Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
Int Forum Allergy Rhinol. 2011 Jan-Feb;1(1):70-7. doi: 10.1002/alr.20007. Epub 2011 Feb 8.
Custom software was developed to integrate intraoperative cone-beam computed tomography (CBCT) images with endoscopic video for surgical navigation and guidance. A cadaveric head was used to assess the accuracy and potential clinical utility of the following functionality: (1) real-time tracking of the endoscope in intraoperative 3-dimensional (3D) CBCT; (2) projecting an orthogonal reconstructed CBCT image, at or beyond the endoscope, which is parallel to the tip of the endoscope corresponding to the surgical plane; (3) virtual reality fusion of endoscopic video and 3D CBCT surface rendering; and (4) overlay of preoperatively defined contours of anatomical structures of interest.
Anatomical landmarks were contoured in CBCT of a cadaveric head. An experienced endoscopic surgeon was oriented to the software and asked to rate the utility of the navigation software in carrying out predefined surgical tasks. Utility was evaluated using a rating scale for: (1) safely completing the task; and (2) potential for surgical training. Surgical tasks included: (1) uncinectomy; (2) ethmoidectomy; (3) sphenoidectomy/pituitary resection; and (4) clival resection. CBCT images were updated following each ablative task.
As a teaching tool, the software was evaluated as "very useful" for all surgical tasks. Regarding safety and task completion, the software was evaluated as "no advantage" for task (1), "minimal" for task (2), and "very useful" for tasks (3) and (4). Landmark identification for structures behind bone was "very useful" for both categories.
The software increased surgical confidence in safely completing challenging ablative tasks by presenting real-time image guidance for highly complex ablative procedures. In addition, such technology offers a valuable teaching aid to surgeons in training.
为了将术中锥形束计算机断层扫描（CBCT）图像与内窥镜视频整合用于手术导航和指导，开发了定制软件。使用一具尸体头颅评估以下功能的准确性和潜在临床实用性：（1）术中三维（3D）CBCT 中内窥镜的实时跟踪；（2）在超出内窥镜的位置投射与内窥镜尖端相对应的手术平面的正交重建 CBCT 图像；（3）内窥镜视频与 3D CBCT 表面渲染的虚拟现实融合；以及（4）术前定义的感兴趣解剖结构轮廓的叠加。
在尸体头颅的 CBCT 中描绘解剖学标志。一位经验丰富的内窥镜外科医生熟悉该软件，并要求他评估导航软件在执行预定义手术任务中的实用性。使用以下评分量表评估实用性：（1）安全完成任务；以及（2）手术培训的潜力。手术任务包括：（1）钩突切除术；（2）筛窦切除术；（3）蝶窦切除术/垂体切除术；以及（4）颅底切除术。在完成每个消融任务后更新 CBCT 图像。
作为一种教学工具，该软件在所有手术任务中均被评估为“非常有用”。关于安全性和任务完成，该软件在任务（1）中被评估为“无优势”，在任务（2）中被评估为“最小”，在任务（3）和（4）中被评估为“非常有用”。对于骨后结构的标志识别，这两种类别均被评估为“非常有用”。
该软件通过为高度复杂的消融手术提供实时图像引导，增加了外科医生安全完成具有挑战性的消融任务的信心。此外，这种技术为培训中的外科医生提供了有价值的教学辅助工具。
