Computer Assisted Orthopaedic Surgery (CAOS) Navigation in ...Nurse teleconference on live...
Transcript of Computer Assisted Orthopaedic Surgery (CAOS) Navigation in ...Nurse teleconference on live...
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Computer Assisted Orthopaedic Surgery (CAOS)
Navigation in Hip Fracture
Source: http://www.stryker.com/navigation/us/trauma/apps.htm
Chau Pui Man, Jasmine, Registered Nurse, Department of Anaesthesia & Intensive Care (Operating Theatre), Prince of Wales Hospital, Hong Kong
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The Development of CAOS
1st performed by Prof. K. S. Leung in 2001 SeptTotally more than 300 operationsLeading positionRoutine orthopaedic practice, especially in fracture fixation Different from CAOS in total joint arthroplastyIncreasing demands on perioperative nurse
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Applications of CAOS in fracture fixation surgery
Fixation of femoral neck fractures with percutaneous cannulated screwIntramedullary locked nails for long bone fracturesIntramedullary fixation of trochanteric fractures e.g. Gamma nailsPercutaneous fixation of sacro-iliac fracture dislocations (SI joint screw)Percutaneous fixation of iliac wing fracturesPercutaneous fixation of acetabulum fractures
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Types of Navigation for surgical planning
Image-guided navigation1. CT, MRI based
Intra-op registration of anatomical landmark that correspond to pre-op CT scan
2. FluoroscopyMake use of C-arm fluroscope to create images in operating room
Image-free navigationIntra-operative determination of anatomical structures and reference landmarks to establish a virtual representation of the surgical object
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How to localizing target within the operating room?
Principle of tracking systemInfra-redElectromagnetic wave Ultrasound andLaser
Most commonly used technique is infrared optical tracking system
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Robotic arm (Surgical navigation arm)
The strength of robots includes:
1. Precision2. Stability 3. repeatability
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Phantom and C-arm tracker
Phantom
LEDs
Phantom attached on the C-arm tracker to correct image distortion. The C-arm tracker is located with the LEDs.
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Technique of Fluoro-NavigationFour basic steps
1. (Referencing): The patient tracker is anchored to the part of the bone that is going to be operated
2. (Tracking): The surgical instruments are fitted with tracking sensor
3. (Image acquisition and transfer): Images are taken using the C-arm and loaded into the navigation computer
4. (Navigation): The surgical instrument is displayed as a virtual instrument in the medical images in real time
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Workflow of computer Infrared optical tracking navigation system (image-guided)
Patient tracker anchored on anterior iliac crest
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Skin incision planning
The camera receive the signal then the computer recognize the signal
The result is shownon the computer screen
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Operation Room Layout (Hip fracture)
Fluoro machine
Sensor/camera
Monitor/screen Computer System
Patient Tracker
Fluoromonitor
The operating room should be of adequate size to accommodate the fluoro unit, fluoro monitor and the computer system
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Advanced Practice Nursing RoleOrthopaedic team nurses- Have expert clinical skills and knowledge- Have thorough understanding of how equipment
function, distinguishing between a device failure and user error
- Quick response in the complexity of new devices, their application and integration with traditional instrument
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Advanced Practice Nursing Role
Circulating Nurse2 circulating nurses – one for operating the computer, one for providing patient care
Scrub Nursewell familiar with the navigation instrument
Formation of a surgical team dedicated to CAOS
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Enhancement
Departmental training and educationProtocols and procedure guidelines Organize one day course Nurse teleconference on live demonstration Active participate in live surgery Design in the theatre layout Virtual lab study in Orthopaedic Learning Center