A handheld flexible manipulator system for frontal sinus surgery.

Purpose: Draf drainage is the standard treatment procedure for frontal sinus diseases. In this procedure, rigid angled endoscopes and rigid curved instruments are used. However, laterally located pathologies in the frontal sinus cannot be reached with rigid instrumentation.

Anatomical Characterization of Frontal Sinus and Development of Representative Models.

This paper presents the methods and the materials towards characterizing frontal sinus anatomy and developing representative anatomical models which reflect the variance of the anatomy with three different sizes: small, medium and large. Anatomical characterization was performed using computer tomography data of up to 50 anonymous patients. Dimensional and volumetric measurements were conducted using the .

Voice Handicap Index-18 as an Instrument for Assessing Subjective Voice Impairment Between Voice Pre- and Post-treatment.

The Voice Handicap Index (VHI) is today regarded as the gold standard for measuring the subjective impairment of a voice disorder. The aim of our study is to present how the VHI in our version with 18 questions (VHI-18) can be evaluated with other patient collectives (practice visitors or everyday patients). The previous publications have shown that most patient groups were stationary or clinical.

The application of surgical procedure manager (SPM): first experience with FESS.

In our hypothesis, the newly developed program SPM (surgical procedure manager) will ensure successful standardization and efficiency of the FESS (functional endoscopic sinus surgery) and therefore make a decisive contribution in terms of economization and improvement of intraoperative quality. Between 27th March 2015 and 8th October 2015, data from 259 FESS procedures were collected using the SPM. The study took place at the surgical desk, an operating room in the ACQUA clinic in Leipzig, Germany.

Web-tool to Support Medical Experts in Probabilistic Modelling Using Large Bayesian Networks With an Example of Hinosinusitis.

For many complex diseases, finding the best patient-specific treatment decision is difficult for physicians due to limited mental capacity. Clinical decision support systems based on Bayesian networks (BN) can provide a probabilistic graphical model integrating all necessary aspects relevant for decision making. Such models are often manually created by clinical experts.

An Improved Instrument Table for Use in Functional Endoscopic Sinus Surgery.

Background: The clinical motivation for the current study was that various instrument tables are located far away from the patient's head, and the only way for the surgeon to access an instrument is via a scrub nurse. Thus, the idea for this study was the development and evaluation of an improved and conveniently positioned instrument table.

Material And Methods: An improved instrument table (IT) was designed, built, and tested.

Solving challenges in inter- and trans-disciplinary working teams: Lessons from the surgical technology field.

Introduction: Engineering a medical technology is a complex process, therefore it is important to include experts from different scientific fields. This is particularly true for the development of surgical technology, where the relevant scientific fields are surgery (medicine) and engineering (electrical engineering, mechanical engineering, computer science, etc.).

Less is sometimes more: a comparison of distance-control and navigated-control concepts of image-guided navigation support for surgeons.

Unlabelled: Image-guided navigation (IGN) systems provide automation support of intra-operative information analysis and decision-making for surgeons. Previous research showed that navigated-control (NC) systems which represent high levels of decision-support and directly intervene in surgeons' workflow provide benefits with respect to patient safety and surgeons' physiological stress but also involve several cost effects (e.g.

A new evaluation and training system for micro-telemanipulation at the middle ear.

In this article, a new surgical model for evaluating telemanipulators used in middle ear surgery is presented. The purpose of this work was to develop an evaluation and training system which imitates a typical surgical task of middle ear surgery and which can easily be repeated in order to get significant result. The abstract task can be performed manually or by means of a microsurgical telemanipulator and guaranties stable experimental conditions between different subjects at any time.

Potential of the navigated controlled surgery at the lateral skull base with the navigated control unit (NCU 2.0).

Segmentation for navigated control was in the first generation very time consuming. In the present version (NCU 2.0) the risk structure is segmented (instead of the work space), this leads to an enormous decrease in preparation time.

Surgical assistance for instruments' power control based on navigation and neuromonitoring.

In order to prevent nerve injuries during ear-nose-throat (ENT) and skull base surgery, the method Navigated Control Functional is presented. Thereby, the power of active instruments is controlled based on position information, provided by a surgical navigation system, and nerve activity information, provided by a neurophysiologic monitoring system. Electrical stimulation is usually required for the extraction of distance information from neurophysiologic signals (e.

Design and accuracy evaluation of a new navigated drill system for computer assisted ENT-surgery.

In this article a new navigated drill system for computer assisted ear, nose and throat (ENT) surgery is presented. The navigated drill and the microscope probe are part of a surgical navigation system for ENT-surgery. In particular, the accuracy of the new navigated drill is compared to an existing navigated drill experimentally under conditions close to the surgical workflow.

Automation in surgery: the impact of navigated-control assistance on performance, workload, situation awareness, and acquisition of surgical skills.

Objective: Human performance consequences of a new technology of image-guided navigation (IGN) support for surgeons are investigated.

