Computer aided surgery: concepts and applications in rhinology

Endoscopic Endonasal Trans-Sphenoidal Minimally Invasive Pituitary Surgery with Image Guided Navigation System (Igns): Learning Experience of Ent Surgeon: First Author

Introduction- Endoscopic minimally invasive pituitary surgery (MIPS) is advantageous over microscopic technique, as it provides superior close up, wide angle view of surgical target area. Image guided navigation system (IGNS) guides the surgeon to localize the lesion. In the present study we analyzed the Image Guided Surgical procedure and outcome of Endoscopic minimally invasive pituitary surgery and shared our experiences regarding disease clearance.

MATERIALS AND METHODS

During the period of April 2015 to August 2022 a total 104 patients, diagnosed with pituitary adenoma underwent surgery and further followed up in a multidisciplinary team approach in a tertiary care hospital of Kolkata, India. The data obtained were reviewed statistically to satisfy the study objectives.

RESULTS

Total 104 operations were done on 98 patients and total cases taken for calculation and analysis was 98, which consist of 11 microadenomas, 81 macroadenomas. Among 35 patients with normal preoperative hormonal assay, one patient developed postoperative hypopituitarism. Among 6 patients with preoperative hypopituitarism 4 patients (66.6%) recovered after surgery. Overall, 85 cases had total disease clearance as detected on post-operative MRI. In functioning pituitary adenoma (FPA) clinical and endocrinological improvement occurred after primary surgery in 85.36% (n = 35) and after revision surgery it was 84.44% (n = 38). Macroadenomas, giant adenomas were found to have statistically significant higher risk of incomplete disease clearance but large adenomas do not have statistically higher risk of incomplete clearance.

CONCLUSION

IGNS requires extra time for setup, but with proper registration of tracker instruments it adds precision to the surgery. IGNS supplements endoscopic visualization with localization of target lesion by real time stereotactic feedback using preset preoperative imaging data, thus increasing accuracy, safety and effectiveness of minimally invasive surgery.

The Evolution and Application of Artificial Intelligence in Rhinology: A State of the Art Review

OBJECTIVE

To provide a comprehensive overview on the applications of artificial intelligence (AI) in rhinology, highlight its limitations, and propose strategies for its integration into surgical practice.

DATA SOURCES

Medline, Embase, CENTRAL, Ei Compendex, IEEE, and Web of Science.

REVIEW METHODS

English studies from inception until January 2022 and those focusing on any application of AI in rhinology were included. Study selection was independently performed by 2 authors; discrepancies were resolved by the senior author. Studies were categorized by rhinology theme, and data collection comprised type of AI utilized, sample size, and outcomes, including accuracy and precision among others.

CONCLUSIONS

An overall 5435 articles were identified. Following abstract and title screening, 130 articles underwent full-text review, and 59 articles were selected for analysis. Eleven studies were from the gray literature. Articles were stratified into image processing, segmentation, and diagnostics (n = 27); rhinosinusitis classification (n = 14); treatment and disease outcome prediction (n = 8); optimizing surgical navigation and phase assessment (n = 3); robotic surgery (n = 2); olfactory dysfunction (n = 2); and diagnosis of allergic rhinitis (n = 3). Most AI studies were published from 2016 onward (n = 45).

IMPLICATIONS FOR PRACTICE

This state of the art review aimed to highlight the increasing applications of AI in rhinology. Next steps will entail multidisciplinary collaboration to ensure data integrity, ongoing validation of AI algorithms, and integration into clinical practice. Future research should be tailored at the interplay of AI with robotics and surgical education.

Clinical Application of Augmented Reality in Computerized Skull Base Surgery

Cranial base tactics comprise the regulation of tiny and complicated structures in the domains of otology, rhinology, neurosurgery, and maxillofacial medical procedure. Basic nerves and veins are in the nearness of these buildings. Increased the truth is a coming innovation that may reform the cerebral basis approach by supplying vital physical and navigational facts brought together in a solitary presentation. In any case, the awareness and acknowledgment of prospective results of expanding reality frameworks in the cerebral base region are really poor. This article targets examining the handiness of expanded reality frameworks in cranial foundation medical procedures and emphasizes the obstacles that present innovation encounters and their prospective adjustments. A specialized perspective on distinct strategies used being produced of an improved realty framework is furthermore offered. The newest item offers an expansion in interest in expanded reality frameworks that may motivate more secure and practical procedures. In any case, a couple of concerns have to be cared to before that can be for the vast part fused into normal practice.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

I.

