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Scherl C, Otto M, Ghanem I, Moviglia J, Sadi F, Gnilka T, Rotter N, Zaubitzer L, Stallkamp J. [Development and evaluation of ultrasound navigation for free-hand biopsies of small masses in the head and neck area]. HNO 2024; 72:76-82. [PMID: 38051313 PMCID: PMC11362245 DOI: 10.1007/s00106-023-01385-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Ultrasound is an important imaging method in the head and neck area. It is readily available, dynamic, inexpensive, and does not involve radiation exposure. Interventions in the complex head and neck anatomy require good orientation, which is supported by navigation systems. OBJECTIVE This work aimed to develop a new ultrasound-controlled navigation system for taking biopsies of small target structures in the head and neck region. METHODS A neck phantom with sonographically detectable masses (size: 8-10 mm) was constructed. These were automatically segmented using a ResNet-50-based deep neural network. The ultrasound scanner was equipped with an individually manufactured tracking tool. RESULTS The positions of the ultrasound device, the masses, and a puncture needle were recorded in the world coordinate system. In 8 out of 10 cases, an 8‑mm mass was hit. In a special evaluation phantom, the average deviation was calculated to be 2.5 mm. The tracked biopsy needle is aligned and navigated to the masses by auditory feedback. CONCLUSION Outstanding advantages compared to conventional navigation systems include renunciation of preoperative tomographic imaging, automatic three-dimensional real-time registration that considers intraoperative tissue displacements, maintenance of the surgeon's optical axis at the surgical site without having to look at a navigation monitor, and working freely with both hands without holding the ultrasound scanner during biopsy taking. The described functional model can also be used in open head and neck surgery.
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Affiliation(s)
- Claudia Scherl
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
- AI Health Innovation Cluster, Heidelberg-Mannheim Health and Life Science Alliance, Heidelberg, Deutschland.
| | - Marie Otto
- Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland
| | - Ibrahim Ghanem
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Javier Moviglia
- Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland
| | - Fabian Sadi
- Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland
| | - Tirza Gnilka
- Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland
| | - Nicole Rotter
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Lena Zaubitzer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Jan Stallkamp
- Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland
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Švaco M, Stiperski I, Dlaka D, Šuligoj F, Jerbić B, Chudy D, Raguž M. Stereotactic Neuro-Navigation Phantom Designs: A Systematic Review. Front Neurorobot 2020; 14:549603. [PMID: 33192433 PMCID: PMC7644893 DOI: 10.3389/fnbot.2020.549603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022] Open
Abstract
Diverse stereotactic neuro-navigation systems are used daily in neurosurgery and novel systems are continuously being developed. Prior to clinical implementation of new surgical tools, methods or instruments, in vitro experiments on phantoms should be conducted. A stereotactic neuro-navigation phantom denotes a rigid or deformable structure resembling the cranium with the intracranial area. The use of phantoms is essential for the testing of complete procedures and their workflows, as well as for the final validation of the application accuracy. The aim of this study is to provide a systematic review of stereotactic neuro-navigation phantom designs, to identify their most relevant features, and to identify methodologies for measuring the target point error, the entry point error, and the angular error (α). The literature on phantom designs used for evaluating the accuracy of stereotactic neuro-navigation systems, i.e., robotic navigation systems, stereotactic frames, frameless navigation systems, and aiming devices, was searched. Eligible articles among the articles written in English in the period 2000-2020 were identified through the electronic databases PubMed, IEEE, Web of Science, and Scopus. The majority of phantom designs presented in those articles provide a suitable methodology for measuring the target point error, while there is a lack of objective measurements of the entry point error and angular error. We identified the need for a universal phantom design, which would be compatible with most common imaging techniques (e.g., computed tomography and magnetic resonance imaging) and suitable for simultaneous measurement of the target point, entry point, and angular errors.
