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Abstract
Recent technological development has led to the invention of different designs of haptic devices, electromechanical devices that mediate communication between the user and the computer and allow users to manipulate objects in a virtual environment while receiving tactile feedback. The main criteria behind providing an interactive interface are to generate kinesthetic feedback and relay information actively from the haptic device. Sensors and feedback control apparatus are of paramount importance in designing and manufacturing a haptic device. In general, haptic technology can be implemented in different applications such as gaming, teleoperation, medical surgeries, augmented reality (AR), and virtual reality (VR) devices. This paper classifies the application of haptic devices based on the construction and functionality in various fields, followed by addressing major limitations related to haptics technology and discussing prospects of this technology.
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Abstract
Robotic surgery has become more common in otolaryngologic surgery since the introduction of the da Vinci robotic system, but has played a limited role in anterior and central skull base surgery, largely because of technical limitations of existing robots. Current robotic technology has been used in creative ways to access the skull base, but was not designed to navigate these complex anatomic constraints. Novel robots should target many of the limitations of current robotic technology, such as maneuverability, inability to suture, lack of haptic feedback, and absent integration with image guidance.
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Affiliation(s)
- Mitchell Heuermann
- Department of Otolaryngology-Head and Neck Surgery, SIU School of Medicine, 720 North Bond Street, Springfield, IL 62702, USA
| | - Alex P Michael
- Division of Neurosurgery, Neuroscience Institute, SIU School of Medicine, PO Box 19638, Springfield, IL 62794-9638, USA
| | - Dana L Crosby
- Department of Otolaryngology-Head and Neck Surgery, SIU School of Medicine, 720 North Bond Street, Springfield, IL 62702, USA.
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Mattheis S, Schlüter A, Stähr K, Holtmann L, Höing B, Hussain T, Kanaan O, Eckstein A, Lang S. First Use of a New Robotic Endoscope Guiding System in Endoscopic Orbital Decompression. EAR, NOSE & THROAT JOURNAL 2019; 100:443S-448S. [PMID: 31690110 DOI: 10.1177/0145561319885803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Over the last years, robot-assisted surgery gained in importance in head and neck surgery. In our study, we used a new robotic endoscope guiding system in patients undergoing endoscopic balanced orbital decompression. The aim of the study is to evaluate the feasibility and benefit of a robotic arm in endoscopic orbital surgery. METHODS The Medineering Robotic Endoscope Guiding System is a robotic arm designed for holding an endoscope during interventions. An endoscope equipped with a 4K camera was attached at the tip of the robotic arm and placed in the surgical field. The surgeon controlled the movements of the endoscope with foot pedal. Eight patients underwent balanced endoscopic orbital decompression showing typical symptoms of Graves' orbitopathy preoperatively. Balanced decompression was performed via a combined approach transnasally and laterally via a small skin incision. RESULTS Attaching the endoscope to the robotic guiding system and placing it in the nasal cavity were relatively simple procedures. Setup time was less than 10 minutes. Tool motion and control using the foot pedal were comfortable and adequately precise. Movements of the attached endoscope inside the nose were feasible and allowed 2-hand surgery. The patients did not show any adverse events or complications. CONCLUSION The Medineering Robotic Endoscope Guiding System seems to be a safe and effective support in endoscopic skull base surgery especially for orbital decompression, thus allowing 2-hand or even 4-hand settings. To the best of our knowledge, this is the first study describing the successful application of a robotic system in orbital surgery.
