Pelvic tumor resection incision construction system and pelvic tumor en bloc resection system

Abstract

The application discloses a pelvic tumor resection surgical incision construction system and a pelvic tumor whole piece resection system. When a tumor does not affect a Ⅳ area, a projection point of a iliac crest on a body surface is taken as a starting point, and a projection point on the body surface is extended in a pubis direction of the iliac bone. According to different extension points, a single smooth virtual incision path one is constructed by bending downward in a thigh direction. When the tumor affects the Ⅳ area and other areas, the virtual incision path is two independent and non-intersecting first incision paths and second incision paths. The first incision path is extended from a body surface projection point of a longitudinal axis of a vertebral body to a sacrum direction, and is an incision path that is inclined to a tumor side in a sacrum area. The second incision path is a line connecting a body back projection point of the iliac crest to a body front projection point, and is combined with a corresponding smooth virtual incision path one to construct a complete smooth virtual incision path two. Through the above-mentioned method, incision intersection can be effectively avoided, and the incision path is beneficial to blood supply, and the healing effect is ensured.

Description

Technical Field

[0001] This invention relates to the field of pelvic tumor resection system technology, and more particularly to the field of system technology for resecting tumors within the entire pelvis, specifically a pelvic tumor resection surgical incision construction system and a pelvic tumor en bloc resection system. Background Technology

[0002] The pelvis is a symmetrical structure, and tumors can occur on one side of the pelvis. To avoid postoperative risks, the tumor needs to be removed en bloc. Because tumors vary in size and affect different areas of the pelvis, resection procedures may be performed on different pelvic regions. During resection, a larger area of ​​the pelvis on the side with the tumor may need to be removed, or the entire iliac bone may need to be removed. To facilitate tumor resection, one side of the pelvis is divided into four regions: Region I (iliac bone), Region II (hip joint at the junction of the femoral head and acetabulum), Region III (pubis and ischium), and Region IV (the area close to the spine). This allows for surgical planning based on the location of the tumor.

[0003] Different surgical sites require different incisions to create a sufficiently large surgical field, ensuring complete resection of the corresponding tumor. For tumors in zones II-III, current techniques typically employ a cross-incision, including a transverse incision extending from the iliac crest towards the pubic bone, and a curved longitudinal incision extending towards the thigh, intersecting the transverse incision. The transverse incision separates the pelvis from the abdominal region, and the longitudinal incision divides the lower pelvic region into two independent flap areas. These flap areas can be folded in opposite directions, creating a sufficiently large surgical space. Early techniques used a longitudinal incision that curved around the gluteal muscles to maximize surgical exposure; however, this approach caused significant trauma and poor postoperative healing. With advancements, the longitudinal curved incision is now positioned approximately at a 90-degree angle to the transverse incision to reduce patient injury, but a cross-incision still exists.

[0004] Patients undergoing pelvic surgery need at least 45 days of bed rest to ensure the recovery of muscles and tissues and the integration of the implanted prosthesis with the pelvis. During the healing process of the cross-incision sutures created during surgery, non-healing or poor healing is particularly prone to occur at the cross-incision site. If the wound fails to heal, the pelvic area needs to be addressed. Treating non-healing cross-incisions cannot be resolved simply by disinfection; the patient must be transferred to the operating room for re-treatment of the incision. For patients who have undergone total or partial pelvic bone resection, the muscles are cut open during tumor removal surgery, and the implanted prosthesis, lacking the protection of muscles and other tissues, is particularly susceptible to insufficient prosthesis fusion and joint slippage during patient movement. Once slippage occurs, the incision needs to be reopened for reoperation. The risk of tissue infection increases with reoperation; if the infection spreads to the prosthesis, it can lead to surgical failure, causing irreversible harm to the patient and potentially necessitating termination of the procedure. Therefore, poor healing of cross-incisions is a key factor leading to surgical failure. Summary of the Invention

[0005] To address the aforementioned issues, this technology proposes a surgical incision construction system for en bloc resection of pelvic tumors. This en bloc resection system avoids the healing difficulties associated with traditional cross incisions while simultaneously meeting the requirement for adequate exposure of the surgical field, thereby further improving the success rate of postoperative healing.

[0006] Traditional transverse and longitudinal incision setups divide the pelvis and abdomen into upper and lower parts using a transverse incision, and then divide the lower pelvis into left and right regions using a longitudinal incision. After the incisions are constructed, the skin flaps in the pelvic area can be pulled apart in different directions, fully exposing the surgical space and making operations on pelvic regions II and / or III simpler. While this method is very advantageous in terms of exposing the surgical field, the cross-cutting incisions result in poor postoperative prognosis at the intersection. Furthermore, the transverse incisions cause more severe transection of internal muscles and affect blood supply during recovery. Although current techniques have improved the intersection angle of the transverse and longitudinal incisions, they cannot fundamentally solve the problems of blood supply at the intersection and the transverse incision.

[0007] The surgical incision for the resection of pelvic tumors not involving region IV in this application is a single, smooth incision without any intersections. It begins at the anterior surface projection point of the iliac crest and continues to construct surface projection points along the edge of the iliac bone. After a turning point, it extends towards the thigh to construct multiple thigh projection points. Finally, a curved but smooth single incision is constructed.

