúrgica guiada por imagem de ultrassom. Para orientação cirúrgica foi desenvolvido um software que permite extrair fatias do volume de imagens de ressonância magnética (IRM), com orientação fornecida por um transdutor espacial baseado em indução magnética (Polhemus®). As fatias extraídas com este software são importantes porque mostram a região do cérebro que o neurocirurgião está observando durante o ato cirúrgico e, além disso, elas podem ser correlacionadas com imagens de ultrassom (IUS) intra-operatórias para detectar e corrigir a deformação do tecido cerebral durante a cirurgia. A ferramenta para navegação pre-cirúrgica foi desenvolvida para fornecer três fatias ortogonais obtidas através do volume de imagens. Na metodologia usada para a implementação do software, foi utilizada a linguagem de programação Python e a biblioteca gráfica Visualization Toolkit (VTK). O programa para extrair fatias do volume de IRM permitiu a aplicação de transformações ao volume, com base nos valores de coordenadas fornecidos pelo transdutor de posição Polhemus®.
Image guided neurosurgery enables the neurosurgeon to navigate inside the patients brain using pre-operative images as a guide and a tracking system, during a surgery. Following a calibration procedure, three-dimensional position and orientation of surgical instruments may be transmitted to computer. The spatial information is used to access a region of interest, in the pre-operative images, displaying them to the neurosurgeon during the surgical procedure. However, when a craniotomy is involved and the lesion is removed, movements of brain tissue can be a significant source of error in these conventional navigation systems. The architecture implemented in this work intends the development of a system to surgical planning and orientation guided by ultrasound image. For surgical orientation, the software developed allows the extraction of slices from the volume of the magnetic resonance images (MRI) with orientation supplied by a magnetic position sensor (Polhemus®). The slices extracted with this software are important because they show the cerebral area that the neurosurgeon is observing during the surgery, and besides they can be correlated with the intra-operative ultrasound images to detect and to correct the deformation of brain tissue during the surgery. Also, a tool for per-operative navigation was developed, providing three orthogonal planes through the image volume. In the methodology used for the software implementation, the Python programming language and the Visualization Toolkit (VTK) graphics library were used. The program to extract slices of the MRI volume allowed the application of transformations in the volume, using coordinates supplied by the position sensor.
Asunto(s)
Imagenología Tridimensional/instrumentación , Imagenología Tridimensional , Neuronavegación/instrumentación , Neuronavegación , Procesamiento de Imagen Asistido por Computador/instrumentación , Cirugía Asistida por Computador/instrumentación , Cirugía Asistida por Computador , Neurocirugia/instrumentación , TransductoresRESUMEN
BACKGROUND: Both Minimally Invasive surgery (MIS) and Computer-Assisted Surgery (CAS) are useful in Total Knee Arthroplasty (TKA). Minimally invasive total knee arthroplasty was associated with decreased blood loss, shorter hospital stays, and increased range of motion. Computer-assisted surgery in total knee arthroplasty was developed to improve the positioning of implants during surgery. OBJECTIVE: To evaluate radiographic results relative to component position and limb alignment when using a navigation system compared with conventional technique in MIS-TKA. MATERIAL AND METHOD: A prospective control study was performed in 180 patients who underwent total knee arthroplasty by one surgeon. All patients were randomly divided into two groups, Conventional and Navigation TKA. Intra-, post-operative data, and postoperative limb alignment were recorded for comparison in both groups. RESULTS: The postoperative mechanical axis was within 3 degrees of neutral mechanical alignment in 94% of the navigation group and 87% in conventional group (p = 0.13). Registration time of navigation group is 13.58 minutes. No statistical significant difference was found in tourniquet time and postoperative blood loss in both groups. CONCLUSION: The use of navigation in total knee arthroplasty increases accuracy in limb and implants alignment, and does not increase complications and surgical times.
Asunto(s)
Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/instrumentación , Femenino , Indicadores de Salud , Humanos , Procesamiento de Imagen Asistido por Computador/instrumentación , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Cirugía Asistida por Computador/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Factores de TiempoRESUMEN
La localización de una lesión de la calota craneana puede ser difícil en especial cuando es pequeña y poco evidente a nivel de la superficie externa del cráneo. En este artículo se describe la localización y extirpación guiada por cintigrafía intraoperatoria, de una lesión de 2 cm que comprometía la cara interna del hueso temporal. La expresión radiológica de la lesión en la radiología simple y en la tomografía computada era pobre. Esto hizo difícil la radiología intraoperatoria y la neuronavegación guiada por tomografía computada. En el presente caso se logró extirpar la lesión en bloque. La biopsia fue informada como "Enfermedad de Paget". No hubo complicaciones quirúrgicas.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Cráneo/lesiones , Neuronavegación/instrumentación , Osteítis Deformante/cirugía , Osteítis Deformante/diagnóstico , Cirugía Asistida por Computador/instrumentación , Procedimientos Neuroquirúrgicos/instrumentación , Tomografía Computarizada por Rayos XRESUMEN
The development of image-guided neurosurgery represents a substantial improvement in the microsurgical treatment of tumors, vascular malformations and other intracranial lesions. Despite the wide applicability and many fascinating aspects of image-guided navigation systems, a major drawback of this technology is they use images, mainly MRI pictures, acquired preoperatively, on which the planning of the operative procedure as well as its intraoperative performance is based. As dynamic changes of the intracranial contents regularly occur during the surgical procedure, the surgeon is faced with a continuously changing intraoperative field. Only intraoperatively acquired images will provide the neurosurgeon with the information he needs to perform real intraoperative image-guided surgery. A number of tools have been developed in recent years, like intraoperative ultrasound and dedicated moveable intraoperative CT units. Because of its excellent imaging qualities, combined with the avoidance of ionizing radiation, MRI currently is and definitely will be in the future for the superior imaging method for intraoperative image guidance. In this short overview, the development as well as some of the current and possible future applications of MRI-guided neurosurgery is outlined.