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European Archives of Oto-Rhino-Laryngology

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01-04-2018 | Otology

Accuracy and feasibility of a dedicated image guidance solution for endoscopic lateral skull base surgery

Authors: Christoph Rathgeb, Lukas Anschuetz, Daniel Schneider, Cilgia Dür, Marco Caversaccio, Stefan Weber, Tom Williamson

Published in: European Archives of Oto-Rhino-Laryngology | Issue 4/2018

Abstract

Objective

We aimed to design, build and validate a surgical navigation system which fulfills the accuracy requirements for surgical procedures on the ear and the lateral skull base, and which integrates with the endoscopic workflow and operating room setup.

Materials and Methods

The navigation system consists of portable tablet computer (iPad Pro, Apple Computer, USA) and an optical tracking system (Cambar B1, Axios3D, Germany), both connected via a wireless Bluetooth link and attached directly to the OR table. Active optical tracking references are rigidly fixed to both the patient and surgical tools. Software to support image import, registration and 2D/3D visualization has been developed. Two models were used for targeting accuracy assessment: a technical phantom model and an ex vivo temporal bone model. Additionally, workflow integration and usability of the navigation system during endoscopic lateral skull base procedures was investigated in ex vivo experiments on 12 sides of cadaver head specimens.

Results

The accuracy experiments revealed a target registration error in the technical phantom model of 0.20 ± 0.10 mm (n = 36) and during the ex vivo assessment of 0.28 ± 0.10 mm (n = 21). Navigation was successfully carried out in n = 36 procedures (infracochlear, suprageniculate and transpromontorial approach), with navigated instruments usable without interference with the endoscope. The system aided in the successful and accurate identification of vital anatomical structures.

Conclusions

Useful surgical navigation is, to a large extent, a result of sufficiently accurate tracking technology. We have demonstrated sufficient accuracy and a potentially suitable integration for surgical application within endoscopic lateral skull base procedures.

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Title: Accuracy and feasibility of a dedicated image guidance solution for endoscopic lateral skull base surgery
Authors: Christoph Rathgeb
Lukas Anschuetz
Daniel Schneider
Cilgia Dür
Marco Caversaccio
Stefan Weber
Tom Williamson
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 4/2018
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-018-4906-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Accuracy and feasibility of a dedicated image guidance solution for endoscopic lateral skull base surgery

Abstract

Objective

Materials and Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Materials and Methods

Results

Conclusions

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