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

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

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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Funding

This work was partially funded by the CTU-Grant Nr. 2017-01 (University of Bern) allocated to Lukas Anschuetz.

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Author notes

  1. Christoph Rathgeb and Lukas Anschuetz contributed equally to this work.

Authors and Affiliations

  1. ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland

    Christoph Rathgeb, Daniel Schneider, Stefan Weber & Tom Williamson

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland

    Lukas Anschuetz, Cilgia Dür & Marco Caversaccio

Authors
  1. Christoph Rathgeb
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  2. Lukas Anschuetz
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  3. Daniel Schneider
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  4. Cilgia Dür
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  5. Marco Caversaccio
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  6. Stefan Weber
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  7. Tom Williamson
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Corresponding author

Correspondence to Lukas Anschuetz.

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The authors declare no conflict of interest.

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All of the authors have read and approved the manuscript.

Research involving human participants

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional, regional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required.

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Rathgeb, C., Anschuetz, L., Schneider, D. et al. Accuracy and feasibility of a dedicated image guidance solution for endoscopic lateral skull base surgery. Eur Arch Otorhinolaryngol 275, 905–911 (2018). https://doi.org/10.1007/s00405-018-4906-7

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  • DOI: https://doi.org/10.1007/s00405-018-4906-7

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