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Warning navigation system using real-time safe region monitoring for otologic surgery

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose We developed a surgical navigation system that warns the surgeon with auditory and visual feedback to protect the facial nerve with real-time monitoring of the safe region during drilling.

Methods Warning navigation modules were developed and integrated into a free open source software platform. To obtain high registration accuracy, we used a high-precision laser-sintered template of the patient’s bone surface to register the computed tomography (CT) images. We calculated the closest distance between the drill tip and the surface of the facial nerve during drilling. When the drill tip entered the safe regions, the navigation system provided an auditory and visual signal which differed in each safe region. To evaluate the effectiveness of the system, we performed phantom experiments for maintaining a given safe margin from the facial nerve when drilling bone models, with and without the navigation system. The error of the safe margin was measured on postoperative CT images. In real surgery, we evaluated the feasibility of the system in comparison with conventional facial nerve monitoring.

Results The navigation accuracy was submillimeter for the target registration error. In the phantom study, the task with navigation (\(0.7 \pm 0.25\) mm) was more successful with smaller error, than the task without navigation (\(1.37 \pm 0.39\) mm, \(P<0.05\)). The clinical feasibility of the system was confirmed in three real surgeries.

Conclusions This system could assist surgeons in preserving the facial nerve and potentially contribute to enhanced patient safety in the surgery.

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Acknowledgments

This work was supported in part by the Innovation Center for Medical Redox Navigation at Kyushu University, Japan. Jaesung Hong was partly supported by Korea government with the grants of MIREBrain and Convergence Science Center (12-BD-0402) of DGIST.

Conflict of interest

We certify that there is no real or potential conflict of interest in relation to this article.

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Authors and Affiliations

  1. Department of Advanced medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan

    Byunghyun Cho, Jaesung Hong & Makoto Hashizume

  2. Department of Otorhinolaryngology,  Kyushu University, Fukuoka, Japan

    Masamichi Oka & Nozomu Matsumoto

  3. Division of Fixed Prosthodontics, Faculty of Denstal Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Riichi Ouchida

  4. Department of Robotics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), 50-1 Sang-ri, Hyeonpung-myeon, Dalseong-gun, Daegu, 711-873, Republic of Korea

    Jaesung Hong

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  1. Byunghyun Cho
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  2. Masamichi Oka
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Correspondence to Jaesung Hong.

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Cho, B., Oka, M., Matsumoto, N. et al. Warning navigation system using real-time safe region monitoring for otologic surgery. Int J CARS 8, 395–405 (2013). https://doi.org/10.1007/s11548-012-0797-z

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  • DOI: https://doi.org/10.1007/s11548-012-0797-z

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