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Affiliation(s)
- Marko Švaco
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Ivan Stiperski
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
| | - Domagoj Dlaka
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Filip Šuligoj
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Bojan Jerbić
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Darko Chudy
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
- Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
- Department of Surgery, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
- Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
- Department of Anatomy and Clinical Anatomy, School of Medicine University of Zagreb, Zagreb, Croatia
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Prospect of robotic assistance for fully automated brachytherapy seed placement into skull base: Experimental validation in phantom and cadaver. Radiother Oncol 2020; 131:160-165. [PMID: 29269094 DOI: 10.1016/j.radonc.2017.11.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE To investigate the feasibility and accuracy of robot-assisted brachytherapy for skull base tumours. MATERIAL AND METHODS A custom robot system was tested on both phantom and cadaveric specimen. Cone beam CT (CBCT) images were transferred to the graphical user interface (GUI) for planning trajectories and the data were sent to the robot control unit. Following registration, the puncture needle was inserted into the target by the robot under navigation guidance, and seeds were implanted. Placement error was instantly displayed on the GUI; the result was verified after postoperative image scanning. RESULTS A total of 150 seeds (100 for phantom experiments, 50 for cadaveric studies) were deposited by the robot system. In phantom experiments the mean placement error was 0.57 ± 0.21 mm (measured by the navigation system) vs. 1.41 ± 0.38 mm (measured by image fusion) (p < 0.001); in cadaveric studies the corresponding figures were 0.60 ± 0.30 mm vs. 2.48 ± 0.32 mm (p < 0.001). There was no significant difference for comparison of accuracy test in phantom experiments (p = 0.173) as well as in cadaveric studies (p = 0.354). Accuracy was better in the phantom experiment than in cadaveric studies (p < 0.001). CONCLUSIONS The performance of robot-assisted skull base brachytherapy is feasible and accurate. Dosimetric coverage will need to be demonstrated in further studies.
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Batista PD, Machado IP, Roios P, Lavrador J, Cattoni MB, Martins J, Carvalho H. Position and Orientation Errors in a Neuronavigation Procedure: A Stepwise Protocol Using a Cranial Phantom. World Neurosurg 2019; 126:e342-e350. [PMID: 30822590 DOI: 10.1016/j.wneu.2019.02.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Neuronavigation procedures demand high precision and accuracy. Despite this need, there are still few studies analyzing errors in such procedures. The aim of this study was to use a custom-built cranial phantom to measure target position and orientation errors in different phases of a simulated neuronavigation procedure. METHODS A cranial phantom with 10 target sites was designed and imaged with computed tomography and magnetic resonance. A segmentation of a cloud of points of the phantom (ground truth) was obtained using an optical tracking system and compared with the images (imaging phase). Targets and trajectories were then planned with neuronavigation software and compared with the ground truth (planning phase). The same plan was used to identify the points in real space after image-to-phantom registration and calculate the final error of the procedure by comparison with the ground truth (registration and execution phase). RESULTS The mean errors after the imaging phase were 1.11 ± 0.42 mm and 3.23° ± 1.69° for position and orientation, respectively. After planning the mean errors were 1.10 ± 0.39 mm and 5.55° ± 2.91°. The global errors after the registration and mechanical execution were 3.93 ± 1.70 mm and 3.65° ± 1.29°. CONCLUSIONS After a stepwise analysis, registration and mechanical execution were the main contributors to the global position error.
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Affiliation(s)
- Pedro D Batista
- Department of Neurosurgery, Hospital de Santa Maria, CHLN, Lisbon, Portugal.
