This work was supported by the Youth Cultivation Project of Xi&#39;an Health Commission (Program No. 2023qn17) and the Key Research and Development Program of Shaanxi Province (Program No. 2023-YBSF-099).

The present study was approved by the ethics committee of Honghui Hospital Xi&#39;an Jiaotong University. Informed consent was obtained from the patients.
1. Diagnosis of femoral neck fracture by X-ray fluoroscopy
<ol>
	<li>Identify patients who have a femoral neck fracture with tenderness or percussed pain around the hip joint, shortening of the lower extremity, limitation of the hip joint, etc.</li>
	<li>Use an antero-posterior (AP) view and a lateral view of an X-ray fluoroscopy or CT scan to diagnose the femoral neck fracture.</li>
	<li>Order FNS treatment for patients who are less than 60 years old and diagnosed with femoral neck fracture. Use these additional criteria for inclusion: fracture with a clear history of trauma; no history or evidence of metabolic diseases or pathological fractures; well-developed hip joint, with no manifestations of FHN and no deformity; a diagnosis of femoral neck fracture by an X-ray or CT scan.</li>
</ol>
2. Fracture close reduction, X-ray examination, and preparation of the robot-assisted orthopedic surgery system
<ol>
	<li>After general anesthesia, conduct closed reduction of fracture by manual traction and adjustment.
	<ol>
		<li>Restore the length of the affected limb by longitudinal traction with the surgeon holding the limb for traction, and restore the alignment of the fracture gap through limb rotation.</li>
		<li>Fix the limb to the traction bed (a kind of operation table that provides continuous limb traction) for continuous traction during the operation.</li>
	</ol>
	</li>
	<li>Examine the quality of the closed reduction by X-ray fluoroscopy. Restore the neck-shaft angle and alignment of the cortex in the AP and lateral views, and ensure that no angular deformities occur.</li>
	<li>Before the operation, connect the components of the robot-assisted orthopedic surgery system-the workstation, the optical tracking system, and the robotic arm-with the C-arm X-ray machine. Log into the system, and record the patient&#39;s medical records.</li>
</ol>
3. Disinfection, image collection, and surgical path planning
<ol>
	<li>After routine surgical disinfection, place a Schanz pin on the ipsilateral iliac wing, and fix the patient&#39;s tracer on the pin.</li>
	<li>Put sterile protective sleeves on the robotic arm and C-arm. Assemble the positioning ruler (with the 10 identification points on the positioning ruler for the robot positioning system) with the robotic arm.</li>
	<li>Position the C-arm X-ray machine centrally to the femoral neck, and put the robotic arm with the positioning ruler between the C-arm and the patient. Ensure that there is no obstruction of the optical tracking system, including the patient tracer and the robotic arm.</li>
	<li>Collect AP view (the X-ray image intensifier is perpendicular to the plane of the patient) and lateral view (the X-ray image intensifier is perpendicular to the femoral neck channel plane) X-ray images containing the 10 identification points of the positioning ruler.</li>
	<li>Import the AP and lateral view images into the workstation; the images must clearly contain 10 identification points and the entire proximal femur.</li>
	<li>Perform surgical screw path planning on the software of the workstation.
	<ol>
		<li>Locate the screw channel in the center of the femoral neck, with a neck-shaft angle of 130&#176; and parallel to the long axis of the femoral neck on the AP and lateral views.</li>
		<li>Locate the tip of the screw 5 mm under the cartilage of the femoral head.</li>
	</ol>
	</li>
</ol>
4. FNS placement and verification
<ol>
	<li>Replace the positioning ruler to the sleeve on the robotic arm. Run the robotic arm to the position of the entry point according to the planned path. Make a 3 cm incision on the skin along the long axis of the femur with a knife, blunt separate the subcutaneous tissue, and insert the sleeve to contact the bone cortex.</li>
	<li>Confirm the entry point and direction of the sleeve in accordance with the planned path. Fine-tune the path if necessary.</li>
	<li>Drill the guide wire into the bone through the sleeve until it is 5 mm from the subchondral bone. Remove the robotic arm, and check the position of the guide wire by X-ray.</li>
	<li>Ream the hole along the guide wire using a hollow drill bit, and insert the bolt and plate into the femoral head. Place the anti-rotation screw and locking screw.</li>
	<li>Apply dynamic compression using the compression design of the FNS. The fluoroscopy verifies the FNS placement, with the bolt in the center of the femoral neck both on the AP and lateral views and 5 mm from the subchondral bone, and with the plate fitting the bone.</li>
	<li>Suggest assisted passive hip flexion activities and active exercise of the knee and ankle joints post-operation. Perform follow-ups at 4 weeks, 8 weeks, 12 weeks, 24 weeks, 36 weeks, and 48 weeks postoperatively, with the weight-bearing time depending on the follow-up.</li>
</ol>

