Surgical planning
Image:SurgicalPlanningArtikulator.jpg for the osteotomy of the jaw bones, based on models fixed into an articulator (registration based on infrared devices)]]
Surgical planning is the preoperative method of pre-visualising a surgical intervention, in order to predefine the surgical steps and furthermore the bone segment navigation in the context of computer-assisted surgery.{{Cite web|title=Surgical Planning - an overview {{!}} ScienceDirect Topics|url=https://www.sciencedirect.com/topics/medicine-and-dentistry/surgical-planning|access-date=2020-09-18|website=www.sciencedirect.com}}
The surgical planning is most important in neurosurgery and oral and maxillofacial surgery. The transfer of the surgical planning to the patient is generally made using a medical navigation system.
__TOC__
Principles of surgical planning
Image:StereolithographiemodellSchaedel.jpg for the osteotomy of the left orbit, based on stereolithographic models (registration based on infrared devices)]]
The imagistic dataset used for surgical planning is mainly based on a CT or MRI. In oral and maxillofacial surgery, a different, more "traditional" surgical planning can be used for orthognatic surgery, based on cast models fixed into an articulator.{{cn|date=January 2022}}
History of the concept
In order to make a surgical planning, one would need a 3D image of the patient. The starting point was made by G. Hounsfield in the 1970s, by using CT in order to record data about the anatomical situation of the patients.[https://royalsocietypublishing.org/doi/epdf/10.1098/rsbm.2005.0014 Wells PNT: Sir Godfrey Newbold Hounsfield, Biogr. Mems Fell. R. Soc. 51, 221-235, 2005] In the 1980s, advances were made by the radiologist M. Vannier and his team, by creating the first computed three-dimensional reconstruction from a CT dataset.{{cite journal | author = Vannier MW, Marsh JL, Warren JO | year = 1984 | title = Three Dimensional CT Reconstruction Images for Craniofacial Surgical Planning and Evaluation | url = http://radiology.rsnajnls.org/cgi/reprint/150/1/179.pdf | journal = Radiology | volume = 150 | issue = 1| pages = 179–84 | doi=10.1148/radiology.150.1.6689758| pmid = 6689758 }} In the early 1990s, the surgical planning was performed by using stereolithographic models.{{cite journal | author = Klimek L, Klein HM, Schneider W, Mosges R, Schmelzer B, Voy ED | year = 1993 | title = Stereolithographic modelling for reconstructive head surgery | journal = Acta Oto-Rhino-Laryngologica Belgica | volume = 47 | issue = 3| pages = 329–34 | pmid = 8213143 }} During the late 1990s, the first full computer-based virtual surgical planning was made for osteotomies, and then transferred to the operating theatre by a navigation system.{{cite journal | author = Marmulla R, Niederdellmann H | year = 1999 | title = Surgical Planning of Computer Assisted Repositioning Osteotomies | url = http://www.plasreconsurg.com/pt/re/prs/abstract.00006534-199909040-00007.htm;jsessionid=H8FQBGq1ly19ldpw1vTY1LyWGCnvsDrpFpHgTjZ4R9zbvQ5RQVbB!-383192544!181195628!8091!-1 | journal = Plast Reconstr Surg | volume = 104 | issue = 4| pages = 938–944 | doi=10.1097/00006534-199909020-00007| pmid = 10654731 | url-access = subscription }} Currently 3D Printed models are also used to plan a procedure and improve patient outcomes.{{Cite journal|last1=Thomas|first1=D. J.|last2=Azmi|first2=M. A. B. Mohd|last3=Tehrani|first3=Z.|date=2014-04-01|title=3D additive manufacture of oral and maxillofacial surgical models for preoperative planning|url=https://doi.org/10.1007/s00170-013-5587-4|journal=The International Journal of Advanced Manufacturing Technology|language=en|volume=71|issue=9|pages=1643–1651|doi=10.1007/s00170-013-5587-4|s2cid=109978006|issn=1433-3015|url-access=subscription}}
The first commercially available neurosurgical planning systems appeared in the 1990s (the StealthStation by Medtronic,{{cite journal | author = Smith K R, Frank K J, Bucholz R D | year = 1994 | title = The NeuroStation--a Highly Accurate, Minimally Invasive Solution to Frameless Stereotactic Neurosurgery | journal = Computerized Medical Imaging and Graphics | volume = 18 | issue = 4| pages = 247–56 | doi=10.1016/0895-6111(94)90049-3| pmid = 7923044 }} the VectorVision by BrainlabVilsmeier, Stefan, and Fotios Nisiropoulos. "Introduction of the Passive Marker Neuronavigation System VectorVision." In Computer-Assisted Neurosurgery, edited by Norihiko Tamaki M.D and Kazumasa Ehara M.D, 23–37. Springer Japan, 1997. {{doi|10.1007/978-4-431-65889-4_3}}.). As newer imaging modalities emerged providing increasing anatomical and functional detail for the patient in the 2000s, these surgical planning systems started to incorporate virtual reality technology to facilitate the visualisation and manipulation of the 3D data. One example of such systems is the Dextroscope, manufactured by Volume Interactions Pte Ltd. The Dextroscope is mostly used in the planning of complex neurosurgical procedures.Ferroli, Paolo, Giovanni Tringali, Francesco Acerbi, Domenico Aquino, Angelo Franzini, and Giovanni Broggi. "Brain Surgery in a Stereoscopic Virtual Reality Environment: A Single Institution’s Experience with 100 Cases." Neurosurgery 67, no. 3 Suppl Operative (September 2010): ons79–84; discussion ons84. {{doi|10.1227/01.NEU.0000383133.01993.96}}{{cite journal | author = Kockro R. A., Serra L., Tseng-Tsai Y., Chan C., Yih-Yian S., Gim-Guan C., Lee E., Hoe L. Y., Hern N., Nowinski W. L. | year = 2000 | title = Planning and Simulation of Neurosurgery in a Virtual Reality Environment | doi = 10.1093/neurosurgery/46.1.118 | journal = Neurosurgery | volume = 46 | issue = 1| pages = 118–135 | pmid = 10626943 | doi-access = free }}{{cite journal | author = Matis Georgios K, Danilo O de, Silva A, Chrysou Olga I, Karanikas Michail, Pelidou Sygkliti-Henrietta, Birbilis Theodossios A, Bernardo Antonio, Stieg Philip | year = 2013 | title = Virtual Reality Implementation in Neurosurgical Practice: The 'Can't Take My Eyes off You' Effect | journal = Turkish Neurosurgery | volume = 23 | issue = 5| pages = 690–91 | pmid = 24101322 }}{{cite journal | author = Robison R. A., Liu C. Y., Apuzzo M. L. J. | year = 2011 | title = Man, Mind, and Machine: The Past and Future of Virtual Reality Simulation in Neurologic Surgery | journal = World Neurosurgery | volume = 76 | issue = 5| pages = 419–30 | doi=10.1016/j.wneu.2011.07.008 | pmid=22152571}}