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Affiliation(s)
- Stefan Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Anke Schlüter
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Kerstin Stähr
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Laura Holtmann
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Timon Hussain
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Oliver Kanaan
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Anja Eckstein
- Department of Ophthalmology, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
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Friedrich DT, Sommer F, Scheithauer MO, Greve J, Hoffmann TK, Schuler PJ. An Innovate Robotic Endoscope Guidance System for Transnasal Sinus and Skull Base Surgery: Proof of Concept. J Neurol Surg B Skull Base 2017; 78:466-472. [PMID: 29134165 PMCID: PMC5680027 DOI: 10.1055/s-0037-1603974] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/16/2017] [Indexed: 12/18/2022] Open
Abstract
Objective Advanced transnasal sinus and skull base surgery remains a challenging discipline for head and neck surgeons. Restricted access and space for instrumentation can impede advanced interventions. Thus, we present the combination of an innovative robotic endoscope guidance system and a specific endoscope with adjustable viewing angle to facilitate transnasal surgery in a human cadaver model. Materials and Methods The applicability of the robotic endoscope guidance system with custom foot pedal controller was tested for advanced transnasal surgery on a fresh frozen human cadaver head. Visualization was enabled using a commercially available endoscope with adjustable viewing angle (15-90 degrees). Results Visualization and instrumentation of all paranasal sinuses, including the anterior and middle skull base, were feasible with the presented setup. Controlling the robotic endoscope guidance system was effectively precise, and the adjustable endoscope lens extended the view in the surgical field without the common change of fixed viewing angle endoscopes. Conclusion The combination of a robotic endoscope guidance system and an advanced endoscope with adjustable viewing angle enables bimanual surgery in transnasal interventions of the paranasal sinuses and the anterior skull base in a human cadaver model. The adjustable lens allows for the abandonment of fixed-angle endoscopes, saving time and resources, without reducing the quality of imaging.
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Affiliation(s)
- D T Friedrich
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - F Sommer
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - M O Scheithauer
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - J Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - T K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - P J Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
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Bolzoni Villaret A, Doglietto F, Carobbio A, Schreiber A, Panni C, Piantoni E, Guida G, Fontanella MM, Nicolai P, Cassinis R. Robotic Transnasal Endoscopic Skull Base Surgery: Systematic Review of the Literature and Report of a Novel Prototype for a Hybrid System (Brescia Endoscope Assistant Robotic Holder). World Neurosurg 2017; 105:875-883. [PMID: 28645603 DOI: 10.1016/j.wneu.2017.06.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although robotics has already been applied to several surgical fields, available systems are not designed for endoscopic skull base surgery (ESBS). New conception prototypes have been recently described for ESBS. The aim of this study was to provide a systematic literature review of robotics for ESBS and describe a novel prototype developed at the University of Brescia. METHODS PubMed and Scopus databases were searched using a combination of terms, including Robotics OR Robot and Surgery OR Otolaryngology OR Skull Base OR Holder. The retrieved papers were analyzed, recording the following features: interface, tools under robotic control, force feedback, safety systems, setup time, and operative time. A novel hybrid robotic system has been developed and tested in a preclinical setting at the University of Brescia, using an industrial manipulator and readily available off-the-shelf components. RESULTS A total of 11 robotic prototypes for ESBS were identified. Almost all prototypes present a difficult emergency management as one of the main limits. The Brescia Endoscope Assistant Robotic holder has proven the feasibility of an intuitive robotic movement, using the surgeon's head position: a 6 degree of freedom sensor was used and 2 light sources were added to glasses that were therefore recognized by a commercially available sensor. CONCLUSIONS Robotic system prototypes designed for ESBS and reported in the literature still present significant technical limitations. Hybrid robot assistance has a huge potential and might soon be feasible in ESBS.