[0008] When the tumor area extends to Zone I and Zone II, when it reaches the edge of the iliac bone corresponding to the acetabulum, the surface projection point is constructed downwards towards the thigh. When constructing the surface projection point along the thigh, important blood vessels and nerves are avoided. The line connecting all projection points forms a single smooth incision trajectory. Finally, a single incision is constructed on the body surface, starting from the surface projection point at the edge of the iliac bone corresponding to the acetabulum, curving downwards in an arc.

[0009] When the tumor area extends to zones II and III, surface projection points are continuously constructed along the edge of the iliac crest. After passing the iliac crest, surface projection points are constructed along the ulna. At the ipsilateral ulnar edge, surface projection points are constructed downwards towards the thigh, avoiding important blood vessels and nerves. The line connecting all projection points forms the trajectory of a single, smooth incision. Finally, a single, smooth incision is constructed on the skin surface, starting from the iliac crest and curving downwards from the surface projection point at the ulnar edge. The construction of this single, smooth incision ensures that a large area can be opened with a single skin flap due to the curved position, resulting in clear exposure of the surgical field. Furthermore, the smooth incision without intersections during the process leads to good blood supply restoration.

[0010] When the tumor affects zone IV and other zones, including at least zone I, two independent but non-intersecting incisions are constructed. The projection point of the first incision starts from the projection point constructed on the body surface along the midline of the lumbar spine, moving towards the sacrum and continuing along the midline of the sacrum until the third posterior sacral foramen. Then, the projection point is constructed at an angle towards the tumor side, avoiding important blood vessels and nerves. The projection point of the second incision starts from the projection point on the body surface of the upper edge of the ilium behind the body, then moves to the projection point on the body surface of the iliac crest on the anterior side. Curve segment one is constructed along the lumbar region. Then, depending on whether the tumor affects zone I and zone II or zone I to zone III, corresponding curve segment two is constructed. The curve segment two of the tumor is consistent with the curve of the single smooth incision between zone I and zone II or zone II and zone III tumors, ensuring the smoothness of curve segment one and curve segment two. The second incision is constructed along curve segment one and curve segment two. This method effectively exposes the entire pelvic area that needs to be treated, and the two incisions do not overlap, allowing each incision to heal independently, resulting in a better recovery.

[0011] The surgical incision construction system involved in this application comprises the following steps:

[0012] 1) Obtain imaging images of the patient's pelvis;

[0013] 2) Using the patient's pelvic images, construct a three-dimensional model of the patient's pelvis, and analyze the patient's pelvic condition and the pelvic region where the tumor is located in the three-dimensional model.

[0014] 3) Construct a virtual incision path in the 3D model based on the pelvic regions affected by the tumor, and use 3D printing technology to print a patient pelvic model from the 3D model, and construct the virtual incision path in the pelvic model.

[0015] When the tumor only affects areas I and II, or areas II and III, or areas I to III, the path starts from the projection point of the iliac crest on the body surface, extends along the iliac bone towards the pubic bone at the projection point on the body surface, and bends downward towards the thigh at different extension points depending on the affected area, thus constructing the first single smooth virtual incision path.

[0016] When the tumor involves zone IV and other zones, the virtual incision path consists of two independent and non-intersecting first and second incision paths. The first incision extends from the longitudinal axis of the vertebral body towards the sacrum, and is biased towards the tumor side in the sacral region. The second incision is a complete second single smooth virtual incision path constructed by combining the line connecting the posterior projection point of the iliac crest to the anterior projection point, corresponding to the first single smooth virtual incision path involving zones I and II, or zones II and III, or zones I to III.

[0017] 4) Construct a real incision path on the patient's body surface using a virtual incision path;

[0018] During the actual surgical procedure, the surgical incision is constructed using the aforementioned real incision path.

[0019] Furthermore, when the tumor only involves zones I and II, the virtual incision path is a single, smooth incision path extending from the projection point of the iliac crest to the anterior surface of the iliac bone corresponding to the acetabulum, and then towards the thigh; this is defined as path one. When the tumor involves zone III, the virtual incision path is from the posterior aspect of the iliac crest...

[0020] When the tumor only involves areas II and III or from area I to area III, the virtual incision path is a single smooth incision path extending towards the thigh from the projection point of the ulnar edge on the same side of the iliac crest. This is defined as path two.

[0021] When the tumor involves zone IV and other zones, the virtual incision path consists of two independent and non-intersecting first and second incision paths. The first incision path is a smooth incision path extending from the projection point of the lumbar midline on the body surface towards the sacrum, and then sloping towards the ipsilateral tumor direction after passing the projection point corresponding to the third posterior sacral foramen. This is defined as path three. The second incision path includes curve segment one, which is the projection point of the upper edge of the ilium on the posterior side of the body, and then curve segment one, which is the projection point of the iliac crest on the anterior side of the body. When the tumor also involves zones I and II, it also includes curve segment two, which is connected to curve segment one. The path of curve segment two is consistent with path one. When the tumor also involves zones I to III, it also includes curve segment two, which is connected to curve segment one. The path of curve segment two is consistent with path two.

[0022] Furthermore, the specific path construction method is as follows: The construction method of path one is as follows: construct multiple projection points on the anterior body surface from the iliac crest to the iliac bone position corresponding to the acetabulum, and construct projection points towards the thigh after the surface projection point at the iliac bone position corresponding to the acetabulum. Finally, connect all the projection points to construct a single smooth incision with a curve at the surface projection point at the iliac bone position corresponding to the acetabulum.

