Real-Time, Vision-Guided Orthopedic Surgery for Wide Resection of Primary Bone Sarcomas

The advancement of image processing and robotic technology has facilitated the development of new methodologies in computer-assisted orthopedic surgery (CAOS). Precise replication of a preoperative plan is crucial for effectively removing malignant bone tumors through wide resection surgery. Recent advancements in computer navigation have significantly enhanced the precision of resection accuracy, albeit accompanied by several practical challenges. These include their cumbersome nature and large footprint, high cost, dependence on intraoperative radiation, lengthy setup time in the operating room (OR), and substantial impact on OR workflow. In this chapter, we introduce a novel real-time, vision-guided system that accurately projects the preoperative osteotomy lines onto the bone, significantly enhancing surgeons' ability to visualize and replicate the preoperative plan accurately during surgery by utilizing a compact and low-cost camera-projector system. In addition to being more cost-effective and compact compared to traditional navigation systems, it eliminates harmful intraoperative radiation and streamlines workflow with fast registration and minimal user interaction. This system includes (1) a machine-vision camera for capturing real-time bone images, (2) a light projector to project osteotomy lines onto the bone, (3) a three-dimensional (3D) structured light scanner for bone registration, and (4) a computer workstation that is connected to the camera and projector to track bone movement and refresh projection of osteotomy lines in real-time during surgery. Based on experimental results, our real-time, vision-guided system achieved significantly higher accuracy in replicating the planned osteotomy lines than a traditional manual approach for a simulated wide resection of a malignant bone tumor. Compared to the manual method, corner deviation was reduced from 2.53 to 0.35mm, angular deviation from 2.10 to 0.31 degrees, and point deviation from 4.66 to 0.48mm.