EXECUTIVE SUMMARY

BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document.

METHODS

ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary.

RESULTS

ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided.

CONCLUSION

This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.

Image-Guided Surgery and Intraoperative Imaging in Rhinology: Clinical Update and Current State of the Art

INTRODUCTION

Image-guided surgery (IGS) has gained widespread acceptance in otorhinolaryngology for its applications in sinus and skull base surgery. Although the core concepts of IGS have not changed, advances in image guidance technology, including the incorporation of intraoperative imaging, have the potential to enhance surgical education, allow for more rigorous preoperative planning, and aid in more complete surgery with improved outcomes.

OBJECTIVES

Provide a clinical update regarding the use of image guidance and intraoperative imaging in the field of rhinology and endoscopic skull base surgery with a focus on current state of the art technologies.

METHODS

English-language studies published in PubMed, Cochrane, and Embase were searched for articles relating to image-guided sinus surgery, skull base surgery, and intraoperative imaging. Relevant studies were reviewed and critical appraisals were included in this clinical update, highlighting current state of the art advances.

CONCLUSIONS

As image guidance and intraoperative imaging systems have advanced, their applications in sinus and skull base surgery have expanded. Both technologies offer invaluable real-time feedback on the status and progress of surgery, and thus may help to improve the completeness of surgery and overall outcomes. Recent advances such as augmented and virtual reality offer a window into the future of IGS. Future advancements should aim to enhance the surgeon's operative experience by improving user satisfaction and ultimately lead to better surgical results.

Next-Generation Surgical Navigation Systems in Sinus and Skull Base Surgery

Over the past 25 years, rhinologists have adopted surgical navigation technology for endoscopic sinus and skull base procedures. Navigation systems often produce a wide target registration error (TRE). Ideally, next-generation systems will include a leap in target registration error reduce TRE through innovative hardware and software. Incorporation of microsensors will be another important innovation. Future systems are likely to include augmented reality, which can project overlays of critical anatomy on real-world endoscopic images. Recent trends in surgical navigation suggest a phase of rapid evolution.

Binasal endoscopic approach to the sellar region: experience and outcome analysis of 80 cases

A prospective study was performed on 80 cases of different types of sellar lesions during the period between January 2007 and December 2010. The binasal approach was used in all patients. Functioning lesions were diagnosed in 59 patients. The most common secretory tumors were prolactinomas (37 patients) followed by adrenocorticotropic hormone producing tumors (11 patients) and growth hormone producing tumors (11 patients). Nonfunctioning lesions included: 14 pituitary adenomas, 2 chordomas, 2 metastatic lesions (ovarian carcinoma and thyroid carcinoma), and 1 case of sarcoidosis, Rathke's cleft cyst, and craniopharyngioma. Seven nonfunctioning cases developed apoplexy. Among the 59 patients with functioning pituitary lesions, postoperative endocrinological control was achieved in 51 of them (86.5%) 3 months postoperatively with normalization of pituitary functions and complete tumor resection as proved by postoperative magnetic resonance imaging. Postoperative visual field defect improvement was achieved in 15 out of 23 patients (65.2%), including the cases with apoplexy, with complete tumor resection. Postoperative discomfort such as headache, vomiting, or dizziness was minimal and hospitalization period was 2 to 3 days. Postoperative leak continued in one patient in whom revision surgical repair was performed 7 days later. The merits, outcome, and limitations of the approach were discussed.

