OBJECTIVES: The aim of this study was to investigate the long-term effects of computer-assisted CiTM navigation on clinical, radiological, and functional results versus conventional total knee arthroplasty (TKA). PATIENTS AND METHODS: Between January 2005 and July 2011, a total of 85 patients (36 males, 49 females; mean age: 66.2±5.2 years; range, 59 to 84 years) who underwent P.F.C. SigmaTM knee system implantation using computer-assisted CiTM navigation system (BrainLAB®, DePuy International, Leeds, UK) and completed a minimum follow-up of eight years were included in the study. In the control group, a total of 100 patients (40 males, 60 females; mean age: 68.3±3.9 years; range, 60 to 79 years) who completed a minimum follow-up of eight years were randomly selected from a dataset of implanted P.F.C. SigmaTM knee systems in the same period using Specialist® 2 instrumentation without navigation. An implant survival analysis was used to compare implant survivorship between the groups throughout 12 years. The Knee Society Score (KSS) and range of motion (ROM) were assessed. Based on long-format X-ray images, the implant position in the frontal and sagittal planes was evaluated. RESULTS: The ratio for navigation to control group survival is approximately 1.01 at 12 years. The clinical outcomes showed no significant difference between the groups (knee scores, p=0.707 and functional scores, p=0.485). In the measured angles analysis, we observed a consistent pattern in both groups. In the control group, there was a trend toward implanting the tibial component with slight varus alignment (p=0.038) and a higher posterior slope (p<0.001). On average, the operation was prolonged by 13 min in the navigated group (p<0.001). CONCLUSION: In conclusion, our study results demonstrate that while kinematic navigation in TKA improves the precision of implant alignment, it does not provide significant benefits in terms of long-term implant survival or functional outcomes compared to conventional TKA methods. The use of the computer-assisted CiTM navigation system is associated with prolonged operation duration, although no technical complications related to the navigation device's software can be observed. Therefore, although navigation offers theoretical advantages in component positioning, its use may be more justifiable in cases with challenging alignment requirements rather than as a routine practice.
- MeSH
- Osteoarthritis, Knee * surgery physiopathology diagnostic imaging MeSH
- Time Factors MeSH
- Surgery, Computer-Assisted * adverse effects methods instrumentation MeSH
- Knee Joint * surgery diagnostic imaging physiopathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Recovery of Function MeSH
- Knee Prosthesis MeSH
- Retrospective Studies MeSH
- Range of Motion, Articular MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Arthroplasty, Replacement, Knee * methods instrumentation adverse effects MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
PURPOSE OF THE STUDY: The annual number of spinal fusion procedures has been increasing and is well documented worldwide. The O-arm is slowly becoming the standard for transpedicular screw insertion. The accuracy and safety of this method have been confirmed by many studies. Therefore, the learning curve of this method and its use by younger surgeons is the focus of our investigation. Longer operative time and radiation exposure to the patient are its only disadvantages. Our aim was to evaluate the learning curve of neurosurgical residents receiving specialist training and to demonstrate the safety and accuracy compared to the conventional C-arm-guided screw insertion used in the surgical management of spondylolisthesis. MATERIAL AND METHODS: Two groups of patients were evaluated - a retrospective cohort composed of patients with degenerative lumbar spinal instability indicated for C-arm-guided posterior transpedicular screw fixation and a prospective group of patients with the same diagnosis and surgical indication for O-arm-navigated screw insertion. In the retrospective group, the surgeons were largely experienced certified spine surgeons and neurosurgeons, whereas in the prospective group there were mainly neurosurgical residents receiving specialist training under the supervision of a certified physician. Both groups underwent a postoperative CT scan to evaluate the pedicle screw malposition using the Grade system and the anatomical plane of malposition. The operative times for both groups were recorded and for the O-arm navigated group a learning curve from the introduction of the method was generated. The values obtained were statistically analysed. RESULTS: A relatively favourable learning curve of the O-arm-navigation was obtained, with operative times approximating the Carm-guided group at two years after the introduction of the method. Safety of the O-arm navigation applied by less experienced surgeons was confirmed through statistically significantly higher accuracy achieved in the O-arm group at the expense of longer operative times. Also, a significantly lower number of significant Grade 2 and 3 malposition was reported in the O-arm group. DISCUSSION: The higher accuracy of transpedicular screw insertion in the navigation method has been confirmed multiple times. In our study, even in the group of less experienced surgeons. The favourable learning curve of neurological residents receiving specialist training is less documented. Time efficiency of the method and its safety when applied by younger surgeons could help make O-arm navigation the new gold standard in spine surgery. The longer operative time, the purchase price of the device, and a relatively higher radiation exposure to the patient continue to be its disadvantages. CONCLUSIONS: Based on the data obtained, a conclusion can be drawn that the O-arm navigation in spine surgery represents a safer and more accurate method for transpedicular fixation compared to the conventional C-arm technique, even when used by less experienced surgeons. In future, we should focus on increasing its time-efficiency. We are convinced that the navigationassisted spinal instrumentation will soon become a necessity for spine surgery centres. KEY WORDS: O-arm, transpedicular fixation, spondylolisthesis, fusion, navigation, learning curve.
