Increased safety in robotic paranasal sinus and skull base surgery with redundant navigation and automated registration. 2005

J Wurm, and T Dannenmann, and C Bohr, and H Iro, and K Bumm
Department of Otorhinolaryngology, Head and Neck Surgery, University Erlangen-Nürnberg, Germany. jochen.wurm@hno.imed.uni-erlangen.de

We present an advanced version of our robotic setup for paranasal sinus surgery that was developed at the Department of Otorhinolaryngology, Head and Neck Surgery in Erlangen, Germany. The system was interconnected with a redundant navigation system for increasing intraoperative safety while performing telemanipulatory as well as fully automated maneuvers.In contrast to the previous "all in one" version, we built a modular three component setup. The basic feature of the computer navigation system is the "CAPPA ENT" station. The system references by automatically detecting a referencing frame mounted on a non-invasive upper jaw mouthpiece. Software components of both systems, navigation and robotics were combined on one user interface. Accuracy as well as clinical applicability studies were carried out. For better surveillance and increased safety, we decided to evaluate the robots reproducibility errors and overall stereotactic accuracy by means of redundant navigational control on a phantom model for paranasal sinus and skull base surgery. Multiple measurements from 14 CT-markers were taken representing different surgical approaches.A modular setup was designed and was deemed feasible in its size and weight dimensions as well as its maneuvrability for application in a routine operating room environment. The navigational feedback is integrated in real time in the robots user interface. In case of blocked visibility to the Dynamic Referencing Frame the robot powers down and activates the force torque sensor, thus softening all articulating joints. We found only adequate accuracies in pinpointing a specific CT-marker both in telemanipulatory and fully automated maneuvers. No significant offsets were observed evaluating accuracies for different surgical approaches.By using redundant navigation feedback, we were able to add another safety feature, the "loss of control" function, which shuts down any robotic action. However, no increase of the absolute accuracy was observed by adding this feature. We conclude that redundant navigational control does not make the robot more accurate, but it adds a potent safety feature to the system.

