Robot-assisted endoscope guidance versus manual endoscope guidance in functional endonasal sinus surgery (FESS)

Abstract

Background: Having one hand occupied with the endoscope is the major disadvantage for the surgeon when it comes to functional endoscopic sinus surgery (FESS). Only the other hand is free to use the surgical instruments. Tiredness or frequent instrument changes can thus lead to shaky endoscopic images.

Methods: We collected the pose data (position and orientation) of the rigid 0° endoscope and all the instruments used in 16 FESS procedures with manual endoscope guidance as well as robot-assisted endoscope guidance. In combination with the DICOM CT data, we tracked the endoscope poses and workspaces using self-developed tracking markers.

Results: All surgeries were performed once with the robot and once with the surgeon holding the endoscope. Looking at the durations required, we observed a decrease in the operating time because one surgeon doing all the procedures and so a learning curve occurred what we expected. The visual inspection of the specimens showed no damages to any of the structures outside the paranasal sinuses.

Conclusion: Robot-assisted endoscope guidance in sinus surgery is possible. Further CT data, however, are desirable for the surgical analysis of a tracker-based navigation within the anatomic borders. Our marker-based tracking of the endoscope as well as the instruments makes an automated endoscope guidance feasible. On the subjective side, we see that RASS brings a relief for the surgeon.

Chinese abstract

背景: 当外科医生进行功能内窥镜鼻窦手术 (FESS) 时, 用一只手控制内窥镜成了医生的主要障碍。只有另一只手可以自由使用手术器械。因此, 疲劳或频繁的仪器替换可导致内窥镜图像颤动。

方法: 我们收集了16例 FESS手术中使用的固定性0°内窥镜和所有其它器械的姿度数据 (位置和方向) , 有手动内窥镜导向以及机器人辅助内窥镜导向。结合DICOM CT数据, 我们使用自己开发的跟踪标记来观察内窥镜姿度和工作空间。

结果: 所有手术用机器人进行一次, 外科医生握住内窥镜进行一次。对于所需时间, 我们观察到手术时间的减少, 因为一个外科医生执行所有程序, 所以学习曲线正如我们所预期的那样。标本的目视检查显示鼻旁窦外的任何结构没有遭到损害。

结论: 在鼻窦手术中, 由机器人辅助内窥镜导向是可行的。然而, 进一步的CT数据对于在解剖边界内的基于跟踪器导向的外科分析是需要的。我们基于标记的内窥镜追踪和仪器使得自动化内窥镜导向成为可行的。主观上, 我们看到RASS可为外科医生减轻负担。

Keywords:

• 3D-Navigation
• sinus surgery
• computer-assisted surgery
• robot-assisted surgery
• medical robotics

Acknowledgements

We are grateful to the Deutsche Forschungsgemeinschaft (DFG) for funding this project. Bonfor, a research trust of the University of Bonn, has funded this project as well. The authors wish to express their thanks to Prof. Dr. K. Schild of the Radiology Clinic of the University of Bonn for providing CT image data

Disclosure statement

The authors declare no competing financial interests or conflict of interest.

Additional information

Funding

We are grateful to the Deutsche Forschungsgemeinschaft (DFG) for funding this project. Bonfor, a research trust of the University of Bonn, has funded this project as well.