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	<li>Thorngren, K. G., Hommel, A., Norrman, P. O., Thorngren, J., Wingstrand, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epidemiology+of+femoral+neck+fractures.">Epidemiology of femoral neck fractures.</a> Injury. 33, 1-7 (2002).</li><li>Lowe, J. A., Crist, B. D., Bhandari, M., Ferguson, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optimal+treatment+of+femoral+neck+fractures+according+to+patient's+physiologic+age:+An+evidence-based+review.">Optimal treatment of femoral neck fractures according to patient's physiologic age: An evidence-based review.</a> The Orthopedic Clinics of North America. 41 (2), 157-166 (2010).</li><li>Stoffel, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Biomechanical+evaluation+of+the+femoral+neck+system+in+unstable+Pauwels+III+femoral+neck+fractures:+A+comparison+with+the+dynamic+hip+screw+and+cannulated+screws.">Biomechanical evaluation of the femoral neck system in unstable Pauwels III femoral neck fractures: A comparison with the dynamic hip screw and cannulated screws.</a> Journal of Orthopaedic Trauma. 31 (3), 131-137 (2016).</li><li>Mei, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Finite+element+analysis+of+the+effect+of+cannulated+screw+placement+and+drilling+frequency+on+femoral+neck+fracture+fixation.">Finite element analysis of the effect of cannulated screw placement and drilling frequency on femoral neck fracture fixation.</a> Injury. 45 (12), 2045-2050 (2014).</li><li>Zheng, Y., Yang, J., Zhang, F., Lu, J., Qian, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robot-assisted+vs+freehand+cannulated+screw+placement+in+femoral+neck+fractures+surgery:+A+systematic+review+and+meta-analysis.">Robot-assisted vs freehand cannulated screw placement in femoral neck fractures surgery: A systematic review and meta-analysis.</a> Medicine. 100 (20), 25926 (2021).</li><li>Karthik, K., Colegate-Stone, T., Dasgupta, P., Tavakkolizadeh, A., Sinha, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+surgery+in+trauma+and+orthopaedics:+A+systematic+review.">Robotic surgery in trauma and orthopaedics: A systematic review.</a> The Bone and Joint Journal. 97-B (3), 292-299 (2015).</li><li>Garden, R. 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The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

FNS is a method for fixing femoral neck fractures, which has the advantages of angular stability of the sliding hip screws and minimal invasiveness of the placement of the multiple cannulated screws. This method is less prone to screw cutting and irritation of the surrounding soft tissues. In Tang et al.&#39;s study9, compared with the CCS group, patients in the FNS group had lower rates of no or mild femoral neck shortness, shorter healing times, and higher Harris scores. Biomechanical studies ha...

