New CAS techniques in trauma surgery

Abstract

There is a trend towards less invasive and percutaneous treatment in trauma surgery that aims for shorter hospital stays, faster recovery and better cosmetic results. However, such a treatment is also a technically demanding procedure. Toray's less invasive procedures that show great advantages in healing and therapy often do not allow controlling instruments through direct sight, because muscles and skin left in place hide the surgical target. The surgeon has to rely on intra-operative imaging means such as fluoroscopy or ultrasound. Techniques like the placement of guide-wires prior to the ultimate intervention are used to monitor an intended trajectory with the use of fluoroscopy and subsequently enable safe guidance of the surgical instrument. Preoperatively acquired images such as radiograph, CT, and MRI may also be referred to obtain more detailed information with high image quality. The surgeon is responsible for bringing the information gained from different imaging modalities into spatial relationship within the situation on the operating table. The introduction of computer-assisted surgery (CAS) technique in more than a decade ago overcomes certain difficulties in less invasive treatment and brings following potential advantages: improving accuracy, reducing invasiveness, facilitating planning and simulation, and reducing X-ray radiation for both patent and surgical team. This chapter aims for reviewing recently and currently developed CAS techniques in trauma surgery including: (1) registration-free CT-based navigation; (2) zero-dose fluoroscopy-based close reduction and osteosynthesis of diaphyseal fracture of long bone; (3) virtual implant management; and (4) robot-assisted trauma surgery. © 2007 Springer Medizin Verlag Heidelberg.