Introduction to Navigation - Robotic Total Knee Replacement
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Computer-assisted surgery (CAS) uses computer technology to help guide surgical procedures and has evolved from early systems that located brain tumors to current navigation systems that provide real-time positional information of surgical tools to help surgeons accurately reach anatomical targets and optimally position implants while avoiding areas of risk. CAS systems can be passive with just navigation, semi-active assisting with guide tools but not surgery, or active performing pre-programmed surgical actions. Modern navigation relies on tracking reflective markers in real-time rather than external imaging to construct a 3D model of the patient's anatomy.
Introduction to Navigation - Robotic Total Knee Replacement
- 1. HISTORY of NAVIGATION and its Evolution Dr. Kalaivanan Kanniyan
- 2. CAS - Computer Assisted Surgery is an innovative technology that enhances surgical guidance since late 90s. CAS was initially developed to locate brain tumors based on a surgical intervention that used a three dimensional coordinate system. computer‐assisted orthopaedic surgery (CAOS) Advancement in Imaging modality like digital X‐rays, CT, MRI, ultrasound, or fluoroscopy made CAS to allow surgeons to visualize more accurately on a monitor as a real time image better than the anatomy. CAS may provide real time operative views of surgical instruments and their relative positioning with respect to the human anatomy and previously existing implants.
- 3. CAS major advantages: • increase the accuracy of surgical procedures • reduce iatrogenic damage • minimally invasive surgery • reduce surgical time • early post operative rehabilitation Surgical navigation is a form of CAS and is the visualization system that gives positional information about surgical tools or implants relative to a target organ on a computer display
- 4. CAS (i) passive systems, (ii) semi‐active systems (iii) active systems. CAS: Passive Navigation is the primary mode of passive systems, which may be CT based, imageless, or fluoroscopic optical 3‐D position sensor (Optotrak 3020),
- 5. Semi active systems perform some actions such as moving a drill guide sleeve or a cutting jig. but no direct surgical procedure. Acrobot, allows surgeons to control a drill bit using a robotic arm in real‐time Active systems perform surgical actions that are programmed preoperatively. ROBODOC, which prepares the femoral canal for prosthesis placement based on pre surgical plans
- 6. “Navigation in surgery” ? “Where is my (anatomical) target ? “How do I reach my target safely? “Where am I (anatomically)? “Where and how shall I position my implant? Neurosurgery Stereotaxy Frame based to frameless 1990s when David Roberts Biggest advantage is the capability to track a surgical instrument in “real-time” and constantly visualize its position on the preoperative CT or MRI. This marked the inception of navigation in surgery – became image free
- 7. Navigation is a successor or natural evolution of frame-based stereotaxy. • Guide the surgeon to find a specific anatomical target • avoid areas of risk, • offer intraoperative orientation in the absence of anatomical landmarks • optimal alignment of implants • 3D measurement system. navigation system is in some way the same as a commonly used navigation system in a car, Both attempt to localize or determine a position in space in the context of its surroundings. Difference is surgical navigation doesn’t use triangulation like a GPS - global positioning system with the help of several geostationary satellites.
- 8. Modern surgical navigation systems use a stereoscopic camera emitting infrared light which can determine a 3D position of prominent structures, like reflective marker spheres. This allows for real-time tracking of the marker spheres. Mezger, Uli et al. “Navigation in surgery.” Langenbeck's archives of surgery vol. 398,4 (2013): 501-14. doi:10.1007/s00423-013-1059-4
- 9. Modern orthopedic navigation systems are “model-based” and work almost exclusively without information from external image sources. No need of additional radiation, e.g., through CT or X-ray. Instead the navigation software calculates an individual model of the patients’ anatomy based on defined landmarks on the bone which are acquired using a navigated instrument (registration)
- 10. Image modalities CT MRI Functional MRI fluroscopy Imageless Image registration 1. Extrinsic registration methods (“gold standard”) 2. Curve methods 3. Surface methods 4. Moment and Principal Axes methods 5. Correlation methods 6. Atlas methods 7. Maximized mutual information-based methods 8. Wavelet-based methods 9. Artificial Neural network method (NN) 10.Genetic Algorithm (GA) 11.Fuzzy sets 12.Rough Sets Imageless: computer constructs a digitized anatomical model of the area of interest by referencing the results of the patient's Orthopedic tests, such as joint rotation angles, flexion/extension angles, etc. Although a digital image is constructed by the computer, there are no image-taking processes in both the pre-operative and intra-operative stages thereby eliminating radiation exposure, and reducing operation time
- 11. Tracking of surgical tools Surgical tools are tracked by devices knows as tracking systems. These devices measure the (Tx, Ty, Tz) coordinates of each tool, as well as three angles (Rx, Ry, Rz) to describe the tool orientation, and they report this information many times per second to make it possible to track the motion of the tool Clinical applications of computer assisted surgical navigation Arthroplasty spine surgery Arthroscopy Tumour surgery Fracture surgery Mavrogenis AF, Mimidis G, Koulalis D, Papagelopoulos PJ. Computer- assisted navigation in orthopaedics. OA Orthopaedics 2014 Apr 15;2(1):8.
- 14. Brain LaB - Navigation - TKR
- 16. Thanks all Dr. Kalaivanan Kanniyan
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