| | - Inês P Machado
- IDMEC/LAETA, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Roios
- IDMEC/LAETA, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - José Lavrador
- Department of Neurosurgery, Hospital de Santa Maria, CHLN, Lisbon, Portugal; Department of Adult and Paediatric Neurosurgery, King's College Hospital, Foundation Trust, London, United Kingdom
| | - Maria B Cattoni
- Department of Neurosurgery, Hospital de Santa Maria, CHLN, Lisbon, Portugal
| | - Jorge Martins
- IDMEC/LAETA, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Herculano Carvalho
- Department of Neurosurgery, Hospital de Santa Maria, CHLN, Lisbon, Portugal
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Evaluation of the accuracy of computer-assisted techniques in the interstitial brachytherapy of the deep regions of the head and neck. Brachytherapy 2019; 18:217-223. [DOI: 10.1016/j.brachy.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/14/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022]
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[12 years of Computer-Aided Surgery around the Head : Developments in surgical planning and simulation from a Bern perspective]. HNO 2017; 64:625-9. [PMID: 27138367 DOI: 10.1007/s00106-016-0156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Over the past years, the multidisciplinary character of the international Computer-Aided Surgery around the Head (CAS-H) symposium has advanced many medical technologies, which were often adopted by industry. In Bern, the synergetic effects of the CAS-H symposium have enabled many experiences and developments in the area of computer-aided surgery. Planning and simulation methods in the areas of craniomaxillofacial surgery and otorhinolaryngology were developed and tested in clinical settings. In the future, further CAS-H symposia should follow, in order to promote the possibilities and applications of computer-assisted surgery around the head.
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Huang MW, Zhang JG, Zheng L, Liu SM, Yu GY. Accuracy evaluation of a 3D-printed individual template for needle guidance in head and neck brachytherapy. JOURNAL OF RADIATION RESEARCH 2016; 57:662-667. [PMID: 27422928 PMCID: PMC5137284 DOI: 10.1093/jrr/rrw033] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/30/2015] [Accepted: 02/11/2016] [Indexed: 06/06/2023]
Abstract
To transfer the preplan for the head and neck brachytherapy to the clinical implantation procedure, a preplan-based 3D-printed individual template for needle insertion guidance had previously been designed and used. The accuracy of needle insertion using this kind template was assessed in vivo In the study, 25 patients with head and neck tumors were implanted with 125I radioactive seeds under the guidance of the 3D-printed individual template. Patients were divided into four groups based on the site of needle insertion: the parotid and masseter region group (nine patients); the maxillary and paranasal region group (eight patients); the submandibular and upper neck area group (five patients); and the retromandibular region group (six patients). The distance and angular deviations between the preplanned and placed needles were compared, and the complications and time required for needle insertion were assessed. The mean entrance point distance deviation for all 619 needles was 1.18 ± 0.81 mm, varying from 0.857 ± 0.545 to 1.930 ± 0.843 mm at different sites. The mean angular deviation was 2.08 ± 1.07 degrees, varying from 1.85 ± 0.93 to 2.73 ± 1.18 degrees at different sites. All needles were manually inserted to their preplanned positions in a single attempt, and the mean time to insert one needle was 7.5 s. No anatomical complications related to inaccurately placed implants were observed. Using the 3D-printed individual template for the implantation of 125I radioactive seeds in the head and neck region can accurately transfer a CT-based preplan to the brachytherapy needle insertion procedure. Moreover, the addition of individual template guidance can reduce the time required for implantation and minimize the damage to normal tissues.