Background: Navigated control (NC) represents an advancement of IGN technology. In contrast to currently available pointer-based systems, it represents a higher degree of automation that supports processes not only of information analysis and integration but also of intraoperative decision making.

Distance measurement in middle ear surgery using a telemanipulator.

In this article, a new tool for the intraoperative measurement of distances within the middle ear by means of a micromanipulator is presented. The purpose of this work was to offer the surgeon a highly accurate tool for measuring the distances between two points in the 3D operational field. The tool can be useful in various operations; this article focuses, however, on measuring the distance between the stapes footplate and the long process of the incus of the middle ear.

A technique with manipulator-assisted endoscope guidance for functional endoscopic sinus surgery: proof of concept.

Objective: The goal of this study was to examine the theoretical feasibility of a new manipulator system for endoscope guidance in functional endoscopic sinus surgery.

Study Design: The accuracy of endoscope positioning and time of endoscope movement with an endoscope manipulator system were determined with an artificial sinus model.

Setting: A laboratory trial was performed.

Systematic user-based assessment of "Navigated Control Spine" / Systematische, nutzerzentrierte Evaluation von "Navigated Control Spine".

The aim of this study was the systematic preclinical assessment of a new mill for spinal surgery. This mill automatically switches off at predefined workspace margins. The system is called the "Navigated Control Spine".

The influence of various registration procedures upon surgical accuracy during navigated controlled petrous bone surgery.

Objective: The goal of this study was to investigate the dependence of surgical accuracy with a navigated controlled (NC) drill on selected registration procedures.

Study Design: The target registration error of the instrument and the maximum proximity to a typical high-risk structure (facial nerve) were determined within an artificial petrous bone.

Setting: The studies took place in two groups: group 1, navigation bow with six integrated markers and attachment at the upper jaw, and group 2, landmark registration with four titanium microscrews.

Assessment of technical needs for surgical equipment by surgical process models.

The presented approach introduces a method for estimating the potential benefit of a surgical assist system prior to its actual development or clinical use. The central research question is: What minimal requirements must a future system meet so that its use would be more advantageous than a conventional or already existent method or system, and how can these requirements be obtained from routine clinical data? Forty-three cases of lumbar discectomies were analyzed with regard to activities related to bone ablation in order to predict the temporal requirements for an alternative strategy of using a surgical assist system for bone ablation. The study recorded and analyzed surgical process models (SPM), which are progression models with detailed and exact-to-the-second representations of surgical work steps, as a sensible means for the detailed quantification of the temporal needs of the system.

Image-guided navigation: the surgeon's perspective on performance consequences and human factors issues.

Background: Image-guided navigation (IGN) represents a first step in the automation of surgical functions. The use of IGN can involve several human factors issues that must be taken into account when evaluating their impact on surgical performance and patient safety.

Methods: A nationwide survey was conducted among 213 surgeons from 112 German hospitals in order to assess the perceived performance consequences and human factors issues of IGN, including changes of situation awareness, performance and workload, as well as issues of overreliance, skill degradation and usability.

Validation of knowledge acquisition for surgical process models.

Objective: Surgical Process Models (SPMs) are models of surgical interventions. The objectives of this study are to validate acquisition methods for Surgical Process Models and to assess the performance of different observer populations.

Design: The study examined 180 SPM of simulated Functional Endoscopic Sinus Surgeries (FESS), recorded with observation software.

First clinical application of a navigation-controlled shaver in paranasal sinus surgery.

Conventional, pointer-based navigated Functional Endoscopic Sinus Surgery (FESS) has been shown to have certain limitations: necessity of instrument change for navigation, changes in the surgeon's line-of-sight axis, and limited length of use of the navigation information. These limitations result in negative consequences regarding the surgeon's attentiveness in any given situation, as well as in his cognitive work-load. The principle of Navigated Control offers advantages concerning these problems and limitations of the conventionally navigated FESS.

Virtual endoscopy on a portable navigation system for ENT surgery.

Virtual endoscopy is considered as an ideal aid assessing the complex anatomy of patients and has already been evaluated in several clinical studies. However, due to the increasing quality of modern CT- and MRT-images, present virtual-endoscopy software relies on powerful hardware. In this contribution virtual endoscopy on a portable navigation system for ENT surgery is proposed.

The impact of haptic learning in telemanipulator-assisted surgery.

Background: The use of a telemanipulator requires special training and surgical performance is associated with a learning curve. The aim of this study was to demonstrate the potential value of Haptic-Visual over Visual-Only passive Training in telemanipulator-assisted surgery.

Methods: Two telemanipulator consoles (da Vinci, Intuitive Surgical) were linked through an Application Programer's Interface allowing the applicant at the training console to register the position and passively follow the motions of the instructor's master telemanipulators (MTMs) at the master console (Haptic-Visual Learning group, HVL).