In the treatment of chronic sinusitis, the mucosa should be preserved, or, when severely damaged, only the mucosal surface removed with cutting forceps. It is especially important not to expose the surface of the bone by complete removal of the mucosa. When the mucosa is conserved, or excision is limited to only the mucosal surface, ciliated cells regenerate within 6 months. However, where the mucosa was completely removed during surgery and the bone was exposed, the area was covered with nonciliated cells, and only scattered cilia were present.
We developed a method to enable a time-series comparative analysis of surgical processes based on the surgical data from the navigation system. This method can allow surgeons to identify differences between their procedures and reference procedures such as experts' procedures.
We discuss a procedure for opening the nasofrontal duct and the postoperative findings in endoscopic endonasal surgery. The route of the anterior ethmoidal artery was also studied. The subjects of this study were 57 patients (105 sides) who had frontal sinus disease. The patients all underwent surgery for chronic sinusitis between 1990 and 1992. Patients undergoing revision surgery were excluded. All patients were operated on by the same surgeon. In each patient, following anterior and posterior ethmoidectomy, the frontal sinus ostial region was opened using a 70 endoscope, while carefully monitoring the anterior ethmoidal artery. The agger nasi was left intact. The cells around the ostium were opened using a curved suction tip and upward bent forceps, and the lamellae were removed to achieve the greatest possible communication with the frontal sinus. In 77 sides (73.4%), the communication between the frontal and ethmoidal sinuses was well maintained. The ostium was patent with edematous mucosa in 18 sides (17.1%). The opened ostium could not be confirmed due to presence of polyp, etc., in 10 sides (9.5%). During surgery, the route of the anterior ethmoidal artery was confirmed in 70.8%: and oj these cases, it was located anterior to the third ground lamella in about 50%. (Am J Rhinology 8:67-70,
Endoscopic sinus surgery(ESS)has been performed with a navigation system to reduce a risk of causing injuries and complications during the surgery. However, supporting the improvement of surgeonsskill levels is important to further improve the safety of ESS. We previously developed a method for analyzing and evaluating the motion of the forceps during a glioma surgery and a laparoscopic cholecystectomy in order to help surgeons to learn surgical skills. As a surgeon need to operate an endoscopic camera and a forceps in the case of ESS, we focused on analyzing a camera operation. Therefore, in this study, we present a quantitative analysis method of a camera operation during ESS. By using the information obtained by a navigation system, we developed a method for quantifying a camera operation with five analytical parameters and estimating surgeonsʼ skill levels based on discrimination analysis. For fundamental validation, we analyzed a camera operation during a simulated bone resection task for ESS using a nasal bone phantom. Eight surgeons (four experts and four novices)participated to the study and the task was performed five times by each surgeon. A total of forty procedures were analyzed to validate our method. Based on the validation results, we believe that our analytical method is effective for quantitatively analyzing and evaluating surgical performances without depending on years of experience.
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