- MeSH
- Lumbar Vertebrae * surgery MeSH
- Surgery, Computer-Assisted methods instrumentation MeSH
- Operative Time MeSH
- Spinal Fusion instrumentation methods education MeSH
- Bone Screws MeSH
- Learning Curve * MeSH
- Internship and Residency MeSH
- Middle Aged MeSH
- Humans MeSH
- Prospective Studies MeSH
- Retrospective Studies MeSH
- Spondylolisthesis * surgery MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
- Comparative Study MeSH
Radioguidance that makes use of β-emitting radionuclides is gaining in popularity and could have potential to strengthen the range of existing radioguidance techniques. While there is a strong tendency to develop new PET radiotracers, due to favorable imaging characteristics and the success of theranostics research, there are practical challenges that need to be overcome when considering use of β-emitters for surgical radioguidance. In this position paper, the EANM identifies the possibilities and challenges that relate to the successful implementation of β-emitters in surgical guidance, covering aspects related to instrumentation, radiation protection, and modes of implementation.
[Role of bronchology in the diagnosis of lung cancer]
Karcinom plic je stále jedním ze solidních nádorů s nejhorší prognózou. Včasná diagnostika a terapie je pro pacienta zásadní. Jednotlivé bronchologické metody hrají v diagnostice tohoto onemocnění stěžejní roli a za poslední dekády zaznamenaly významný rozvoj. Cílem tohoto přehledného sdělení je výčet jednotlivých metod, jejich využití a očekávané výstupy z nich. Tento text je primárně určen pro onkology, pneumoonkology a další specialisty, kteří se podílejí na diagnostice nádorů plic.
Lung cancer is still one of the solid tumors with the worst prognosis. Early diagnosis and therapy is essential for the patient. Individual bronchological methods play a key role in the diagnosis of this disease and have seen significant development over the past decades. The aim of this article is to list the individual methods, their use and the expected outputs from them. This text is primarily intended for oncologists, pneumo-oncologists and other specialists involved in the diagnosis of lung tumors.