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Affiliation(s)
- Andrea Bolzoni Villaret
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
| | - Andrea Carobbio
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Camilla Panni
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Enrico Piantoni
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Giovanni Guida
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Marco Maria Fontanella
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo Cassinis
- Department of Information Engineering, University of Brescia, Brescia, Italy
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Friedrich DT, Scheithauer MO, Greve J, Hoffmann TK, Schuler PJ. Recent advances in robot-assisted head and neck surgery. Int J Med Robot 2016; 13. [DOI: 10.1002/rcs.1744] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/12/2016] [Accepted: 02/08/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel T. Friedrich
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
| | - Marc O. Scheithauer
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
| | - Jens Greve
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
| | - Thomas K. Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
| | - Patrick J. Schuler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
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Chan JYK, Leung I, Navarro-Alarcon D, Lin W, Li P, Lee DLY, Liu YH, Tong MCF. Foot-controlled robotic-enabled endoscope holder for endoscopic sinus surgery: A cadaveric feasibility study. Laryngoscope 2015; 126:566-9. [PMID: 26372615 DOI: 10.1002/lary.25634] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the feasibility of a unique prototype foot-controlled robotic-enabled endoscope holder (FREE) in functional endoscopic sinus surgery. STUDY DESIGN Cadaveric study. METHODS Using human cadavers, we investigated the feasibility, advantages, and disadvantages of the robotic endoscope holder in performing endoscopic sinus surgery with two hands in five cadaver heads, mimicking a single nostril three-handed technique. RESULTS The FREE robot is relatively easy to use. Setup was quick, taking less than 3 minutes from docking the robot at the head of the bed to visualizing the middle meatus. The unit is also relatively small, takes up little space, and currently has four degrees of freedom. The learning curve for using the foot control was short. The use of both hands was not hindered by the presence of the endoscope in the nasal cavity. The tremor filtration also aided in the smooth movement of the endoscope, with minimal collisions. CONCLUSION The FREE endoscope holder in an ex-vivo cadaver test corroborated the feasibility of the robotic prototype, which allows for a two-handed approach to surgery equal to a single nostril three-handed technique without the holder that may reduce operating time. Further studies will be needed to evaluate its safety profile and use in other areas of endoscopic surgery. LEVEL OF EVIDENCE NA. Laryngoscope, 126:566-569, 2016.
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Affiliation(s)
- Jason Y K Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT
| | - Iris Leung
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT
| | - David Navarro-Alarcon
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, NT
| | - Weiyang Lin
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, NT
| | - Peng Li
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, NT
| | - Dennis L Y Lee
- Department of Ear, Nose and Throat, United Christian Hospital, Kowloon East Cluster, Hong Kong, Special Administrative Region of the People's Republic of China
| | - Yun-hui Liu
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, NT
| | - Michael C F Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT
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A single-port operator-controlled flexible endoscope system for endoscopic skull base surgery. HNO 2015; 63:189-94. [DOI: 10.1007/s00106-014-2950-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Assessment of the endoscopic range of motion for head and neck surgery using the SOLOASSIST endoscope holder. Int J Med Robot 2015; 11:418-23. [DOI: 10.1002/rcs.1643] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 12/19/2014] [Accepted: 12/19/2014] [Indexed: 01/02/2023]
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Kristin J, Kolmer A, Kraus P, Geiger R, Klenzner T. Development of a new endoscope holder for head and neck surgery--from the technical design concept to implementation. Eur Arch Otorhinolaryngol 2014; 272:1239-44. [PMID: 24760308 DOI: 10.1007/s00405-014-3052-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
Abstract
Endoscope holders are utilized by a variety of surgeons but are not commonplace in head and neck surgery. The SOLOASSIST active camera holder, which is currently used for abdominal surgery, will soon be adapted for head and neck surgery in collaboration with AKTORmed GmbH SOLO SURGERY (Barbing, Germany). In our pre-feasibility study, we analyzed the use of the existing endoscope holder on anatomical specimens during head and neck surgery. Based on these results, we are proceeding towards the development of a new endoscope holder for head and neck surgery. First, we drafted the technical concepts and discussed the advantages and disadvantages of the system. Then, we used anatomic specimens to measure the forces that occur intraoperatively during sinus surgery. Next, we designed a computer-aided design (CAD) model. Finally, we developed the first production prototype and used it for a frontal skull base procedure on an anatomical specimen. We present the three most promising concepts for a new holder. The resulting total force (F res = √(X (2) + Y (2) + Z (2))) was calculated to be 3.2 N during sinus surgery. We could observe all necessary intraoperative landmarks with the endoscope and its holder in a sinus and frontal skull base surgery. We developed a production prototype of a new endoscope holder and demonstrate satisfactory results in the use of anatomic specimens for skull base surgery.
