(G-244) Integration of Tumor Curette onto The Digit as a Means of Resection with Minimized Tissue Damage

Introduction:: Tumors within the bone often require extraction utilizing specialized tools such as a curette. A bone curette is used to scrape away tumor tissue in the hopes that healthy bone will grow back and fill the space occupied by the removed mass. To remove particularly large tumors or those that have penetrated deep into the bone, surgeons must create a cavity around the mass before curettage. In some patients, orthopedic surgeons will have to combine curettage with a bone graft or implant within the cavity to fill the void, or the structural integrity of the bone will fail.

The instrument is a rigid fixed-angle device that sometimes requires inefficient handling and awkward positioning. This awkward positioning can lead to two significant issues. First, to visualize and remove maximal cancer tissue, the cavity must be enlarged to fit both the curette and its effective angle to reach the tumor. Again, the larger the cavity created, the more structural integrity is lost. The second complication is insufficient tumor tissue removal. Even at a maximum cavity size, there will be angles that the instrument cannot reach. Specific indications for curettage, such as giant cell tumor(s) of bone (GCT), are associated with high recurrence rates, one hypothesis being that their initial resection had insufficient tumor removal.

Both aforementioned issues create massive adverse outcomes for patients. This study aimed to initiate the design of a device that conserves the curettage method while minimizing the need for large bone cavities and maximizing tumor tissue removal.


Materials and Methods:: The device was required to take the design of the conventional curette and integrate the dexterity of the user’s hands to facilitate tumor tissue removal. Other device characteristics required ease of integration into the operating room and a well-fit design for the user.



Design A was an externally fixated apparatus on one or two fingers of the user that mimicked the shape of a curette. This allowed the user to move the device in and out of the bone cavity with ease without sacrificing the curette design - thus still allowing a scraping motion to be utilized (Figure 1). Design B had similar characteristics. However, the body of the design allowed for easier fixation upon the digit (Figure 2).



Both designs were tested in a simulated environment attempting to recreate a mock tumor removal. The proof-of-concept experiment was designed utilizing a plastic container and a stick of butter. To test the designs, the butter (“tumor”) was frozen and impacted along the container’s side (Figure 3). Designs A and B were then utilized to scrape off the mass, and their effectiveness was analyzed (Figure 4).


Results, Conclusions, and Discussions:: From their performance in the simulated environment, both designs were effective in tumor removal while maintaining the original curettage method. Designs A and B were still scraping away the mass, but the available tumor surface area was drastically increased by integrating the degrees of freedom allowed in the finger.

Testing both designs also elicited their pitfalls. Design A was challenging to apply to the user and difficult to remove, indicating that the time associated with integrating this device into the operating room would impede the procedure. Design B’s curette tip towards the distal portion of the digit seemed undersized, which required more tumor cleaning from the instrument, thereby delaying the procedure.

The use of the curette for tumor removal is a method preserved for decades within the surgical field. It is a well-defined skill that has been proven to remove cancer from patients properly. Despite this, the instrument’s design and handling can be improved to create better patient outcomes by minimizing collateral damage to the healthy tissue and facilitating higher rates of tissue removal by increasing the available surface area to the surgeon by integrating the tool right onto their fingertips.

The global orthopedic devices market is massive, valued at $40.9 billion USD in 2021, with a projected CAGR of 3.1% from 2022 to 2030. With such an increasing demand and push for innovation within this space, the design of the curette has barely changed over the past few decades. The results of this study indicate that while the curette may currently be adequate, there exist ways to improve its performance, and the outcomes shown from the aforementioned designs show a preserved method with increased efficacy, perfect for operating room integration.

These designs will constantly be iterated upon for future testing - increasing their effectiveness, ease, and consumer desirability. Shortcomings of the experimental design include quantitative confirmation that tumor removal was higher in the designed curettes instead of relying on visual inspection. In the future, the designs will also include different materials, those best suited for finger flexibility and manipulation while maintaining the strength of the curette edge.


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