Femoral neck fracture is one of the most common fractures in the clinic and accounts for about 3.6% of human fractures and 54.0% of hip fractures1. For young patients with femoral neck fractures, surgical treatment is performed to reduce the risk of nonunion and femoral head necrosis (FHN) by anatomical reduction and rigid internal fixation and to restore their function to the preoperative level as much as possible2. The most commonly used surgical treatment is fixation by three cannulated compression screws (CCS). With the increase in patient requirements, especially in young patients, the femoral neck system (FNS) is gradually being used, which combines the advantages of angular stability, minimal invasiveness, and better biomechanical stability than CCS for unstable femoral neck fractures3.
Traditionally, the screws were placed freehand by surgeons under fluoroscopic intraoperative guidance. The freehand method has many shortcomings, such as inability to plan the path intraoperatively, difficulty in controlling the direction of the guide wire during drilling, damage to the bone and blood supply due to repeated drilling, and penetration of the screw through the cortex due to improper positioning. These factors can directly or indirectly cause postoperative complications, such as fracture nonunion, FHN, and internal fixation failure, which influence the functional prognosis4. The freehand method has also been associated with increased radiation injury to patients and surgeons from frequent fluoroscopies5. Therefore, determining the optimal screw entry point and precise screw placement during pre-operative planning are key to the success of the operation. In recent years, robot-assisted minimally invasive internal fixation has been used with increasing frequency in orthopedic surgery6, and it is widely accepted by orthopedic surgeons because of its high precision and its ability to reduce the operation time and radiation injury. We applied the robot-assisted orthopedic surgery system to assist in FNS fixation for the treatment of femoral neck fractures, which resulted in a more accurate and efficient screw placement process, a higher success rate of the screw placement, and better functional recovery.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>C-arm X-ray</td>
			<td>Siemens&#160;</td>
			<td>CFDA Certified No:20163542280</td>
			<td>Type: ARCADIS Orbic 3D</td>
		</tr>
		<tr>
			<td>Femoral neck system</td>
			<td>DePuy, Synthes, Zuchwil, Switzerland</td>
			<td>CFDA Certified No: 20193130357</td>
			<td>Blot:length (75mm-130mm,5mm interval), 
			diameter (10mm); 
			Anti-rotation screw:length (75mm-130mm,5mm interval,match the lenth of the blot), 
			diameter (6.5mm); 
			Locking screw:length(25mm-60mm,5mm interval),diameter(5mm)</td>
		</tr>
		<tr>
			<td>Robot-assisted orthopedic surgery system</td>
			<td>Tianzhihang, Beijing,China</td>
			<td>CFDA Certified No:20163542280</td>
			<td>3rd generation</td>
		</tr>
		<tr>
			<td>Traction Bed</td>
			<td>Nanjing Mindray biomedical electronics Co.ltd.</td>
			<td>Jiangsu Food and Drug Administration Certified No:20162150342</td>
			<td>Type:HyBase 6100s</td>
		</tr>
	</tbody>
</table>

orthopedic robot-assisted femoral neck system in the treatment of femoral neck fracture

Cannulated screw fixation is the main therapy for femoral neck fractures, especially in young patients. The traditional surgical procedure uses C-arm fluoroscopy to place the screw freehand and requires several guide wire adjustments, which increases the operation time and radiation exposure. Repeated drilling can also cause damage to the blood supply and bone quality of the femoral neck, which can be followed by complications such as screw loosening, nonunion, and femoral head necrosis. In order to make fixation more precise and reduce the incidence of complications, our team applied robot-assisted orthopedic surgery for screw placement using the femoral neck system to modify the traditional procedure. This protocol introduces how to import a patient's X-ray information into the system, how to perform screw path planning in software, and how the robotic arm assists in screw placement. Using this method, the surgeons can place the screw successfully the first time, improve the accuracy of the procedure, and avoid radiation exposure. The whole protocol includes the diagnosis of femoral neck fracture; the collection of intraoperative X-ray images; screw path planning in the software; precise placement of the screw under the assistance of the robotic arm by the surgeon; and verification of the implant placement.

