The use of computerized navigation in the treatment of gunshot and shrapnel injury

Rami Mosheiff*, Yoram Weil, Amal Khoury, Meir Liebergall

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Objective: Trauma surgeons encounter numerous penetrating injuries nowadays. In some cases, missiles causing infection, pain and discomfort, or those retained within joints, bursae and other strategic sites, must be removed. This paper describes an innovative high-tech modality for use in the immediate removal of shrapnel and bullets from strategic anatomical sites. Methods: Surgical computerized navigation based on real-time acquisition of fluoroscopic data was employed. Several fluoroscopic images of the required anatomical site were obtained. The accurate spatial location of the foreign object could be seen on the images displayed on the computer screen. No further fluoroscopic radiation was necessary. During surgery, the infra-red camera tracked the position of a surgical probe on the patient's anatomy and continuously updated its three-dimensional position simultaneously on all displayed images until the missile's location was reached. Results: The use of percutaneous fluoroscopic navigation to remove retained metal objects, including bullets and shrapnel, has proved itself in 12 cases as an accurate measure involving reduced exposure to radiation. In contrast to CT- or MRI-based navigation, computerized fluoroscopic navigation does not require long preliminary preparation. Thus, it is highly efficient in the treatment of acute trauma victims. Conclusions: The use of this accurate technique in complex and dangerous situations where the foreign body is located in proximity to blood vessels, nerves and narrow 'safe-zones', is promising. This innovative technique reduces surgical time and radiation exposure. In our experience, it has rendered percutaneous missile removal much safer, even in hazardous situations.

Original languageEnglish
Pages (from-to)39-43
Number of pages5
JournalComputer Aided Surgery
Issue number1-2
StatePublished - 2004
Externally publishedYes


  • Computerized fluoroscopic navigation
  • Gunshot wounds
  • Penetrating injury


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