UI MeSH Term Description Entries
D007090 Image Interpretation, Computer-Assisted Methods developed to aid in the interpretation of ultrasound, radiographic images, etc., for diagnosis of disease. Image Interpretation, Computer Assisted,Computer-Assisted Image Interpretation,Computer-Assisted Image Interpretations,Image Interpretations, Computer-Assisted,Interpretation, Computer-Assisted Image,Interpretations, Computer-Assisted Image
D010256 Paranasal Sinuses Air-filled spaces located within the bones around the NASAL CAVITY. They are extensions of the nasal cavity and lined by the ciliated NASAL MUCOSA. Each sinus is named for the cranial bone in which it is located, such as the ETHMOID SINUS; the FRONTAL SINUS; the MAXILLARY SINUS; and the SPHENOID SINUS. Nasal Sinuses,Osteomeatal Complex,Ostiomeatal Complex,Ostiomeatal Unit,Sinonasal Tract,Supraorbital Ethmoid Cell,Cell, Supraorbital Ethmoid,Complex, Osteomeatal,Ethmoid Cell, Supraorbital,Osteomeatal Complices,Ostiomeatal Complices,Ostiomeatal Units,Sinonasal Tracts,Sinuses, Nasal,Supraorbital Ethmoid Cells,Tract, Sinonasal
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012371 Robotics The application of electronic, computerized control systems to mechanical devices designed to perform human functions. Formerly restricted to industry, but nowadays applied to artificial organs controlled by bionic (bioelectronic) devices, like automated insulin pumps and other prostheses. Companion Robots,Humanoid Robots,Remote Operations (Robotics),Social Robots,Socially Assistive Robots,Telerobotics,Soft Robotics,Assistive Robot, Socially,Companion Robot,Humanoid Robot,Operation, Remote (Robotics),Operations, Remote (Robotics),Remote Operation (Robotics),Robot, Companion,Robot, Humanoid,Robot, Social,Robot, Socially Assistive,Robotic, Soft,Social Robot,Socially Assistive Robot,Soft Robotic
D012449 Safety Freedom from exposure to danger and protection from the occurrence or risk of injury or loss. It suggests optimal precautions in the workplace, on the street, in the home, etc., and includes personal safety as well as the safety of property. Safeties
D013523 Surgical Equipment Nonexpendable apparatus used during surgical procedures. They are differentiated from SURGICAL INSTRUMENTS, usually hand-held and used in the immediate operative field. Equipment, Surgical,Equipments, Surgical,Surgical Equipments
D014057 Tomography, X-Ray Computed Tomography using x-ray transmission and a computer algorithm to reconstruct the image. CAT Scan, X-Ray,CT Scan, X-Ray,Cine-CT,Computerized Tomography, X-Ray,Electron Beam Computed Tomography,Tomodensitometry,Tomography, Transmission Computed,X-Ray Tomography, Computed,CAT Scan, X Ray,CT X Ray,Computed Tomography, X-Ray,Computed X Ray Tomography,Computerized Tomography, X Ray,Electron Beam Tomography,Tomography, X Ray Computed,Tomography, X-Ray Computer Assisted,Tomography, X-Ray Computerized,Tomography, X-Ray Computerized Axial,Tomography, Xray Computed,X Ray Computerized Tomography,X Ray Tomography, Computed,X-Ray Computer Assisted Tomography,X-Ray Computerized Axial Tomography,Beam Tomography, Electron,CAT Scans, X-Ray,CT Scan, X Ray,CT Scans, X-Ray,CT X Rays,Cine CT,Computed Tomography, Transmission,Computed Tomography, X Ray,Computed Tomography, Xray,Computed X-Ray Tomography,Scan, X-Ray CAT,Scan, X-Ray CT,Scans, X-Ray CAT,Scans, X-Ray CT,Tomographies, Computed X-Ray,Tomography, Computed X-Ray,Tomography, Electron Beam,Tomography, X Ray Computer Assisted,Tomography, X Ray Computerized,Tomography, X Ray Computerized Axial,Transmission Computed Tomography,X Ray Computer Assisted Tomography,X Ray Computerized Axial Tomography,X Ray, CT,X Rays, CT,X-Ray CAT Scan,X-Ray CAT Scans,X-Ray CT Scan,X-Ray CT Scans,X-Ray Computed Tomography,X-Ray Computerized Tomography,Xray Computed Tomography
D019047 Phantoms, Imaging Devices or objects in various imaging techniques used to visualize or enhance visualization by simulating conditions encountered in the procedure. Phantoms are used very often in procedures employing or measuring x-irradiation or radioactive material to evaluate performance. Phantoms often have properties similar to human tissue. Water demonstrates absorbing properties similar to normal tissue, hence water-filled phantoms are used to map radiation levels. Phantoms are used also as teaching aids to simulate real conditions with x-ray or ultrasonic machines. (From Iturralde, Dictionary and Handbook of Nuclear Medicine and Clinical Imaging, 1990) Phantoms, Radiographic,Phantoms, Radiologic,Radiographic Phantoms,Radiologic Phantoms,Phantom, Radiographic,Phantom, Radiologic,Radiographic Phantom,Radiologic Phantom,Imaging Phantom,Imaging Phantoms,Phantom, Imaging
D019291 Skull Base The inferior region of the skull consisting of an internal (cerebral), and an external (basilar) surface. Basicranium,Cranial Base,Base of Skull,Basis cranii,Base, Cranial,Base, Skull
D025321 Surgery, Computer-Assisted Surgical procedures conducted with the aid of computers. Used in various types of surgery for implant placement and instrument guidance. Image-guided surgery interactively combines prior CT scans or MRI images with real-time video. Computer-Assisted Surgery,Image-Guided Surgery,Surgery, Image-Guided,Surgical Navigation,Computer-Aided Surgery,Computer Aided Surgery,Computer Assisted Surgery,Computer-Aided Surgeries,Computer-Assisted Surgeries,Image Guided Surgery,Image-Guided Surgeries,Navigation, Surgical,Surgeries, Computer-Aided,Surgeries, Computer-Assisted,Surgeries, Image-Guided,Surgery, Computer Assisted,Surgery, Computer-Aided,Surgery, Image Guided

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