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Sarcoma
Volume 2014 (2014), Article ID 842709, 9 pages
http://dx.doi.org/10.1155/2014/842709
Clinical Study

Computer-Assisted Planning and Patient-Specific Instruments for Bone Tumor Resection within the Pelvis: A Series of 11 Patients

1Clinique Chirurgicale Orthopédique et Traumatologique, CHU Hôtel-Dieu, Place Alexis-Ricordeau 1, 44093 Nantes Cedex 1, France
2Laboratoire Physiopathologie de la Résorption Osseuse, Inserm UI957, Faculté de Medecine, Université de Nantes, rue Gaston Veil, 44000 Nantes, France
3Computer Assisted and Robotic Surgery (CARS), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 53, 1200 Brussels, Belgium

Received 31 January 2014; Revised 9 June 2014; Accepted 9 June 2014; Published 2 July 2014

Academic Editor: Charles Catton

Copyright © 2014 François Gouin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pelvic bone tumor resection is challenging due to complex geometry, limited visibility, and restricted workspace. Accurate resection including a safe margin is required to decrease the risk of local recurrence. This clinical study reports 11 cases of pelvic bone tumor resected by using patient-specific instruments. Magnetic resonance imaging was used to delineate the tumor and computerized tomography to localize it in 3D. Resection planning consisted in desired cutting planes around the tumor including a safe margin. The instruments were designed to fit into unique position on the bony structure and to indicate the desired resection planes. Intraoperatively, instruments were positioned freehand by the surgeon and bone cutting was performed with an oscillating saw. Histopathological analysis of resected specimens showed tumor-free bone resection margins for all cases. Available postoperative computed tomography was registered to preoperative computed tomography to measure location accuracy (minimal distance between an achieved and desired cut planes) and errors on safe margin (minimal distance between the achieved cut planes and the tumor boundary). The location accuracy averaged 2.5 mm. Errors in safe margin averaged −0.8 mm. Instruments described in this study may improve bone tumor surgery within the pelvis by providing good cutting accuracy and clinically acceptable margins.