The robot-assisted orthopedic surgery system simulates the screw path virtually and assists in the precise placement of the screw, meaning this system has the advantages of being highly stable, having improved surgical precision and success rate, and having a lower risk of surgical trauma and radiation injury. Finally, the accuracy of the screw fixation results in a better clinical prognosis and a lower incidence of complications.
Patients diagnosed with a femoral neck fracture received surger...

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Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture

This article introduces a method of robot-assisted orthopedic surgery for screw placement during the treatment of femoral neck fracture using the femoral neck system, which allows for more accurate screw placement, improved surgical efficiency, and fewer complications.

Cannulated screw fixation is the main therapy for femoral neck fractures, especially in young patients. The traditional surgical procedure uses C-arm ...

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2.3K Views.  Xi'an Jiaotong University. This article introduces a method of robot-assisted orthopedic surgery for screw placement during the treatment of femoral neck fracture using the femoral neck system, which allows for more accurate screw placement, improved surgical efficiency, and fewer complications.

Video: Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture

Femoral Bone Marrow Aspiration in Live Mice

Serial sampling of the cellular composition of bone marrow (BM) is a routine procedure critical to clinical hematology. This protocol describes a detailed step-by-step technical procedure for an analogous procedure in live mice which allows for serial characterization of cells present in the BM. This procedure facilitates studies aimed to detect the presence of exogenously administered cells within the BM of mice as would be done in xenograft studies for instance. Moreover, this procedure allows for the retrieval and characterization of cells enriched in the BM such as hematopoietic stem and progenitor cells (HSPCs) without sacrifice of mice. Given that the cellular composition of peripheral blood is not necessarily reflective of proportions and types of stem and progenitor cells present in the marrow, procedures which provide access to this compartment without requiring termination of the mice are very helpful. The use of femoral bone marrow aspiration is illustrated here for cytological analysis of marrow cells, flow cytometric characterization of the hematopoietic stem/progenitor compartment, and culture of sorted HSPCs obtained by femoral BM aspiration compared with conventional marrow harvest.

This protocol describes a procedure for serial sampling of femoral bone marrow (BM) without requiring the sacrifice of mice. This procedure facilitates longitudinal studies of the BM composition of mice over time and provides serial access to cells within the BM for ex vivo and transplantation studies.

Serial sampling of the cellular composition of bone marrow (BM) is a routine procedure critical to clinical hematology. This protocol describes a detailed ...

A Simple Critical-sized Femoral Defect Model in Mice

While bone has a remarkable capacity for regeneration, serious bone trauma often results in damage that does not properly heal. In fact, one tenth of all limb bone fractures fail to heal completely due to the extent of the trauma, disease, or age of the patient. Our ability to improve bone regenerative strategies is critically dependent on the ability to mimic serious bone trauma in test animals, but the generation and stabilization of large bone lesions is technically challenging. In most cases, serious long bone trauma is mimicked experimentally by establishing a defect that will not naturally heal. This is achieved by complete removal of a bone segment that is larger than 1.5 times the diameter of the bone cross-section. The bone is then stabilized with a metal implant to maintain proper orientation of the fracture edges and allow for mobility. 
Due to their small size and the fragility of their long bones, establishment of such lesions in mice are beyond the capabilities of most research groups. As such, long bone defect models are confined to rats and larger animals. Nevertheless, mice afford significant research advantages in that they can be genetically modified and bred as immune-compromised strains that do not reject human cells and tissue.
Herein, we demonstrate a technique that facilitates the generation of a segmental defect in mouse femora using standard laboratory and veterinary equipment. With practice, fabrication of the fixation device and surgical implantation is feasible for the majority of trained veterinarians and animal research personnel. Using example data, we also provide methodologies for the quantitative analysis of bone healing for the model.

Animal models are frequently employed to mimic serious bone injury in biomedical research. Due to their small size, establishment of stabilized bone lesions in mice are beyond the capabilities of most research groups. Herein, we describe a simple method for establishing and analyzing experimental femoral defects in mice.