- MeSH
- Bronchoscopy * methods instrumentation MeSH
- Surgery, Computer-Assisted methods MeSH
- Humans MeSH
- Lung Neoplasms diagnostic imaging MeSH
- Image-Guided Biopsy methods instrumentation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
PURPOSE: Treatment of pelvic fractures is often complicated. Here, we intended to evaluate the intraoperative benefits of using 2D computer navigation when compared with traditional fluoroscopy on X-ray burden, surgical time and screw placement accuracy. METHODS: In this study, we retrospectively evaluated the records of 25 patients who underwent osteosynthesis of a posterior pelvic fracture using fluoroscopy at the University Hospital Ostrava, Czech Republic between 2011 and 2019, and 32 patients from the same department and period in whom 2D computer navigation was used. RESULTS: Intraoperative X-ray burden was significantly lower in the group with 2D computer navigation (median 650 vs 1024 cGy/cm2), as was the duration of the surgery (41 vs 45 min). This was most obvious where two screws were inserted (X-ray dose of 994 vs 1847 cGy/cm2 and 48 vs 70 min, respectively). Correction of the path for wire placement after the original drilling was necessary in 2 patients (6%) from the 2D computer navigation group and 15 patients from the fluoroscopy group (60%). Still, no malposition of the screws nor dislocation of the posterior pelvic segment after 12 months was observed in any patient of either group; of complications, only three superficial infections in the 2D navigation group and 2 in the fluoroscopy group were observed. CONCLUSION: 2D computer navigation is a safe and accurate method for placement of screws during posterior pelvic fracture osteosynthesis, associated with lower intraoperative radiation burden and shorter surgical times compared to standard fluoroscopy, especially if two screws are inserted.
- MeSH
- Surgery, Computer-Assisted * methods MeSH
- Fluoroscopy methods MeSH
- Fractures, Bone * diagnostic imaging surgery MeSH
- Bone Screws MeSH
- Humans MeSH
- Computers MeSH
- Retrospective Studies MeSH
- Fracture Fixation, Internal methods MeSH
- Imaging, Three-Dimensional methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Toothache etiology MeSH
- Surgical Navigation Systems MeSH
- Surgery, Computer-Assisted methods instrumentation MeSH
- Digital Technology methods instrumentation MeSH
- Endodontics * methods instrumentation MeSH
- Tooth Apex * MeSH
- Dental Informatics methods instrumentation MeSH
- Middle Aged MeSH
- Humans MeSH
- Periapical Periodontitis diagnostic imaging therapy MeSH
- Radiography, Dental MeSH
- Oral Surgical Procedures methods instrumentation MeSH
- Treatment Outcome MeSH
- Dentistry, Operative methods instrumentation MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Publication type
- Case Reports MeSH
[Figure: see text].
- MeSH
- Time Factors MeSH
- Surgery, Computer-Assisted methods MeSH
- Equipment Design MeSH
- Adult MeSH
- Atrial Fibrillation physiopathology surgery MeSH
- Fluoroscopy methods MeSH
- Catheter Ablation instrumentation MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Heart Conduction System physiopathology MeSH
- Prospective Studies MeSH
- Recurrence MeSH
- Aged MeSH
- Cardiac Catheters * MeSH
- Pulmonary Veins surgery MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
Stanovisko práce: Transperineálně prováděné navigované biopsie prostaty mají srovnatelnou výtěžnost a představují nižší riziko infekčních komplikací než biopsie transrektální. Cíl: V současné době se do popředí zájmu dostávají biopsie prostaty prováděné transperineálním přístupem. V našem souboru jsme retrospektivně hodnotili výtěžnost transperineálně prováděných biopsií a současně jejich bezpečnost především s ohledem na případné infekční komplikace. Pacienti a metoda: Od ledna 2019 do března 2020 jsme provedli 208 navigovaných fúzních US/MRI biopsií prostaty – transperineálním přístupem. Magnetická rezonance byla hodnocena systémem skórování PI‑RADS v2, respektive v2.1. U pacientů bez předchozí biopsie jsme odebrali systematicky vzorky z periferní zóny a dále nejméně tři vzorky z radiologem popsaného ložiska. U rebiopsií jsme odebírali nejméně tři vzorky z ložiska či ložisek, které byly hodnoceny dle PI‑RADS skóre 3 a více, neprováděli jsme systematickou biopsii. Výsledky: Výtěžnost metody v našem souboru, bez ohledu na PI‑RADS skóre, byla u primobiopsií 52,9 % prokázaných karcinomů, z toho 35,3 % klinic ky nesignifikatních a 17,6 % klinicky signifikantních. U rebiopsií pak bylo prokázáno 53,6 % karcinomů, z toho 38,6 % klinicky nesignifikantních a 15 % klinicky signifikatních. Při porovnání výtěžnosti dle daného PI‑RADS skóre bylo ve skupině PI‑RADS 3 celkově 68,5 % negativních, 31,5 % pozitivních (27,8 % nesignifikantních a 3,7 % signifikantních), ve skupině PI‑RADS 4 to bylo 44,3 % negativních a 55,7 % pozitivních (41,8 %, resp. 13,9 %), ve skupině PI‑RADS 5 pak 22,9 % negativních, 77,1 % pozitivních (43,8 % resp. 33,3 %). Prokázal se statisticky významný rozdíl ve výtěžnosti biopsií (P < 0,001). 182 pacientů absolvovalo výkon zcela bez komplikací. Stran infekčních komplikací jsme zaznamenali pouze dva pacienty s dysuriemi, ale bez průkazu bakteriální infekce. Závěr: Výtěžnost transperineálně prováděných fúzních biopsiích prostaty v našem souboru odpovídá literárním údajům. Zaznamenali jsme minimum komplikací, a proto se domníváme, že takto prováděné biopsie jsou bezpečnou alternativou.