[0023] The construction method of Path 2 is as follows: construct multiple projection points on the anterior surface of the body from the iliac crest to the edge of the ipsilateral ulna, and construct projection points towards the thigh after the surface projection points at the edge of the ipsilateral ulna. Finally, connect all the projection points to construct a single smooth incision with a curved surface projection point at the iliac bone position corresponding to the acetabulum.

[0024] The construction method of Path 3 is as follows: starting from the projection point of the lumbar midline on the body surface, construct projection points along the sacral midline towards the sacrum until the third posterior sacral foramen is reached, then tilt the projection point towards the tumor side and connect the projection points along the direction of construction to construct Path 3.

[0025] The construction method of curve segment one is as follows: take the projection point of the upper edge of the ilium on the body surface at the back as the starting point, then set multiple connection points on the body surface along the waist region, and take the projection point of the iliac crest on the body surface at the front as the ending point. Connect the points on the body surface from the back of the body along the waist to the front of the body to construct curve segment one.

[0026] Furthermore, the projection points for Path 1 and Path 2 should be set to avoid important blood vessels and nerves.

[0027] Furthermore, the endpoint path from the surface projection point of the iliac bone corresponding to the acetabulum in Path 1 to the projection point of the thigh is defined as the first thigh path. The vertical distance of the first thigh path is not less than 10cm, and the overall length is not less than 13cm. The first thigh path extends from the surface projection point of the iliac bone corresponding to the acetabulum in the direction of the outer thigh. This method can ensure the formation of a relatively large arc, ensuring that the incision constructed along Path 1 has a large arc, so that the skin flap can be lifted.

[0028] Furthermore, the second thigh path is defined as the path from the projection point on the anterior surface of the body at the edge of the ipsilateral ulna to the endpoint of the projection point downwards towards the thigh; the vertical distance of the second thigh path is not less than 13cm. This distance extends to more than one-third of the way down the thigh, and the curved curve constructed in this way can form a large, foldable skin flap.

[0029] This application also relates to a system for en bloc resection of pelvic tumors; which includes:

[0030] S1. Real surgical incision path construction unit;

[0031] The cut-out path is constructed according to the method of the cut-out construction system described above.

[0032] S2. Patient positioning unit;

[0033] For cases where the tumor involves areas I and II, areas II and III, or areas I and III, patients should be advised to adopt a floating position.

[0034] In cases where the tumor involves zone IV, the patient is first placed in a supine position, and an incision is made along path three via the posterior approach. Then, the patient is changed to a floating position and an incision is made along the path of curve segment one and curve segment two.

[0035] S3. Expose tumor tissue units along the incision path.

[0036] S31. Cut open the skin and subcutaneous tissue;

[0037] S32. Muscle management: Dissect the muscle; carefully dissect the muscle from its origin and insertion points and mark them for suturing during reconstruction; remove the muscle, and if the tumor has invaded the muscle, the muscle should be removed as part of the overall resection;

[0038] S33. Recognition and Control of Neurovascular Bundles

[0039] S331. Before entering the tumor-risk area, first expose and free the common iliac artery and vein, and the internal and external iliac arteries and veins in normal tissue, and then apply a occlusion band.

[0040] S332. When the tumor involves area IV, locate the sciatic nerve below the piriformis muscle via the posterior approach;

[0041] S333. On the anterior approach, identify the femoral artery, vein, and nerve below the inguinal ligament, and carefully dissect and protect them.

[0042] S34. Protection and displacement of pelvic organs

[0043] Use a retractor to gently push the bladder, ureters, intestines, etc., toward the midline to expose the pelvic rim and the front of the sacroiliac joint.

[0044] S35. The "Skeletalization" of Tumors

[0045] Within 1-5 cm of the tumor capsule, important nerve and blood vessel structures are freed, and the tumor forms a well-defined tissue mass.

[0046] S4. Tumor Resection Unit

[0047] First, treat the parts that are far from the tumor and easy to separate, and finally treat the most difficult and dangerous core area;

[0048] Cut the bone using an osteotome at least 1-2 cm away from the edge of the tumor in normal bone.

[0049] After all soft tissue and high-risk bony connections were severed, the tumor was removed whole.

[0050] S5. Bone Defect Reconstruction Unit

[0051] Reconstruction is performed by matching appropriate prostheses to different excision areas.

[0052] S6. Close the cut-out unit

[0053] Extensive irrigation of the surgical field reduces the risk of residual tumor cells and infection. Multiple large negative pressure drainage tubes are placed to prevent hematoma formation; any remaining muscles (such as gluteal and abdominal muscles) are reattached to the prosthesis or residual bone as much as possible; then the incision is sutured layer by layer.

[0054] Technical effect

[0055] For tumors affecting different areas, a single smooth incision path or two non-intersecting incision paths can be constructed using imaging simulation. The surgical incision is then created on the body surface through these paths. This method avoids important blood vessels and nerves, resulting in a smooth incision. This is particularly effective for tumors affecting areas I and II, II and III, or I and III. A single smooth path with a bend can be used for both paths. The bend allows for proper folding, ensuring full exposure of the surgical area. Furthermore, the smooth, non-intersecting incision ensures healing after closure. Additionally, the ratio of the vertical distance from the highest to the lowest point to the horizontal distance from the leftmost to the rightmost point in the single smooth incision constructed using this method is greater than 3:2, resulting in a long vertical length. This is highly beneficial for blood supply recovery, minimizing the risk of poor healing after incision closure.

