Ein Konzept für eine automatisierte Endoskopführung für die Nasennebenhöhlenchirurgie

Strauß, Gero; Hofer, Mathias; Kehrt, S; Grunert, Ronny; Korb, Werner; Trantakis, C.; Winkler, Dirk; Meixensberger, Jürgen; Bootz, Friedrich; Dietz, Andreas; Wahrburg, Jürgen

doi:10.1007/s00106-006-1434-3

Cited by 33 publications

(9 citation statements)

References 13 publications

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“…To estimate the sinus volume precisely, a time-consuming manual measurement on coronal slices was performed, similar to the one suggested by Pirner et al [24] According to our experience and literature, an automatic measurement often gives an inexact result (for example it does not include the mucosa or exceeds the bony walls of the sinus) [24–26]. Only few other authors used similar measurement techniques [24,27], while others used automatic measurements [5,18,28]. Emirzeouglu used a different method – square grid test systems with six different point densities combined with the Cavalieri principle [23,29].…”

Section: Discussionmentioning

confidence: 99%

Nasal Septal Deviation and Concha Bullosa – Do They Have an Impact on Maxillary Sinus Volumes and Prevalence of Maxillary Sinusitis?

et al. 2018

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SummaryBackgroundThe aim of the study was to assess if the presence of nasal septal deviation and concha bullosa is connected with the development of sinuses and the incidence of inflammation within them.Material/MethodsWe retrospectively analysed 214 patients who underwent paranasal sinus computed tomography. There were 125 females and 89 males, the mean age being 47.67±16.74 years (range 18–97). Exclusion criteria included: age under 18 years, prior sinonasal surgery and S-shaped septum.ResultsMean volume of the right maxillary sinus was 17.794 cm3, while for the left one it was 17.713 cm3. Nasal septal deviation was found in 79.9% of computed tomography examinations and concha bullosa was observed in 42.1% of the patients’ examinations. There was an association between the presence of unilateral or dominant concha bullosa and contralateral direction of septal deviation [right-sided (p=0.039), left-sided (p=0.003)]. There was higher incidence of bilateral maxillary sinusitis in patients with septal deviation (p=0.007). Bilateral concha bullosa did not influence the incidence of bilateral maxillary sinusitis (p=0.495). Neither septal deviation (right sided: p=0.962; left-sided: p=0.731), nor unilateral/dominant concha bullosa (right: p=0.512; left: p=0,430) affected the asymmetry in volumes of maxillary sinuses. Bilateral concha bullosa was connected with larger volume of maxillary sinuses (right sinus: p=0.005; left sinus: p=0.048).ConclusionsNasal septal deviation, contrary to concha bullosa, has influence on the development of maxillary sinusitis. There is a connection between the presence of concha bullosa and direction of septal deviation. Only bilateral concha bullosa affects maxillary sinus volumes.

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Section: Discussionmentioning

confidence: 99%

Nasal Septal Deviation and Concha Bullosa – Do They Have an Impact on Maxillary Sinus Volumes and Prevalence of Maxillary Sinusitis?

et al. 2018

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“…Frequent changes of instruments and image agitation, and frequent tissue contacts entail in frequent cleaning intervals, which are drawbacks of the conventional technique [4]. Human assistance is tiring and adjusting the endoscope often causes difficulties [5].…”