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Affiliation(s)
- Julia Kristin
- University Hospital Duesseldorf Head and Neck Surgery, Moorenstrasse 5, 40225, Düsseldorf, Germany,
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Robotic endoscopic sinus and skull base surgery: review of the literature and future prospects. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130:201-7. [PMID: 23725665 DOI: 10.1016/j.anorl.2012.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 03/16/2012] [Accepted: 03/27/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE There has been a considerable growth in the indications of endonasal surgery that now include malignant tumours of the nasal fossae and anterior and middle cranial fossa. However, new limitations have also been identified, such as bleeding and cerebrospinal fluid leak, as well as the need to use several instruments simultaneously. Can robotics provide solutions to these problems? METHOD Review of the literature based on the three main databases: Medline, Pubmed and Cochrane. RESULTS Ten publications were identified. Some authors have developed surgical approaches to the skull base using the da Vinci(®) robot, while others have designed specific robots. CONCLUSION None of the currently available solutions appears to be completely suitable. The da Vinci(®) robot is very cumbersome and can only be used in the middle cranial fossa via complex and relatively invasive routes. The other robots are laboratory prototypes. We are currently developing an innovative, compact, ergonomic and safe dedicated endoscope holder.
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Robotic surgery in oral and maxillofacial, craniofacial and head and neck surgery: A systematic review of the literature. Int J Oral Maxillofac Surg 2012; 41:1311-24. [DOI: 10.1016/j.ijom.2012.05.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 03/05/2012] [Accepted: 05/24/2012] [Indexed: 02/07/2023]
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Kristin J, Geiger R, Knapp FB, Schipper J, Klenzner T. [Use of a mechatronic robotic camera holding system in head and neck surgery]. HNO 2012; 59:575-81. [PMID: 21509620 DOI: 10.1007/s00106-011-2273-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND It has been shown that a third hand is useful for holding the endoscope during endoscopic surgery so that both hands of the surgeon are free for instrumentation. MATERIAL AND METHODS Experimental tests were performed with the mechatronic robotic camera holding system Soloassist on anatomical specimens in the area of the nose, nasopharynx and larynx. RESULTS An ergonomic set-up and the practical application are easily possible. The third hand enables a still and clear picture without undesired camera movement and all instruments can be controlled by the surgeon. There would appear to be some room for improvement as the working area is limited due to an additional instrument. The camera holding system shows a very high velocity for head and neck surgery. CONCLUSION Until the active holder can be used regularly in clinical practice in the field of head and neck surgery, more technical modifications have to be implemented.
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Affiliation(s)
- J Kristin
- HNO-Universitätsklinikum, Moorenstrasse 5, 40225, Düsseldorf, Deutschland.
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[Update: catheter-based balloon dilatation of the sinuses without fluoroscopy. Dilation technique with an illumination system]. HNO 2008; 56:817-21. [PMID: 18651115 DOI: 10.1007/s00106-008-1772-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Catheter-based balloon dilation of the sinus ostia follows the general guidelines for functional endoscopic sinus surgery with the goal of reopening the sinus ostium to restore ventilation and drainage of the sinus and reestablish normal mucosal function, while maintaining normal mucosal tissue and avoiding scar tissue formation. A main criticism of this procedure questions the necessity of fluoroscopy with the C-arm since its use exposes patients and medical personnel to radiation and the C-arm is not available in every ENT operating room. MATERIAL AND METHODS Catheter-based balloon dilation of the sinus ostia was performed with the Relieva Luma Sinus Illumination System (Acclarent, Inc.) without fluoroscopy. RESULTS Using this method of illumination, it was possible to localize the device tip transcutaneously in the maxillary and frontal sinus cavities, making radiological exposure unnecessary. CONCLUSION The advantages of catheter-based balloon dilation without fluoroscopy lie in the elimination of radiation exposure to the patient and personnel as well as the cost savings. Randomized controlled trials should be planned to further evaluate this technique.
