{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T01:29:38Z","timestamp":1773797378957,"version":"3.50.1"},"reference-count":29,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T00:00:00Z","timestamp":1700611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Primary malignancies of the sacrum and pelvis are aggressive in nature, and achieving negative margins is essential for preventing recurrence and improving survival after en bloc resections. However, these are particularly challenging interventions due to the complex anatomy and proximity to vital structures. Using virtual cutting guides to perform navigated osteotomies may be a reliable method for safely obtaining negative margins in complex tumor resections of the sacrum and pelvis. This study details the technique and presents short-term outcomes. Patients who underwent an en bloc tumor resection of the sacrum and\/or pelvis using virtual cutting guides with a minimum follow-up of two years were retrospectively analyzed and included in this study. Preoperative computer-assisted design (CAD) was used to design osteotomies in each case. Segmentation, delineating the tumor from normal tissue, was performed by the senior author using preoperative CT scans and MRI. Working with a team of biomedical engineers, virtual surgical planning was performed to create osteotomy lines on the preoperative CT and overlaid onto the intraoperative CT. The pre-planned osteotomy lines were visualized as \u201cvirtual cutting guides\u201d providing real-time stereotactic navigation. A precision ultrasound-powered cutting tool was then integrated into the navigation system and used to perform the osteotomies in each case. Six patients (mean age 52.2 \u00b1 17.7 years, 2 males, 4 females) were included in this study. Negative margins were achieved in all patients with no intraoperative complications. Mean follow-up was 38.0 \u00b1 6.5 months (range, 24.8\u201342.2). Mean operative time was 1229 min (range, 522\u20132063). Mean length of stay (LOS) was 18.7 \u00b1 14.5 days. There were no cases of 30-day readmissions, 30-day reoperations, or 2-year mortality. One patient was complicated by flap necrosis, which was successfully treated with irrigation and debridement and primary closure. One patient had local tumor recurrence at final follow-up and two patients are currently undergoing treatment for metastatic disease. Using virtual cutting guides to perform navigated osteotomies is a safe technique that can facilitate complex tumor resections of the sacrum and pelvis.<\/jats:p>","DOI":"10.3390\/bioengineering10121342","type":"journal-article","created":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T03:54:37Z","timestamp":1700625277000},"page":"1342","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Advances in Virtual Cutting Guide and Stereotactic Navigation for Complex Tumor Resections of the Sacrum and Pelvis: Case Series with Short-Term Follow-Up"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6476-6548","authenticated-orcid":false,"given":"Takashi","family":"Hirase","sequence":"first","affiliation":[{"name":"Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grant R.","family":"McChesney","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"II","given":"Lawrence","family":"Garvin","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9857-8665","authenticated-orcid":false,"given":"Karthik","family":"Tappa","sequence":"additional","affiliation":[{"name":"Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3356-4331","authenticated-orcid":false,"given":"Robert L.","family":"Satcher","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander F.","family":"Mericli","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurence D.","family":"Rhines","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin E.","family":"Bird","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s00586-013-3075-z","article-title":"Surgical techniques for spinopelvic reconstruction following total sacrectomy: A systematic review","volume":"23","author":"Bederman","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"111","DOI":"10.3171\/spi.2005.3.2.0111","article-title":"En bloc resection of primary sacral tumors: Classification of surgical approaches and outcome","volume":"3","author":"Fourney","year":"2005","journal-title":"J. Neurosurg. Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1007\/s11999-008-0495-x","article-title":"Osteosarcoma of the pelvis: Outcome analysis of surgical treatment","volume":"467","author":"Fuchs","year":"2009","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1200\/JCO.2003.01.142","article-title":"Osteosarcoma of the pelvis: Experience of the Cooperative Osteosarcoma Study Group","volume":"21","author":"Ozaki","year":"2003","journal-title":"J. Clin. Oncol."},{"key":"ref_5","first-page":"61","article-title":"Spinal-pelvic fixation in patients with lumbosacral neoplasms","volume":"92","author":"Jackson","year":"2000","journal-title":"J. Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1097\/00007632-199011010-00024","article-title":"Total sacrectomy and reconstruction for huge sacral tumors","volume":"15","author":"Tomita","year":"1990","journal-title":"Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"E15","DOI":"10.3171\/2016.6.FOCUS16125","article-title":"Image-guided resection of aggressive sacral tumors","volume":"42","author":"Drazin","year":"2017","journal-title":"Neurosurg. Focus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1007\/s11999.0000000000000064","article-title":"Can Navigation-assisted Surgery Help Achieve Negative Margins in Resection of Pelvic and Sacral Tumors?","volume":"476","author":"Abraham","year":"2018","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s11999-011-2094-5","article-title":"Navigation-assisted surgery for bone and soft tissue tumors with bony extension","volume":"470","author":"Ieguchi","year":"2012","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1302\/0301-620X.94B10.28638","article-title":"The outcomes of navigation-assisted bone tumour surgery: Minimum three-year follow-up","volume":"94","author":"Cho","year":"2012","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1302\/0301-620X.95B10.31734","article-title":"Can computer navigation-assisted surgery reduce the risk of an intralesional margin and reduce the rate of local recurrence in patients with a tumour of the pelvis or sacrum?","volume":"95","author":"Jeys","year":"2013","journal-title":"Bone Jt. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1007\/s11999-012-2557-3","article-title":"Computer-assisted tumor surgery in malignant bone tumors","volume":"471","author":"Wong","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1097\/PRS.0b013e3182a3c0b1","article-title":"Computer-assisted versus conventional free fibula flap technique for craniofacial reconstruction: An outcome comparison","volume":"132","author":"Seruya","year":"2013","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1097\/01.prs.0000200770.83864.bc","article-title":"Individual CAD\/CAM fabricated glass-bioceramic implants in reconstructive surgery of the bony orbital floor","volume":"117","author":"Klein","year":"2006","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1055\/s-0037-1607394","article-title":"Staged Reconstruction (Delayed-Immediate) of the Maxillectomy Defect Using CAD\/CAM Technology","volume":"34","author":"Pang","year":"2018","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1097\/JU.0000000000002719","article-title":"Effect of 3-Dimensional, Virtual Reality Models for Surgical Planning of Robotic Prostatectomy on Trifecta Outcomes: A Randomized Clinical Trial","volume":"208","author":"Shirk","year":"2022","journal-title":"J. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"790.e1","DOI":"10.1016\/j.joms.2018.08.024","article-title":"Use of Virtual Surgical Planning and Virtual Dataset With Intraoperative Navigation to Guide Revision of Complex Facial Fractures: A Case Report","volume":"77","author":"Nguyen","year":"2019","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"48","DOI":"10.21037\/acr.2018.11.02","article-title":"Use of image-guided bone scalpel for resection of spine tumors: Technical note","volume":"2","author":"Towner","year":"2018","journal-title":"AME Case Rep."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"von Elm, E., Altman, D.G., Egger, M., Pocock, S.J., G\u00f8tzsche, P.C., and Vandenbroucke, J.P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Med., 4.","DOI":"10.1371\/journal.pmed.0040296"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.ijsu.2016.11.016","article-title":"Effects of resection margins on local recurrence of osteosarcoma in extremity and pelvis: Systematic review and meta-analysis","volume":"36 Pt A","author":"He","year":"2016","journal-title":"Int. J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1227\/01.NEU.0000371987.85090.FF","article-title":"En bloc resection for primary and metastatic tumors of the spine: A systematic review of the literature","volume":"67","author":"Cloyd","year":"2010","journal-title":"Neurosurgery"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.1097\/BRS.0b013e3181b8b796","article-title":"Feasibility and safety of en bloc resection for primary spine tumors: A systematic review by the Spine Oncology Study Group","volume":"34","author":"Yamazaki","year":"2009","journal-title":"Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.2106\/JBJS.16.01458","article-title":"Outcomes and Complications of Reconstruction with Use of Free Vascularized Fibular Graft for Spinal and Pelvic Defects Following Resection of a Malignant Tumor","volume":"99","author":"Houdek","year":"2017","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2036","DOI":"10.2106\/JBJS.19.00380","article-title":"Factors Influencing Osseous Union Following Surgical Treatment of Bone Tumors with Use of the Capanna Technique","volume":"101","author":"Li","year":"2019","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s00402-015-2197-7","article-title":"Pelvic ring reconstruction with a double-barreled free vascularized fibula graft after resection of malignant pelvic bone tumor","volume":"135","author":"Ogura","year":"2015","journal-title":"Arch. Orthop. Trauma. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5371\/hp.2020.32.1.1","article-title":"Three-dimensional-printing Technology in Hip and Pelvic Surgery: Current Landscape","volume":"32","author":"Woo","year":"2020","journal-title":"Hip Pelvis"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1007\/s00113-019-0626-8","article-title":"Surgical applications of three-dimensional printing in the pelvis and acetabulum: From models and tools to implants","volume":"122","author":"Fang","year":"2019","journal-title":"Unfallchirurg"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1007\/s11999-012-2536-8","article-title":"Joint-preserving tumor resection and reconstruction using image-guided computer navigation","volume":"471","author":"Wong","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2985","DOI":"10.1007\/s11999-010-1465-7","article-title":"Computer-assisted navigation in bone tumor surgery: Seamless workflow model and evolution of technique","volume":"468","author":"So","year":"2010","journal-title":"Clin. Orthop. Relat. 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