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Affiliation(s)
- Ming-Wei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
| | - Jian-Guo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
| | - Shu-Ming Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
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Widmann G, Schullian P, Ortler M, Bale R. Frameless stereotactic targeting devices: technical features, targeting errors and clinical results. Int J Med Robot 2011; 8:1-16. [DOI: 10.1002/rcs.441] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2011] [Indexed: 01/06/2023]
Affiliation(s)
- Gerlig Widmann
- Medical University of Innsbruck; SIP-Department for Microinvasive Therapy, Department of Radiology; Austria
| | - Peter Schullian
- Medical University of Innsbruck; SIP-Department for Microinvasive Therapy, Department of Radiology; Austria
| | - Martin Ortler
- Medical University of Innsbruck; Department of Neurosurgery; Austria
| | - Reto Bale
- Medical University of Innsbruck; SIP-Department for Microinvasive Therapy, Department of Radiology; Austria
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Kozak J, Krysztoforski K, Kroll T, Helbig S, Helbig M. Error analysis for determination of accuracy of an ultrasound navigation system for head and neck surgery. ACTA ACUST UNITED AC 2010; 14:69-82. [PMID: 20121587 DOI: 10.3109/10929080903230901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The use of conventional CT- or MRI-based navigation systems for head and neck surgery is unsatisfactory due to tissue shift. Moreover, changes occurring during surgical procedures cannot be visualized. To overcome these drawbacks, we developed a novel ultrasound-guided navigation system for head and neck surgery. A comprehensive error analysis was undertaken to determine the accuracy of this new system. MATERIALS AND METHODS The evaluation of the system accuracy was essentially based on the method of error definition for well-established fiducial marker registration methods (point-pair matching) as used in, for example, CT- or MRI-based navigation. This method was modified in accordance with the specific requirements of ultrasound-guided navigation. The Fiducial Localization Error (FLE), Fiducial Registration Error (FRE) and Target Registration Error (TRE) were determined. RESULTS In our navigation system, the real error (the TRE actually measured) did not exceed a volume of 1.58 mm(3) with a probability of 0.9. A mean value of 0.8 mm (standard deviation: 0.25 mm) was found for the FRE. The quality of the coordinate tracking system (Polaris localizer) could be defined with an FLE of 0.4 +/- 0.11 mm (mean +/- standard deviation). The quality of the coordinates of the crosshairs of the phantom was determined with a deviation of 0.5 mm (standard deviation: 0.07 mm). CONCLUSION The results demonstrate that our newly developed ultrasound-guided navigation system shows only very small system deviations and therefore provides very accurate data for practical applications.
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Affiliation(s)
- J Kozak
- Aesculap AG, Tuttlingen, Germany.
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Helbig M, Krysztoforski K, Kroll T, Kucharski J, Popek M, Helbig S, Gstoettner W, May A, Kozak J. Navigation-supported and sonographically-controlled fine-needle puncture in soft tissues of the neck. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:436-442. [PMID: 19056160 DOI: 10.1016/j.ultrasmedbio.2008.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 08/13/2008] [Accepted: 09/17/2008] [Indexed: 05/27/2023]
Abstract
In surgery, sonography has been a well-accepted means of orientation for years. The immediate vicinity of many vital structures in the head and neck region calls for a very exact visualization of the surgical instrument in the 2-D ultrasonic picture. We report on the development of a new method for navigation-supported and sonographically-controlled fine-needle puncture in soft tissues of the neck. Our system comprises a navigated ultrasound probe, a navigated fine-puncture needle and a coordinate sensor. A personal computer with specially-developed software assists calibration and surgical application. The applicability test for the system is described. In vitro, a model lymph node of 9 mm in diameter had been hit. It is shown that the target structure can be aimed at very precisely by the navigated puncture needle. An accuracy of 97% and a specificity of 99% could be demonstrated. The development of a very precise and easy-to-handle method for navigation-supported fine-needle puncture in the neck region is presented. The outstanding advantage of this method is that no rigid reference gadget fixed to the patient's body is necessary. That makes this method very suitable for surgery in the neck region. Contrary to other sonographically-supported navigation methods in the head and neck region, preoperative imaging (CT or MRT) is dispensable.
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Affiliation(s)
- M Helbig
- Department of Otolaryngology, Head and Neck Surgery, University of Frankfurt/Main, Frankfurt/Main, Germany.
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Helbig M, Krysztoforski K, Kucharski J, Popek M, Kroll T, Helbig S, May A, Gstoettner W, Kozak J. [Navigation-assisted sonography for soft tissues in the head and neck region]. HNO 2008; 57:1010-5. [PMID: 18846356 DOI: 10.1007/s00106-008-1801-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In soft tissue surgery of the head and neck region tissue shifts limit the usefulness of conventional CT/MRI-based navigation procedures. Furthermore, changes caused by invasive measures cannot be visualized. METHODS A novel navigation device for sonography of soft tissues was developed. This consists of a navigated ultrasound scanner, a navigated surgical instrument, and a personal computer with custom-made software. Its use makes an additional visualization by means of CT or MRI dispensable. RESULTS The system deviation (three-dimensional error) of this newly developed prototype was less than 1 mm. The practical application in a model setup showed good handling properties of the system. Orientation and approach of the surgical instrument to the sonographically visualized target structure were rapid and accurate. CONCLUSION This new navigation system does not require additional CT or MRI images. The navigated ultrasound probe shows tissue changes in real time. This navigation system is especially suitable for invasive procedures in soft tissues.