[0056] When the tumor involves zone IV and other zones, two independent and non-overlapping surgical incisions are constructed using two patient positions (supine and floating positions). These double incisions ensure the exposure of the corresponding surgical areas. After the incisions are closed, they can heal independently without interfering with each other, and there is no need to consider the problem of poor healing of overlapping incisions. Attached Figure Description

[0057] Figure 1 This is a diagram showing the pelvic regions on one side.

[0058] Figure 2-1 This is a schematic diagram illustrating the existing technology where the intersection angle of two cuts is less than 90°.

[0059] Figure 2-2This is a schematic diagram illustrating the existing technology where two cuts intersect at an angle of 90°.

[0060] Figure 3-1 A real surgical incision path diagram constructed using Path 1, viewed from the patient's side profile.

[0061] Figure 3-2 This is a diagram showing the relationship between Path 1 and the pelvis from a frontal view.

[0062] Figure 4-1 A realistic surgical incision path diagram was constructed using Path 2 for patients in a suspended position in lateral view.

[0063] Figure 4-2 This is a diagram showing the relationship between path two and the pelvis from a frontal view.

[0064] Figure 5-1 The actual surgical incision path was constructed using path three and curve segment one in the prone position;

[0065] Figure 5-2 This is a diagram showing the relationship between path three and curve segment one and the pelvis in a rear view.

[0066] Figure 6 Images of the patient in Case 1: A is the actual incision path, B is the whole bone tumor, and C is the pelvic image after the prosthesis was placed.

[0067] Figure 7 The images are of the patient in Case 2. A is a diagram of the actual incision path constructed on the patient's body surface, B is a diagram of the entire bone tumor removed from the patient, and C is a diagram of the patient's pelvis after the prosthesis was installed.

[0068] Figure 8 The images are of the patient in Case 3. A is the patient in a supine position with the corresponding incision path diagram of Path 3 and Curve Segment 1 constructed on the body surface. B is the patient in a suspended position with the corresponding incision path diagram of Path 2 constructed on the body surface. C is the image of the entire bone tumor removed from the patient. D is the frontal and lateral images of the patient after the incision has healed. E is the dorsal and lateral images of the patient after the incision has healed.

[0069] Explanation of main figure symbols

[0070] 1. Path 1; 11. First thigh path; 2. Path 2; 21. Second thigh path; 3. Path 3; 4. Curve segment 1. Detailed Implementation

[0071] refer to Figure 1This refers to the division of the pelvis on one side, namely, iliac region I, hip joint region II (where the femoral head and acetabulum connect), pubic region III (corresponding to the ischium), and region IV (the area close to the spine). The specific steps below depend on the above division, and the incision path is planned according to the different pelvic regions affected by the tumor.

[0072] For existing techniques used to treat tumors in the pelvic region II-III, the incision method typically involves two intersecting incisions. Figure 2-1 This is a schematic diagram of a simple structure where the intersection angle of two cuts is less than 90°. Figure 2-2 This is a simplified structural diagram showing two incisions at an angle of 90°. It should be noted that the patient in the diagram is in a lateral position.

[0073] The most critical consideration in tumor resection surgery is the effective exposure of the surgical field. However, surgical field exposure is not a single action but a systematic and strategic process that continues throughout the surgery. Its purpose is to "enclose" the tumor and surrounding normal tissue, clearly demonstrating its anatomical boundaries, while avoiding damage to important nerves and blood vessels. In addition to considering surgical field exposure, postoperative wound healing must also be taken into account. Poor wound healing can cause significant harm to tumor surgery patients. This section mainly discusses the role of the incision in surgical field exposure and the optimal healing effect after incision closure.

[0074] The following examples mainly illustrate the system for constructing incisions and the system for en bloc resection of pelvic tumors.

[0075] Example 1: Surgical Incision Construction System for En bloc resection of pelvic tumors

[0076] 1) Obtain imaging images of the patient's pelvis, including but not limited to CT, MRI, CTA / MRA and PET-CT; CT and MRI are used to assess the extent of the tumor and its relationship with surrounding soft tissues; CTA / MRA is used to assess vascular anatomy and invasion.

[0077] 2) Using the patient's pelvic images, construct a three-dimensional model of the patient's pelvis, analyze the patient's pelvic condition and the pelvic region where the tumor is located in the three-dimensional model, and assess the condition of blood vessels and nerves;

[0078] 3) Construct a virtual incision path in the 3D model based on the pelvic regions affected by the tumor; or use 3D printing technology to print a 3D model of the patient's pelvis and construct a virtual incision path in the pelvis model; through the patient's pelvis model, one can intuitively understand the 3D relationship between the tumor and bones, blood vessels, and nerves, and better construct the virtual incision path.

[0079] When the tumor only involves zones I and II, the incision path is a single, smooth incision path extending from the iliac crest to the projection point on the anterior surface of the iliac bone corresponding to the acetabulum, and then towards the thigh. This is defined as Path 1. The method for constructing Path 1 is as follows: construct multiple projection points on the anterior surface of the body from the iliac crest to the iliac bone corresponding to the acetabulum. After the projection point on the surface of the iliac bone corresponding to the acetabulum, construct another projection point towards the thigh. Finally, connect all the projection points to construct a single, smooth incision that curves towards the projection point on the surface of the iliac bone corresponding to the acetabulum. (Reference) Figure 3-1 and Figure 3-2 The actual surgical incision path constructed using path 1; Figure 3-1 A diagram of the actual surgical incision path in the patient's lateral view; Figure 3-2 This is a diagram showing the relationship between path 1 and the pelvis from a frontal view.