Major statement: US/MRI fusion transperineal prostate biopsy has comparable yield and lower risk of infectious complications than transrectal biopsy. Purpose: Nowadays, prostate biopsies performed transperineally are gaining prominence. In our cohort, we retrospectively evaluated the yield of transperineally performed biopsies and at the same time their safety, especially with regard to infectious complications. Patients and methods: From January 2019 to March 2020, we performed 208 fusion US/MRI guided prostate biopsies – transperineally. Magnetic resonance imaging was evaluated by the PI-RADS vs 2 and vs 2.1 scoring systems, respectively. In biopsy naive patients we performed systematic biopsy from the peripheral zone and took at least three samples from the lesion described by the radiologist. In patients with repeated biopsy, we made a targeted biopsy with at least three samples from the lesion or lesions PI-RADS ≥ 3, but we did not make a systematic biopsy. Results: The overall yield of the method in our group, regardless of the PI-RADS score, was 52.9 % of proven cancers in biopsy naive patients, of which 35.3 % were clinically insignificant and 17.6 % were clinically significant. In rebiopsy, 53.6 % of cancers were detected, of which 38.6 % were clinically insignificant and 15 % were clinically significant When comparing the yield according to the PIRADS score, in the PI-RADS 3 group a total of 68.5 % were negative, 31.5 % positive (27.8 % insignificant and 3.7 % significant), in the PI-RADS 4 group it was 44.3 % negative and 55.7 % positive (41.8 % and 13.9 %, respectively), in the PI-RADS 5 group 22.9 % negative, 77.1 % positive (43.8 % and 33.3 %, respectively). There was a statistically significant difference in the yield of biopsies (Chi-square test of independence for contingency tables, P < 0.001). We also assessed the complications of the procedure and we found that 182 patients underwent the procedure without any complications. As our main outcome measure, infectious complications, we recorded only two patients with dysuria, but without evidence of bacterial infection. Conclusion: The yield of transperineally performed prostate biopsy in our cohort corresponds to literature data. We have noticed a minimum of complications, and therefore we believe that biopsy performed this way is a safe alternative.
Intracardiac echocardiography (ICE) is the most practical method for online imaging during electrophysiological procedures. It allows guiding of complex catheter ablation procedures together with electroanatomical mapping systems, either with minimal or with zero fluoroscopy exposure. Besides safe and reproducible transseptal puncture, ICE helps to assess location and contact of the tip of the ablation catheter relative to specific anatomical structures. Another option is visualization of the arrhythmogenic substrate in patients with ventricular arrhythmias. This article describes the clinical utility of ICE in non-fluoroscopic electrophysiology procedures more in detail.
- MeSH
- Surgery, Computer-Assisted methods MeSH
- Echocardiography methods MeSH
- Electrophysiologic Techniques, Cardiac methods MeSH
- Fluoroscopy MeSH
- Catheter Ablation methods MeSH
- Humans MeSH
- Heart diagnostic imaging MeSH
- Arrhythmias, Cardiac diagnostic imaging surgery MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