A noncontact laser-guided system for endoscopic computer-assisted sinus surgery

The limited size of the nose leads to frequent instrument changes in navigated endonasal sinus surgery. Tracked instruments provide limited accuracy, and the pointer gives no navigation information during tissue removal. To overcome information loss, laser triangulation was integrated into navigation information. Accuracy and reliability of the laser-assisted distance-measuring system were evaluated within the distance of 0 and 20 mm. System accuracy of the laser endoscope was compared with a standard pointer using registration via bone screws and surface matching. Accuracy of the laser was 0.12 mm ± 0.12 mm with a reliability of 0.2 mm. The system accuracy of the laser endoscope was 0.59 mm ± 0.16 mm using bone screw registration and 0.64 mm ± 0.22 mm using surface matching. Additionally, laser endoscope is more accurate compared with the pointer using bone screw registration. Overall, navigation information was successfully integrated into an endoscope by laser triangulation with encouraging results.

Augmented image guidance improves skull base navigation and reduces task workload in trainees: a preclinical trial

OBJECTIVES/HYPOTHESIS

Our group has developed an augmented image guidance system that incorporates intraoperative cone-beam computed tomography (CBCT), virtual or augmented displays, and image registration. We assessed the potential benefits of augmented endoscopy derived from this system for use during skull base navigation. Specifically, we wished to evaluate target localization accuracy and the effect on task workload and confidence.

STUDY DESIGN

Prospective, sequential, paired preclinical trial.

METHODS

A single cadaver head underwent computed tomography, and critical structures were contoured. The specimen was reimaged after endoscopic dissection and deformable registration allowed contours to be displayed on postablation CBCT imaging. A real-time virtual view including anatomical contours was provided parallel to the real endoscopic image. Twelve subjects were asked to endoscopically localize seven skull base landmarks in a conventional manner. The same exercise was then performed with augmented endoscopy. Precise three-dimensional (3D) localization was recorded with a tracked probe. The NASA task load index was completed after each exercise. A short questionnaire was also administered.

RESULTS

The real-time augmented image guidance system aided localization in 85% of responses and increased confidence in 97%. There was a significant reduction in mental demand, effort, and frustration when the technology was employed, with an increase in perceived performance (P < .05). Three dimensional navigational precision was improved for all landmarks.

CONCLUSIONS

Real-time augmented image-guided surgery increases accuracy and confidence in trainee surgeons and decreases task workload during skull base navigation. This technology shows great promise in assisting in skull base surgery even for experienced surgeons.

Medicolegal issues in endoscopic sinus surgery

Endoscopic sinus surgery is one of the most litigated areas in otolaryngology. Physicians typically receive little education regarding medicolegal issues during training and may find themselves in an unfamiliar territory during litigation. This article reviews the scope of the problem and provides strategies to improve patient care and mitigate medicolegal risk in endoscopic sinus surgery.

Intraoperative surgical navigation for endoscopic sinus surgery: rationale and indications

PURPOSE OF REVIEW

The present review discusses the rationale and indications for image-guided surgery through a critical discussion of registration concepts as well as clinical reports.

RECENT FINDINGS

The surgical navigation accuracy achieved by commercially available image-guided surgery systems is best reported as target registration error. Clinically achievable target registration error is probably in the 1.5-2.0 mm range. Dry lab studies of registration serve to highlight the principles of registration, the process through which image-guided surgery systems calculate the one-to-one mapping relationship between the preoperative imaging data and the intraoperative surgical volume. Reports on image-guided surgery have highlighted its usefulness in primary and revision endoscopic sinus surgery, osteoplastic frontal sinusotomy, transsphenoidal hypophysectomy, endoscopic cerebrospinal fluid leak repair and endoscopic pterygomaxillary fossa biopsy. Both three-dimensional computed tomography angiography and computed tomography-magnetic resonance fusion images have been incorporated into IGS for advanced minimally invasive endoscopic skull base procedures. The American Academy of Otolaryngology-Head and Neck Surgery policy statement accurately summarizes the current consensus for image-guided surgery applications.

SUMMARY

Image-guided surgery has emerged as an important technology, which both general otolaryngologists and subspecialty rhinologists can employ for a wide variety of procedures.