[0080] When the tumor only involves zones II and III, or zone I to zone III, the incision path is a single, smooth incision path extending towards the thigh from the projection point on the anterior surface of the body at the ipsilateral ulnar edge of the iliac crest. This is defined as path 2. The construction method for path 2 is as follows: construct multiple projection points on the anterior surface of the body from the iliac crest to the ipsilateral ulnar edge, and then construct projection points towards the thigh after the surface projection point at the ipsilateral ulnar edge. Finally, connect all projection points to construct a single, smooth incision with a curved surface projection point at the iliac bone position corresponding to the acetabulum. (Reference) Figure 4-1 and Figure 4-2 The actual surgical incision path constructed using path 2. Figure 4-1 A diagram of the actual surgical incision path in a patient in a suspended position, viewed from the side. Figure 4-2 This is a diagram showing the relationship between path 2 and the pelvis from a frontal view.

[0081] When the tumor involves zone IV and other zones, the incision path consists of two independent and non-intersecting first and second incision paths. The first incision is a smooth path extending along the sacral midline from the projection point constructed on the body surface of the lumbar midline, towards the sacrum, and then tilting towards the tumor on the same side after passing the projection point corresponding to the third posterior sacral foramen. This is defined as path 3. The construction method of path 3 is as follows: starting from the projection point constructed on the body surface of the lumbar midline, projection points are constructed along the sacral midline towards the sacrum until reaching the third posterior sacral foramen. Then, a projection point is constructed tilted towards the tumor side. Path 3 is constructed by connecting the projection points along the direction of their construction. The lumbar midline can start from the fourth or fifth lumbar vertebra and extend towards the sacrum, depending on the specific lumbar vertebral position selected according to the surgical situation. The second incision path includes curve segment 4, which extends from the posterior projection point of the upper edge of the iliac bone to the anterior projection point of the iliac crest. Curve segment 4 is constructed as follows: starting from the posterior projection point of the upper edge of the iliac bone, multiple connection points are established along the lumbar region, ending at the anterior projection point of the iliac crest. This connection continues from the posterior to the anterior region, creating curve segment 4. When the tumor also involves regions I and II, a second curve segment (connected to curve segment 4) is also included. The path of the second curve segment is consistent with path 1. Curve segment 4 and the second curve segment form a complete and smooth virtual path. When the tumor also involves regions I to III, a second curve segment (connected to curve segment 4) is also included. The path of the second curve segment is consistent with path 2. Curve segment 4 and the second curve segment form a complete and smooth virtual path. (Reference) Figure 5-1 and Figure 5-2 The actual surgical incision path was constructed using path 3 (3) and curve segment 1 (4). Figure 5-1 A diagram of the actual surgical incision path in a patient's lateral view in a suspended position; Figure 5-2 This diagram illustrates the relationship between path 3 (3rd path) and curve segment 4 (4th path) and the pelvis from the rear view. (See reference for curve segment 2.) Figure 3-1 With 3-2; Second curve segment (second test) Figure 4-1 The distance from the rear edge point of curve segment 4 to the vertical segment of path 3 is greater than or equal to 5cm to ensure the independence of the first cut and the second cut.

[0082] 4) Transfer the constructed virtual incision path to the patient's body surface to construct the real incision path;

[0083] In practice, the projection points of Path 1 and Path 2 should be set to avoid important blood vessels and nerves.

[0084] In specific implementation, the endpoint path from the surface projection point of the iliac bone corresponding to the acetabulum of Path 1 to the projection point of the thigh is defined as the first thigh path 11. The vertical distance of the first thigh path 11 is not less than 10cm, and the overall length is not less than 13cm. The first thigh path 11 extends from the surface projection point of the iliac bone corresponding to the acetabulum towards the outer side of the thigh. This method can ensure the formation of a relatively large arc, ensuring that the incision constructed along Path 1 has a large arc, so that the skin flap can be lifted.

[0085] In practice, the second thigh path 21 is defined as the endpoint of the projection point on the anterior surface of the body at the edge of the ulna on the same side, extending downwards towards the thigh. The vertical distance of the second thigh path 21 is not less than 13cm. This distance extends to more than one-third of the way down the thigh, and the curved curve constructed in this way can form a large, foldable skin flap.

[0086] For cases where the tumor involves areas I and II, or areas II and III, or areas I and III, the surgical incision constructed using the aforementioned single, smooth incision method creates an incision path along the iliac bone towards the pubis, projecting onto the body surface. This path then bends and extends towards the thigh at an appropriate location. Because this incision is constructed along the edge of the pelvis, it effectively exposes the pelvic region. Furthermore, the bend towards the thigh creates a skin flap that is easily folded, allowing for better exposure of the surgical field. Combined with traction on the other side of the bend, this facilitates easy exposure of the surgical area. Additionally, the incision, constructed along the iliac bone and pubis, forms part of the pelvic edge, minimizing damage to the tumor during construction. Finally, due to its single, smooth incision and reasonable aspect ratio, blood supply is more adequate during healing, resulting in excellent wound healing.

[0087] Example 2: En bloc resection system for pelvic tumors

[0088] 1. Construction of realistic surgical incision paths

[0089] The actual surgical incision path was constructed using the method described in Example 1.