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Caversaccio M, Zheng G, Nolte LP. [Computer-aided surgery of the paranasal sinuses and the anterior skull base]. HNO 2008; 56:376-8, 780-2. [PMID: 18345525 DOI: 10.1007/s00106-008-1705-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Endoscopic or microscopic surgery for chronic rhinosinusitis with or without nasal polyps is a routine intervention in daily practice. It is often a delicate and difficult minimally invasive intervention in a narrow space, with a tunnel view of 4 mm in the case of endoscopy and frequent bleeding in chronically inflamed tissue. Therefore, orientation in such a "labyrinth" is often difficult. In the case of polyp recurrence or tumors, the normal anatomical landmarks are often missing, which renders orientation even more difficult. In such cases, computer-aided navigation together with images such as those from computed tomography or magnetic resonance imaging can support the surgeon to make the operation more accurate and, in some cases, faster. Computer-aided surgery also has great potential for education.
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Affiliation(s)
- M Caversaccio
- Klinik für HNO, Kopf- und Halschirurgie, Inselspital, Universität Bern, Freiburgstrasse, 3010 Bern, Schweiz.
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Affiliation(s)
- P A Federspil
- Univ.-Hals-Nasen-Ohrenklinik, Universitätsklinikum Heidelberg, 69120, Im Neuenheimer Feld 400, Heidelberg.
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Widmann G. Image-guided surgery and medical robotics in the cranial area. Biomed Imaging Interv J 2007; 3:e11. [PMID: 21614255 PMCID: PMC3097655 DOI: 10.2349/biij.3.1.e11] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 02/21/2007] [Indexed: 11/17/2022] Open
Abstract
Surgery in the cranial area includes complex anatomic situations with high-risk structures and high demands for functional and aesthetic results. Conventional surgery requires that the surgeon transfers complex anatomic and surgical planning information, using spatial sense and experience. The surgical procedure depends entirely on the manual skills of the operator. The development of image-guided surgery provides new revolutionary opportunities by integrating presurgical 3D imaging and intraoperative manipulation. Augmented reality, mechatronic surgical tools, and medical robotics may continue to progress in surgical instrumentation, and ultimately, surgical care. The aim of this article is to review and discuss state-of-the-art surgical navigation and medical robotics, image-to-patient registration, aspects of accuracy, and clinical applications for surgery in the cranial area.
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Affiliation(s)
- G Widmann
- Department of Radiology, Innsbruck Medical University, Anichstr, Austria
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Abstract
PURPOSE OF REVIEW Patients with advanced head and neck cancer are being treated with chemo-radiotherapy, and life is being prolonged, with or without persistent disease, for longer than was previously. Hypercalcaemia may present in patients with advanced or disseminated head and neck cancer, and, as such, these patients may present to a larger variety of clinicians for advice concerning their symptoms and illness. Modes of presentation of hypercalcaemia and treatment strategies are reviewed. RECENT FINDINGS There were previously few large series of head and neck cancer patients diagnosed with hypercalcaemia, which may or may not have been related to their cancer being treated. Investigations, by way of blood/serum calcium level, may identify such patients. Patients with cancer-related hypercalcaemia have a poor prognosis, but many may respond temporarily to treatment when offered, with an improvement of their quality of life and death. SUMMARY Hypercalcaemia should and must be considered in all patients who have or possibly have a diagnosis of a head and neck cancer and who present unwell with symptoms of fatigue, lethargy and somnolence. Investigation must include serum calcium (corrected for serum albumin binding) and parathyroid hormone level. Patients may be treated by a combination of rehydration and bisulphonate therapy until the serum calcium is reduced to a level below 3 mmol/l. The majority of patients diagnosed with hypercalcaemia due to head and neck malignancy die of their diseases in the short term, but some may enjoy a prolongation of life with reasonable quality if diagnosed and treated aggressively.
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Affiliation(s)
- Patrick J Bradley
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Nottingham, UK.
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