Computer Assisted Planning of Complex Bone Tumor Resections Improves Negative Margin Resections in a Sawbones Model

Objective: Can we improve the surgical plan with the aid of computers?

Methods: Using a novel navigation system and 3-dimensional (3D) planning we compared a computer assisted to a non-assisted plan to resect a distal femur parosteal osteosarcoma in a saw-bone model. This was identical to an actual patient scenario. Eight surgeons participated.

Results: In the computer assisted cuts there were 4 positive margins cut in two tumor resections. In the unassisted group there were 14 positive margin cuts in 8 tumor resections. This was significantly different with regard to tumor resections (P value<0.05), as well as for separate cuts (P value<0.05). In the unassisted group there were more cuts which were far away from tumor (14 compared to 5). The resection volume was larger in the unassisted resections although not significantly different.

Conclusions: Computer assisted planning significantly decreased the risk of positive margin resection in this sawbones model. The volume resected was smaller compared to unassisted resections. This proof of concept study sets the ground for developing intuitive planning systems.

Clinical Implication: Computer assisted planning can improve safety and the accuracy of resections.