[0090] 2. Patient Positioning

[0091] Body position is the basis for exposure and determines the ease of operation for the surgeon.

[0092] For cases where the tumor only involves areas I and II, or areas II and III, or areas I and III, the floating position is chosen. The floating position is a semi-lateral decubitus position (approximately 45°), with the trunk not fixed. This is an excellent position for expanding exposure during pelvic tumor surgery, allowing for simultaneous or alternating anterior (abdominal, pelvic) and posterior (buttock) procedures without changing the patient's position during the operation.

[0093] When the tumor involves zone IV and other zones, a combined anterior and posterior approach is selected: generally, anterior approach is used first, followed by a lateral floating position. In the posterior approach, the first incision path is used to construct a real incision to treat the tumor in zone IV, while in the floating position, the second incision path is used to construct a real incision to treat the tumor involving zones I and II, or zones II and III.

[0094] 3. Construct a realistic incision along the actual surgical incision path on the body surface to expose the tumor tissue.

[0095] 3.1. First, cut open the skin and subcutaneous tissue.

[0096] 3.2. Muscle treatment: Not all muscles need to be cut.

[0097] Detachment: The muscle is carefully dissected from its origin and insertion points and marked for suturing during reconstruction. For example, the gluteal muscle is dissected from the lateral plate of the iliac bone.

[0098] Resection: If the tumor has invaded the muscle, the muscle must be removed as part of the overall resection (e.g., if it has invaded the gluteal muscle).

[0099] 3.3. Recognition and Control of Neurovascular Bundles (The Golden Rule)

[0100] First, locate and control the proximal vessels: Before entering the tumor-risk area, expose and free the common iliac artery and vein, as well as the internal and external iliac arteries and veins, within normal tissue, and apply occlusion bands. In case of fatal massive hemorrhage, immediate occlusion can be achieved. Currently, a low-lying abdominal aortic balloon is usually implanted preoperatively to effectively block blood flow to the pelvis and lower extremities during surgery.

[0101] Exposure and protection of the sciatic nerve: On the posterior approach, locate the sciatic nerve below the piriformis muscle, carefully dissect it, and protect it with a rubber band.

[0102] Exposure and protection of the femoral neurovascular bundle: On the anterior approach, identify the femoral artery, vein and nerve below the inguinal ligament, and carefully dissect and protect them.

[0103] 4. Protection and displacement of pelvic organs

[0104] Using a wide "Cobra" retractor or abdominal retractor, gently push the bladder, ureters, intestines, etc., toward the midline to expose the pelvic rim and the front of the sacroiliac joint.

[0105] 5. The "skeletonization" of tumors

[0106] Within normal tissue at a certain distance from the tumor capsule, after all important neurovascular structures are freed, the tumor itself becomes like an "island" with clearly visible boundaries, preparing it for en bloc resection.

[0107] 6. Tumor resection (En bloc resection)

[0108] 6.1. Follow the principle of "from far to near, from periphery to center": treat the parts that are far from the tumor and easy to separate first, and treat the most difficult and dangerous core area last.

[0109] 6.2. Osteotomy: According to the preoperative plan, osteotomy is performed using an oscillating saw or a Gigli saw in normal bone at least 1-2 cm from the tumor margin. The osteotomy sequence is usually: first, the pubic bone, ischial rami, or sacrum are osteotomized, and finally the ilium or sacroiliac joint is addressed. Osteotomy guides are now commonly designed preoperatively to facilitate intraoperative osteotomy.

[0110] 6.3. Specimen Removal: After all soft tissue and high-risk bony connections have been severed, the bone fragment containing the tumor is removed entirely. It is immediately sent for pathological examination to determine the boundaries.

[0111] 7. Reconstruction of Defect

[0112] The reconstruction method depends on the extent of resection (Enneking zone) and the patient's condition.

[0113] Type I (iliac wing) resection

[0114] If the supraacetabular column is preserved, the defect may not require reconstruction; if the defect is large, bone grafting or reconstruction using a titanium mesh / 3D-printed prosthesis may be considered.

[0115] Type II (periacetabular) resection

[0116] Using custom / modular hemipelvic prostheses (Megaprosthesis): This is currently the most common method, which can provide early stability, but has a high risk of infection, loosening, and wear.

[0117] Alternatively, resection arthroplasty can be used: the femoral head is fused with or not fused to the remaining pelvic stump. This method can result in lower limb shortening and joint instability, but the risk of infection is low.

[0118] Alternatively, allogeneic bone grafts or allogeneic bone-prosthetic composites (APCs) can provide good soft tissue attachment points, but there are risks of nonunion and resorption.

[0119] Alternatively, 3D printing of personalized porous prostheses is a future development direction, enabling precise anatomical matching and bone ingrowth.

[0120] Type III (pubischiectomy)

[0121] Usually, complex reconstruction is not required. Hernias may occur due to the loss of the insertion point of the abdominal wall muscles, and need to be repaired with a mesh patch.

[0122] Type IV (Sacroiliac Joint) Resection

[0123] If the resection area is less than 1 / 3 of the sacral wing, reconstruction may not be necessary.

[0124] If the resection area is larger, lumbopelvic reconstruction is required using massive bone grafting, titanium rod and screw systems, or L-shaped reconstruction plates to restore the continuity of the spine and pelvis.

