Implementing metal detector technology and a navigation system in the removal of shrapnel.

Introduction: The removal of metal shrapnel in the sub-acute phase of casualty treatment requires the utmost accuracy in detection and removal, especially when there is proximity to major neurovascular structures. Inability to successfully locate and remove retained fragments may lead to a variety of complications due to fragment migration. In this study we prove the feasibility of a new technique which uses metal detector technology combined with a surgical navigation system, resulting in improved accuracy and decreased operating time.

Methods: In each of the experiments, 6 metal nuts were inserted into a dummy leg to simulate shrapnel wounds. Two major experiments were then conducted. Experiment 1 was a comparison of two methods: (a) localization of the nuts using surgical navigation alone, and (b) localization by means of metal detector technology combined with a surgical navigation system (StealthStation® TREON® plus). Experiment 2 employed the same two methods, but this time migration of the metal fragments was introduced. The localization time was measured from incision of the dummy skin to the moment the metal fragment was touched by the searching device.

Results: In experiment 1 the results showed no significant differences between the two approaches. In experiment 2 the new technique was found to significantly decrease the mean fragment localization time, taking 9.6 seconds (±7.2 seconds) as compared to 26.4 seconds (±13.8 seconds) when using the regular technique.

Conclusion: Combining a metal detector probe and a surgical navigation system was found to significantly decrease operating time and increase the surgeon's confidence, especially in cases where migration of the metal fragment occurred during searching and extraction.