Computer navigation assisted tumor surgery for internal hemipelvectomy - Early experience

Abstract

Internal hemipelvectomy is a surgically challenging entity, owing, among other reasons, to a complex anatomy. The apprehension of an inadequate margin or injury to critical structures adds to the complexity of these major surgical procedures. Computer assisted tumor surgery (CATS) has been increasingly used to improve outcomes of internal hemipelvectomy over the last decade. We analyzed the surgical and postoperative details of first four patients undergoing internal hemipelvectomy with CATS assistance at our institute, the first ever report in an Indian setting. The patients were analyzed for blood loss (mean 1300 ml), operative time (mean 306 min) and hospital stay (mean 7 days). The histopathological margins were free of disease in all the patients, even as the average closest bony margin was 0.9 cm. Sparing of sacral nerve root was made possible by the close yet free margins in two patients. In this retrospective analysis of a small series of patients with computer navigation assisted internal hemipelvectomy, we found this technique to be feasible and effective in achieving the oncological aim of negative margins with preservation of critical structures.

Keywords: Computer navigation; Computer-assisted tumor surgery (CATS); Internal hemipelvectomy; Orthopedic oncology; Sarcoma.

Fig. 1

Large pelvic tumor involving sacroiliac area, close to sacral nerve root. With the use of navigated instruments, sacral nerve root was preserved while maintaining oncological safety. CBM was 1 cm, margins free.

Fig. 2

Ewing sarcoma of pelvis in a 7 years old boy. CATS internal hemipelvectomy was done with pseudoarthrosis with meshplasty. CBM was 0.5 cm, margins free.