[0125] 8. Close the incision

[0126] 8.1. Thorough irrigation: Use a pulse irrigator to thoroughly irrigate the surgical field to reduce residual tumor cells and the risk of infection.

[0127] 8.2. Drainage placement: Multiple large negative pressure drainage tubes must be placed to prevent hematoma formation.

[0128] 8.3. Soft tissue coverage: Reattach any remaining muscle (such as gluteal and abdominal muscles) to the prosthesis or residual bone as much as possible. Sometimes, it is necessary to consult a plastic surgeon to use a vascularized myocutaneous flap (such as a tensor fasciae latae flap or rectus abdominis flap) for coverage, which is crucial for preventing prosthesis infection.

[0129] Ultimately, this system is a personalized en bloc resection surgical system for pelvic tumors, utilizing a surgical robot to perform the relevant procedures.

[0130] Example 3

[0131] Using the system described in Example 2, en bloc resection of pelvic tumors of varying weights has been performed on more than 100 patients in clinical practice, all with good results. Postoperative wound healing was good. Three typical cases were identified to demonstrate that the above system can effectively complete the resection of en bloc bone tumors and ensure effective wound healing after surgery.

[0132] Case 1

[0133] A 48-year-old male with a malignant tumor in the left pelvic region I-II underwent a left hemipelvic replacement surgery (April 2016) via a SP incision, preserving the pubis-ischium. The wound healed well, and five years post-surgery (2021), he was able to walk normally without tumor recurrence. (Reference) Figure 6 A is a diagram of the actual incision path constructed on the patient's body surface; B is a diagram of the entire bone tumor removed from the patient; and C is an image of the patient's pelvis after the prosthesis has been placed.

[0134] Case 2

[0135] Hu X, male, 12 years old, with Ewing sarcoma in the right pelvic region II-III, underwent neoadjuvant chemotherapy before surgery. Following the procedure described in Example 2, he underwent en bloc resection of the tumor in region II-III (August 2018) and total hemipelvic replacement. The patient recovered well post-operatively, and at the 7th year follow-up examination, the tumor has not recurred, and his walking function is normal. (Reference) Figure 7 A is a diagram of the actual incision path constructed on the patient's body surface; B is a diagram of the entire bone tumor removed from the patient; and C is an image of the patient's pelvis after the prosthesis has been placed.

[0136] Case 3

[0137] A 14-year-old female presented with a giant osteosarcoma in the right pelvis (level I-IV). Following neoadjuvant chemotherapy, she underwent en bloc resection of the tumor via anterior and posterior approach, followed by rod-and-screw hemipelvic replacement. Four years post-surgery, the tumor has not recurred, and she walks normally. (Reference) Figure 8 A shows the patient in a supine position with the corresponding incision path diagrams for path 3 and curve segment 4 constructed on the body surface; B shows the patient in a suspended position with the corresponding incision path diagram for path 2 constructed on the body surface; C shows the entire bone tumor removed from the patient; D shows the patient's frontal and lateral views after the incision has healed; E shows the patient's dorsal view after the incision has healed.

[0138] The technical solutions of the embodiments of the present invention have been clearly and completely described above through specific embodiments. Obviously, the described embodiments are only some embodiments of the present invention, and not all embodiments. Those skilled in the art can easily understand other advantages and effects of the present invention from the content disclosed in this specification. The present invention can also be implemented or applied through other different specific embodiments. In the absence of conflict, the above embodiments and features in the embodiments can be combined with each other. Based on the embodiments of the present invention, all other embodiments obtained by those skilled in the art without creative effort are within the scope of protection of the present invention.

Claims

1. A surgical incision construction system for en bloc resection of pelvic tumors, characterized in that, The steps are as follows: 1) Obtain imaging images of the patient's pelvis; 2) Using the patient's pelvic images, construct a three-dimensional model of the patient's pelvis, and analyze the patient's pelvic condition and the pelvic region where the tumor is located in the three-dimensional model; 3) Construct a virtual incision path in the 3D model based on the pelvic regions affected by the tumor, or use 3D printing technology to print a 3D model of the patient's pelvis and construct a virtual incision path in the pelvic model. When the tumor only affects areas I and II, or areas II and III, or areas I to III, the path starts from the projection point of the iliac crest on the body surface, extends along the iliac bone towards the pubic bone at the projection point on the body surface, and bends downward towards the thigh at different extension points depending on the affected area, thus constructing the first single smooth virtual incision path. When the tumor involves zone IV and other zones, the virtual incision path consists of two independent and non-intersecting first and second incision paths. The first incision extends from the longitudinal axis of the vertebral body towards the sacrum, and is biased towards the tumor side in the sacral region. The second incision is a complete second single smooth virtual incision path constructed by combining the line connecting the posterior projection point of the iliac crest to the anterior projection point, corresponding to the first single smooth virtual incision path involving zones I and II, or zones II and III, or zones I to III. 4) Construct a real incision path on the patient's body surface using a virtual incision path.

