Validation of patient-specific 3D impression models for pelvic oncological orthopedic surgery

Abstract

Introduction: Pelvic ring tumors pose a challenge due to the difficulty in obtaining adequate surgical margins. Tools such as surgical navigation or 3D printing for the fabrication of patient-specific surgical positioning templates help in preoperative planning and intraoperative execution. Their correct positioning is essential in complex locations such as the pelvis, so it is necessary to identify positioning errors. The aim of this study is to demonstrate the reliability of 3D template placement for pelvic ring osteotomies.

Material and methods: Experimental study in cadaver with 10 hemipelvis. CT was performed to obtain the three-dimensional model, planning of osteotomies, design of positioning templates in ischiopubic (I), iliopubic (P), supracetabular (S) and iliac crest (C) branches; and a positioning marker (rigid-body) on the C and S templates for navigation. The templates and rigid-body are 3D printed and positioned according to pre-planning. Navigation allows the final position of the inserts and osteotomies to be checked.

Results: The positioning of the templates with respect to the preoperative planning varied depending on the location, being greater the error in those of the iliac crest. Using navigation the mean error of distance to the cutting plane is 3.5mm, except in pubis (5-8mm), being conditioned by the position of the rigid body.

Conclusion: The use of patient-specific templates printed in 3D is a reliable tool for performing osteotomies in pelvic cancer surgery.

Keywords: 3D assisted navigation; Cadaveric study; Desktop 3D printing; Estudio en cadáver; Impresión 3D; Instrumentos paciente-específicos; Navegación asistida por 3D; Patient-specific instruments; Pelvic tumor; Tumores pélvicos.