Paper #51 - ISHA Annual Scientific Meeting 2016

Virtual Arthroscopic Simulator For Estimating Optimal Portal Placements In Arthroscopic Hip Surgery

Takashi Nishii, MD, PhD, Osaka JAPAN
Shinnosuke Kawakami, MS, Nara JAPAN
Norio Fukuda, MS, Nara JAPAN
Yoshito Otake, PhD, Nara JAPAN
Yoshinobu Sato, PhD, Nara JAPAN

Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, JAPAN

FDA Status Not Applicable

Summary: Virtual arthroscopic simulator provided patient-specific optimal portal positions for the best visualization within the central compartment and easier and safer placement of anterior and superior anchors for labral repair.

Abstract:
When performing hip arthroscopic surgery, the limited maneuverability of arthroscopic instruments due to limited work space in the joint cavity and deeply-located joint in the body requires expert surgeon's dexterity. To ensure wide access of suture anchors and arthroscope, and to avoid unwanted iatrogenic chondral or labral injuries due to instrument collision, optimal portal placement is critical because the portal is a fulcrum of the tool motion. Pioneer surgeons proposed several representative portal positions for anterolateral, mid-anterior and posteolateral portal defined by the uniform distances relative to anatomical point landmarks, e.g. ASIS and the greater trochanter. However, they are not always optimal due to the anatomical variation among patients as well as various pathological variations.
For this solution we developed computational arthroscope simulator to verify visibility of the inserted arthroscope and accessibility of the surgical instruments inserted into the hip joint model. The novelty of our system is the followings; 1) Individual hip models including the acetabulum, femoral head, articular cartilage, acetabular labrum, and joint capsule are created from CT arthrography in each patient. 2) Traction for 1-2 cm of distance between the femoral head and acetabulum and 10-20º internal rotation of the hip are applied to simulate real surgical situation. 3) Virtual 70-degree arthroscope and instrument models are operated in the individual hip model by haptic interface on screen of 3D Slicer.
In a preliminary clinical test, an expert surgeon evaluated performance of the computational simulator in ten patients applicable for hip arthroscopic surgery. Patient-specific optimal positions of anterolateral and mid-anterior portals could be determined for the best visualization within the central compartment and easier and safer placement of anterior and superior anchors for labral repair.