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Affiliation(s)
- M Helbig
- Zentrum für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main.
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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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Schulz AP, Tarabolsi M, Faber A, Meiners J, Kammal M, Mantwill F. Determination of optimal non-invasive patient fixation methods for use in robotic hip replacement surgery--an in vitro study. Int J Med Robot 2007; 3:135-9. [PMID: 17619243 DOI: 10.1002/rcs.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND A robotic system for the implantation of a total hip arthroplasty (THA) is currently under development. One of the goals of this system is non-invasive patient fixation, aiding the robotic system by an infrared tracking system. To determine the extent of fixation that can be achieved by non-invasive methods, an in vitro study was performed. METHODS In cadaver testing, different non-invasive fixation methods (Arthrex leg holder with tourniquet mechanism; arthroscopic leg holder with disposable foam inserts; gynaecological leg holder; Goepel knee crutch) were evaluated under load in different directions. RESULTS Deviation was measured in the range 0.33-18.1 mm with up to 20 N load. The testing showed the pneumatic leg holder system to provide the highest stability, followed by an arthroscopic leg holder system with foam inserts. CONCLUSIONS Use of a leg holder with foam inserts produced a stability that should enable tracking of the remaining deviation by the navigation system. We will therefore use this method in our future development of the robotic milling tool.
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Affiliation(s)
- A P Schulz
- Department of Trauma, Orthopaedics and Reconstructive Surgery, BG Trauma Hospital, Hamburg, Germany.
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Caversaccio M, Langlotz F, Nolte LP, Häusler R. Impact of a self-developed planning and self-constructed navigation system on skull base surgery: 10 years experience. Acta Otolaryngol 2007; 127:403-7. [PMID: 17453461 DOI: 10.1080/00016480601002104] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONCLUSION Our self-developed planning and navigation system has proven its capacity for accurate surgery on the anterior and lateral skull base. With the incorporation of augmented reality, image-guided surgery will evolve into 'information-guided surgery'. OBJECTIVE Microscopic or endoscopic skull base surgery is technically demanding and its outcome has a great impact on a patient's quality of life. The goal of the project was aimed at developing and evaluating enabling navigation surgery tools for simulation, planning, training, education, and performance. This clinically applied technological research was complemented by a series of patients (n=406) who were treated by anterior and lateral skull base procedures between 1997 and 2006. MATERIALS AND METHODS Optical tracking technology was used for positional sensing of instruments. A newly designed dynamic reference base with specific registration techniques using fine needle pointer or ultrasound enables the surgeon to work with a target error of < 1 mm. An automatic registration assessment method, which provides the user with a color-coded fused representation of CT and MR images, indicates to the surgeon the location and extent of registration (in)accuracy. Integration of a small tracker camera mounted directly on the microscope permits an advantageous ergonomic way of working in the operating room. Additionally, guidance information (augmented reality) from multimodal datasets (CT, MRI, angiography) can be overlaid directly onto the surgical microscope view. The virtual simulator as a training tool in endonasal and otological skull base surgery provides an understanding of the anatomy as well as preoperative practice using real patient data. RESULTS Using our navigation system, no major complications occurred in spite of the fact that the series included difficult skull base procedures. An improved quality in the surgical outcome was identified compared with our control group without navigation and compared with the literature. The surgical time consumption was reduced and more minimally invasive approaches were possible. According to the participants' questionnaires, the educational effect of the virtual simulator in our residency program received a high ranking.
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Affiliation(s)
- Marco Caversaccio
- Department of ORL, Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland.
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