While bone has a remarkable capacity for regeneration, serious bone trauma often results in damage that does not properly heal. In fact, one tenth of all ...

Surgical Labyrinthectomy of the Rat to Study the Vestibular System

To study the vestibular system or the vestibular compensation process, a number of methods have been developed to cause vestibular damage, including surgical or chemical labyrinthectomy and vestibular neurectomy. Surgical labyrinthectomy is a relatively simple, reliable, and rapid method. Here, we describe the surgical technique for rat labyrinthectomy. A postauricular incision is made under general anesthesia to expose the external auditory canal and the tympanic membrane, after which the tympanic membrane and the ossicles are removed without the stapes. The stapes artery, which is located between the stapes and the oval window, is a vulnerable structure and must be preserved to obtain a clear surgical field. A hole to fenestrate the vestibule is made with a 2.1-mm drill bur superior to the stapes. Then, 100% ethanol is injected through this hole and aspirated several times. Meticulous dissection under a microscope and careful bleeding control are essential to obtain reliable results. Symptoms of vestibular loss, such as nystagmus, head tilting, and a rolling motion, are seen immediately after surgery. The rotarod or rotation chair test can be used to objectively and quantitatively evaluate the vestibular function.

This protocol describes the surgical labyrinthectomy of a rat, which is a useful method for studying the vestibular system.

To study the vestibular system or the vestibular compensation process, a number of methods have been developed to cause vestibular damage, including ...

The Chick Chorioallantoic Membrane In Vivo Model to Assess Perineural Invasion in Head and Neck Cancer

Perineural invasion is a phenotype in which cancer surrounds or invades the nerves. It is associated with poor clinical outcome for head and neck squamous cell carcinoma and other cancers. Mechanistic studies have shown that the molecular crosstalk between nerves and tumor cells occurs prior to physical interaction. There are only a few in vivo models to study perineural invasion, especially to investigate early progression, before physical nerve-tumor interactions occur. The chick chorioallantoic membrane model has been used to study cancer invasion, because the basement membrane of the chorionic epithelium mimics that of human epithelial tissue. Here we repurposed the chick chorioallantoic membrane model to investigate perineural invasion, grafting rat dorsal root ganglia and human head and neck squamous cell carcinoma cells onto the chorionic epithelium. We have demonstrated how this model can be useful to evaluate the ability of cancer cells to invade neural tissue in vivo.&#160;

The Chick Chorioallantoic Membrane In Vivo Model to Assess Perineural Invasion in Head and Neck Cancer

Perineural invasion is an aggressive phenotype for head and neck squamous cell carcinomas and other tumors. The chick chorioallantoic membrane model has been used for studying angiogenesis, cancer invasion, and metastasis. Here we demonstrate how this model can be utilized to assess perineural invasion in vivo.

Perineural invasion is a phenotype in which cancer surrounds or invades the nerves. It is associated with poor clinical outcome for head and neck squamous ...

Robot-Assisted Kidney Transplantation

This paper describes robot-assisted kidney transplantation (RAKT) from a living donor. The robot is docked between the parted legs of the patient, placed in the supine Trendelenburg position. Kidney allografts are provided by a living donor. Before vascular anastomosis, the kidney allograft is prepared by inserting a double-J stent in the ureter, and the temperature for the anastomosis is lowered by wrapping it in an ice-packed gauze. A 12 mm or 8 mm port for the robotic camera and three 8 mm ports for robotic arms are placed. A peritoneal pouch is created for the kidney allograft by raising the peritoneal flaps on both sides over the psoas muscle before dissecting the iliac vessels and bladder. A 6 cm Pfannenstiel incision is made to insert the kidney into the peritoneal pouch, lateral to the right iliac vessels. 
After clamping the external iliac vein with Bulldogs clamps, a venotomy is performed, and the graft renal vein is anastomosed to the external iliac vein in an end-to-side continuous manner with a 6/0 polytetrafluoroethylene suture. After clamping the graft renal vein, the iliac vein is declamped. This is followed by clamping of the external iliac artery, arteriotomy, arterial anastomosis with a 6/0 polytetrafluoroethylene suture, clamping of the graft renal artery, and declamping of the external iliac artery. Reperfusion is then carried out, and ureteroneocystostomy is performed using the Lich-Gregoir technique. The peritoneum is closed at a few locations with polymer locking clips, and a closed-suction drain is placed through one of the working ports. After deflating the pneumoperitoneum, all incisions are closed.