Section: Resultsmentioning

confidence: 99%

Computer Assisted Head and Neck, and ENT Surgery

2009

Int J CARS

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Keywords Image-guided surgery Á Cone-beam CT Á Mobile C-arm Á Image registration Á Surgical navigation Purpose Intraoperative 3D imaging with sub-millimeter spatial resolution and soft-tissue visibility is an essential next step in the advancement of precision image-guided surgery. To this end, a prototype mobile C-arm for cone-beam CT (CBCT) has been developed and applied in preclinical studies across a broad spectrum of surgical applications. The current work describes the integration of C-arm CBCT with other image guidance subsystems (including surgical planning, deformable registration, real-time tracking, and visualization) and reports implementation in a prospective clinical trial in head and neck surgery. Methods (a) Integration of C-Arm CBCT guidance systems As illustrated in Fig. 1, the prototype is based on a mobile isocentric C-arm (Siemens PowerMobil) developed in collaboration with Siemens Healthcare. The C-arm was modified to include a flat-panel detector, motorized orbit, geometric calibration, and control system. The system demonstrates 3D image quality with sub-mm spatial resolution and soft-tissue visibility at low radiation dose. Fast 3D reconstruction provides volume images within *15 s of completing the scan.Subsystems ranging from surgical planning to tracking and visualization have been integrated with the C-arm in phased implementation for clinical trials. Fast deformable registration using a multi-scale Demons algorithm transforms preoperative images, the surgical plan, and other intraoperative CBCT to the most recent CBCT image. An adaptive convergence criterion provides accurate registration on a timescale consistent with intra-operative use. Novel real-time tracking developments include: (i) automatic registration of CBCT and tracking systems (eliminating manual registration); and (ii) real-time tracking of endoscopes (augmenting endoscopy with image data and/or virtual representation of the endoscope in CBCT). 3D visualization software developed using the IGSTK library provides triplanar/oblique views, surface and MIP renderings, fusion with preop images and surgical plan, fusion with video endoscopy, and real-time tracking/navigation. (b) Clinical trial in head and neck surgery A prospective trial has been conducted involving 12 patients undergoing surgery of the head and neck. Cases include anterior skull base and sinus tumor resection, maxillectomy, mandibulectomy, and maxillofacial reconstruction. Phase 1 of the trial (6 patients) involved Fig. 1 Systems integrated with C-arm CBCT. a C-arm in the OR. b Surgical target volume registered to CBCT. c Deformable registration showing differences associated with jaw flexion in rigid and deformable registration. d Intraoperative 3D visualization

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“…The robot-assisted access to the skull base would enormously extend the surgical possibilities of the partly vulnerable anatomical structures of this region. Because of technical limitations, the application of robotic systems in this field is only limited to cadaver models and individual clinical case descriptions 171 177 . Due to its size, the DaVinci system seems to have a suboptimal structure for an approach to the skull base 155 .…”

Section: Paranasal Sinuses and Skull Basementioning

confidence: 99%

Robotische Chirurgie – operiert der Roboter?

Schuler

2018

Laryngo-Rhino-Otol

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ZuSammenfaSSungDer Roboter-assistierten Chirurgie (RAC) im Kopf-Hals-Bereich wird ein großes Potenzial zugeschrieben. Vor allem in der operativen Onkologie wird der Einsatz von Roboter-Systemen als besonders interessant erachtet. Bislang sind 2 Gerätetypen (DaVinci ® und FLEX ® ) für die klinische Anwendung im Kopf-HalsBereich zugelassen, und multiple weitere Systeme befinden sich in der präklinischen Erprobungsphase. Auch wenn prinzipiell bestimmte Patientengruppen von der RAC profitieren könnten, finden sich keine systematischen randomisierten Studien. Ein möglicher Vorteil der RAC gegenüber den bisherigen Standardverfahren kann daher bisher nicht nachgewiesen werden. Der begrenzte klinische Nutzen und die finanzielle Zusatzbelastung scheinen aktuell der Hauptgrund zu sein, warum der flächende-ckende Einsatz der RAC bislang ausgeblieben ist. Diese Über-sichtsarbeit beschreibt die verschiedenen Anwendungsmöglich-keiten der RAC im Kopf-Hals-Bereich. Außerdem werden die finanziellen und technischen Herausforderungen, sowie anstehende Weiterentwicklungen der RAC beleuchtet. Besonderes Augenmerk wird auf spezielle Risiken der Roboter-Chirurgie und aktuell laufende klinische Studien gelegt. Mittelfristig wird davon ausgegangen, dass die RAC Einzug in die klinische Routine erhalten wird und sich das medizinische Personal zunehmend mit den technischen, wissenschaftlichen und auch ethischen Besonderheiten auseinandersetzen muss.

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Ein Konzept für eine automatisierte Endoskopführung für die Nasennebenhöhlenchirurgie

Cited by 33 publications

References 13 publications

Nasal Septal Deviation and Concha Bullosa – Do They Have an Impact on Maxillary Sinus Volumes and Prevalence of Maxillary Sinusitis?

Nasal Septal Deviation and Concha Bullosa – Do They Have an Impact on Maxillary Sinus Volumes and Prevalence of Maxillary Sinusitis?

Computer Assisted Head and Neck, and ENT Surgery

Robotische Chirurgie – operiert der Roboter?

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