2. The incision construction system according to claim 1, characterized in that, When the tumor only involves Zones I and II, the virtual incision path is a single, smooth incision path extending from the projection point of the iliac crest to the iliac bone corresponding to the acetabulum on the anterior body surface and then towards the thigh, which is defined as Path 1; when the tumor involves Zone III, the virtual incision path is from behind the iliac crest. When the tumor only involves areas II and III or from area I to area III, the virtual incision path is a single smooth incision path extending towards the thigh from the projection point of the ulnar edge on the same side of the iliac crest. This is defined as path two. When the tumor involves zone IV and other zones, the virtual incision path consists of two independent and non-intersecting incision paths: a first incision path and a second incision path. The first incision path is a smooth incision path extending along the sacral midline from the projection point constructed on the body surface from the midline of the lumbar spine towards the sacrum, and then sloping towards the ipsilateral tumor direction after passing the projection point corresponding to the third posterior sacral foramen. This is defined as path three. The second incision path includes curve segment one, which is the projection point of the upper edge of the ilium on the posterior side of the body, and then curve segment one, which is the projection point of the iliac crest on the anterior side of the body. When the tumor also involves zones I and II, it also includes a first curve segment two connected to curve segment one. The path of the first curve segment two is consistent with that of path one. When the tumor also involves zones I to III, it also includes a second curve segment two connected to curve segment one. The path of the second curve segment two is consistent with that of path two.

3. The incision construction system according to claim 1, characterized in that, The construction method of Path 1 is as follows: construct multiple projection points on the anterior body surface from the iliac crest to the iliac bone position corresponding to the acetabulum, and construct projection points towards the thigh after the surface projection point at the iliac bone position corresponding to the acetabulum. Finally, connect all the projection points to construct a single smooth incision with a curve at the surface projection point at the iliac bone position corresponding to the acetabulum.

4. The incision construction system according to claim 2, characterized in that, The construction method of Path 2 is as follows: construct multiple projection points on the anterior surface of the body from the iliac crest to the edge of the ipsilateral ulna, and construct projection points towards the thigh after the surface projection points at the edge of the ipsilateral ulna. Finally, connect all the projection points to construct a single smooth incision with a curved surface projection point at the iliac bone position corresponding to the acetabulum.

5. The incision construction system according to claim 2, characterized in that, The construction method of Path 3 is as follows: starting from the projection point of the lumbar midline on the body surface, construct projection points along the sacral midline towards the sacrum until the third posterior sacral foramen is reached, then tilt the projection point towards the tumor side and connect the projection points along the direction of construction to construct Path 3.

6. The incision construction system according to claim 2, characterized in that, The construction method of curve segment one is as follows: take the projection point of the upper edge of the ilium on the body surface at the back as the starting point, then set multiple connection points on the body surface along the waist region, and take the projection point of the iliac crest on the body surface at the front as the ending point. Connect the points on the body surface from the back of the body along the waist to the front of the body to construct curve segment one.

7. The incision construction system according to claim 2, characterized in that, When setting the projection points for Path 1 and Path 2, important blood vessels and nerves should be avoided.

8. The incision construction system according to claim 2, characterized in that, The first thigh path is defined as the path from the surface projection point of the iliac bone corresponding to the acetabulum to the projection point of the thigh. The vertical distance of the first thigh path is not less than 10cm and the overall length is not less than 13cm. The first thigh path extends from the surface projection point of the iliac bone corresponding to the acetabulum towards the outer side of the thigh.

9. The incision construction system according to claim 2, characterized in that, The second thigh path is defined as the endpoint of the projection point on the anterior surface of the body at the edge of the ulna on the same side, extending downwards towards the thigh. The vertical distance of the second thigh path is not less than 13cm.

10. A system for en bloc resection of pelvic tumors, characterized in that, It includes S1. Real surgical incision path construction unit The incision construction system according to any one of claims 1-9 is used to construct a real surgical incision path; S2. Patient Positioning Selection Unit For cases where the tumor involves areas I and II, areas II and III, or areas I and III, patients should be advised to adopt a floating position. In cases where the tumor involves zone IV, the patient is first placed in a supine position, and an incision is made along path three via the posterior approach. Then, the patient is changed to a floating position and an incision is made along the path of curve segment one and curve segment two. S3. Expose tumor tissue units along the incision path. S31. Cut open the skin and subcutaneous tissue; S32. Muscle management: Dissect the muscle; carefully dissect the muscle from its origin and insertion points and mark them for suturing during reconstruction; remove the muscle, and if the tumor has invaded the muscle, the muscle should be removed as part of the overall resection; S33. Recognition and Control of Neurovascular Bundles S331. Before entering the tumor-risk area, first expose and free the common iliac artery and vein, and the internal and external iliac arteries and veins in normal tissue, and then apply a occlusion band. S332. When the tumor involves zone IV, locate the sciatic nerve below the piriformis muscle via the posterior approach; S333. Identify the femoral artery, vein, and nerve below the inguinal ligament via the anterior approach; perform freeing and protection. S34. Protection and displacement of pelvic organs Use a retractor to gently push the bladder, ureter, and intestines toward the midline, exposing the pelvic rim and the area in front of the sacroiliac joint; S35. The "Skeletalization" of Tumors Within 1-5 cm of the tumor capsule, important nerve and blood vessel structures are freed, and the tumor forms a well-defined tissue block. S4. Tumor Resection Unit First, treat the parts that are far from the tumor and easy to separate, and finally treat the most difficult and dangerous core area; Use an osteotome to cut the bone; After all soft tissue and high-risk bony connections were severed, the tumor was removed whole. S5. Bone Defect Reconstruction Unit Reconstruction is performed by matching prostheses to different excision extents; S6. Close the cut-out unit The surgical field is thoroughly irrigated; multiple large negative pressure drainage tubes are placed; the remaining muscle is reattached to the prosthesis or residual bone; and finally, the incision is sutured layer by layer.

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