This paper provides technical details for robot-assisted kidney transplantation from a living donor.

This paper describes robot-assisted kidney transplantation (RAKT) from a living donor. The robot is docked between the parted legs of the patient, placed ...

Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head

Osteonecrosis of the femoral head (ONFH) is a common joint disease in young and middle-aged patients, which seriously burdens their lives and work. For early-stage ONFH, core decompression surgery is a classical and effective hip preservation therapy. In traditional procedures of core decompression with Kirschner wire, there are still many problems such as X-ray exposure, repeated puncture verification, and damage to normal bone tissue. The blindness of the puncture process and the inability to provide real-time visualization are crucial reasons for these problems.
To optimize this procedure, our team developed an intraoperative navigation system on the basis of augmented reality (AR) technology. This surgical system can intuitively display the anatomy of the surgical areas and render preoperative images and virtual needles to intraoperative video in real-time. With the guide of the navigation system, surgeons can accurately insert Kirschner wires into the targeted lesion area and minimize the collateral damage. We conducted 10 cases of core decompression surgery with this system. The efficiency of positioning and fluoroscopy is greatly improved compared to the traditional procedures, and the accuracy of puncture is also guaranteed.

Augmented reality technology was applied to core decompression for osteonecrosis of the femoral head to realize real-time visualization of this surgical procedure. This method can effectively improve the safety and precision of core decompression.

Osteonecrosis of the femoral head (ONFH) is a common joint disease in young and middle-aged patients, which seriously burdens their lives and work. For ...

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer

Laparoscopic radical resection of the pancreatic neck is one of the most complicated radical operations for pancreatic cancer, especially for patients who have had neoadjuvant chemotherapy. Here, we present a technique to perform laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) using the dorsal-caudal artery approach by making full use of the high-definition vision and operation modes of the laparoscope.
The innovation and optimization of this operation are provided in the protocol. Priority should be given to the dorsal resection plane, including the dorsal side of the superior mesenteric artery (SMA), the dorsal side of the pancreatic head, the root of the celiac artery (CeA), the ventral side of the left renal vessels, and the renal hilum. On the condition that the operation for pancreatic neck-body cancer is feasible and safe, the second step is to perform tumor resection en bloc surrounding the SMA and CeA from the caudal to the cephalic side to increase the rate of R0 (radical zero) resection and further prognosis.

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer

With advancements in laparoscopic techniques, laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) has been widely recognized. However, owing to several technical difficulties in this procedure, the artery-first approach in L-RAMPS still remains uncommon. Here, we developed the dorsal-caudal artery approach for L-RAMPS, which might be safe and beneficial for pancreatic neck tumors.

Laparoscopic radical resection of the pancreatic neck is one of the most complicated radical operations for pancreatic cancer, especially for patients who ...

Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy

Anterior knee pain (AKP) is a common pathology among adolescents and adults. Increased femoral anteversion (FAV) has many clinical manifestations, including AKP. There is growing evidence that increased FAV plays a major role in the genesis of AKP. Furthermore, this same evidence suggests that derotational femoral osteotomy is beneficial for these patients, as good clinical results have been reported. However, this type of surgery is not widely used among orthopedic surgeons.
The first step in attracting orthopedic surgeons to the field of rotational osteotomy is to give them a methodology that simplifies preoperative surgical planning and allows for the previsualization of the results of surgical interventions on computers. To that end, our working group uses 3D technology. The imaging dataset used for surgical planning is based on a CT scan of the patient. This 3D method is open access (OA), meaning it is accessible to any orthopedic surgeon at no economic cost. Furthermore, it not only allows for the quantification of femoral torsion but also for carrying out virtual surgical planning. Interestingly, this 3D technology shows that the magnitude of the intertrochanteric rotational femoral osteotomy does not present a 1:1 relationship with the correction of the deformity. Additionally, this technology allows for the adjustment of the osteotomy so that the relationship between the magnitude of the osteotomy and the correction of the deformity is 1:1. This paper outlines this 3D protocol.

This work presents a detailed surgical planning protocol using 3D technology with free open-source software. This protocol can be used to correctly quantify femoral anteversion and simulate derotational proximal femoral osteotomy for the treatment of anterior knee pain.

Anterior knee pain (AKP) is a common pathology among adolescents and adults. Increased femoral anteversion (FAV) has many clinical manifestations, ...

Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer

The diagnosis and treatment of locally advanced thyroid carcinoma are challenging. The challenge lies in the evaluation of the tumor scope and the formulation of an individualized treatment plan. Three-dimensional (3D) visualization has a wide range of applications in the field of medicine, although there are limited applications in thyroid cancer. We previously applied 3D visualization for the diagnosis and treatment of thyroid cancer. Through data collection, 3D modeling, and preoperative evaluation, we can obtain 3D information regarding the tumor outline, determine the extent of tumor invasion, and conduct adequate preoperative preparation and surgical risk assessment. This study aimed to demonstrate the feasibility of 3D visualization in locally advanced thyroid cancer. Computer-aided 3D visualization can be an effective method for accurate preoperative evaluation, the development of surgical methods, shortening the surgical time, and reducing the surgical risks. Furthermore, it can contribute to medical education and doctor-patient communication. We believe that the application of 3D visualization technology can improve outcomes and quality of life in patients with locally advanced thyroid cancer.

In diagnosing and treating locally advanced thyroid cancer, the application of computer-aided three-dimensional reconstruction can provide additional information regarding the tumor scope and anatomic characteristics, thereby assisting in risk assessment and surgical planning.

The diagnosis and treatment of locally advanced thyroid carcinoma are challenging. The challenge lies in the evaluation of the tumor scope and the ...

Robot-Assisted Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma

Congenital cholesteatoma accounts for 25% of cholesteatoma cases in children. Transcanal Endoscopic Ear Surgery (TEES) is ideal for these patients because it offers a wide endoscopic view of the middle ear and a minimally invasive approach. The two main limitations are the loss of one operative hand and a narrow external auditory canal in younger children. Here, we present the case of a 3-year-old patient with a Potsic stage III congenital cholesteatoma adherent to the incus and branches of the stapes. A robotic-assisted TEES procedure was performed, during which a robotic arm with 6 degrees of freedom held a 0&#176;, 2.9 mm wide endoscope, enabling the surgeon to work in a narrow environment with both hands. The procedure's duration was 2 h and 9 min, including 16 min for the installation and draping of the robotic arm. After a trans-canal approach, the cholesteatoma was dissected from the ossicles using both a needle (or sickle knife) and suction to stabilize the ossicles and limit the risk of hearing trauma. The cholesteatoma was debulked to reduce its size, allowing it to be pushed under the malleus anteriorly and then separated from other adherences before removal. A tragal cartilage graft was used to reinforce the tympanic membrane.

This protocol describes the removal of congenital cholesteatoma using minimally invasive transcanal endoscopic ear surgery with a two-handed approach and a robotic endoscope holder.

Congenital cholesteatoma accounts for 25% of cholesteatoma cases in children. Transcanal Endoscopic Ear Surgery (TEES) is ideal for these patients because ...