Tel Alessandro, Arboit Lorenzo, Sembronio Salvatore, Costa Fabio, Nocini Riccardo, Robiony Massimo
Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy.
Faculty of Medicine and Surgery, Sant'Anna School of Advanced Studies, Pisa, Italy.
Front Surg. 2021 Aug 23;8:715262. doi: 10.3389/fsurg.2021.715262. eCollection 2021.
In the past years, endoscopic techniques have raised an increasing interest to perform minimally invasive accesses to the orbit, resulting in excellent clinical outcomes with inferior morbidities and complication rates. Among endoscopic approaches, the transantral endoscopic approach allows us to create a portal to the orbital floor, representing the most straightforward access to lesions located in the inferior orbital space. However, if endoscopic surgery provides enhanced magnified vision of the anatomy in a bloodless field, then it has several impairments compared with classic open surgery, owing to restricted operative spaces. Virtual surgical planning and anatomical computer-generated models have proved to be of great importance to plan endoscopic surgical approaches, and their role can be widened with the integration of surgical navigation, virtual endoscopy simulation, and augmented reality (AR). This study focuses on the strict conjugation between the technologies that allow the virtualization of surgery in an entirely digital environment, which can be transferred to the patient using intraoperative navigation or to a printed model using AR for pre-surgical analysis. Therefore, the interaction between different software packages and platforms offers a highly predictive preview of the surgical scenario, contributing to increasing orientation, awareness, and effectiveness of maneuvers performed under endoscopic guidance, which can be checked at any time using surgical navigation. In this paper, the authors explore the transantral approach for the excision of masses of the inferior orbital compartment through modern technology. The authors apply this technique for masses located in the inferior orbit and share their clinical results, describing why technological innovation, and, in particular, computer planning, virtual endoscopy, navigation, and AR can contribute to empowering minimally invasive orbital surgery, at the same time offering a valuable and indispensable tool for pre-surgical analysis and training.
在过去几年中，内镜技术越来越受到人们的关注，用于对眼眶进行微创入路，从而取得了良好的临床效果，且发病率和并发症发生率较低。在内镜入路中，经鼻窦内镜入路使我们能够创建一个通向眶底的通道，这是进入眶下间隙病变最直接的途径。然而，如果内镜手术能在无血视野中提供增强的解剖结构放大视野，那么与传统开放手术相比，由于手术空间受限，它也存在一些不足之处。虚拟手术规划和解剖学计算机生成模型已被证明对规划内镜手术入路非常重要，并且随着手术导航、虚拟内镜模拟和增强现实（AR）的整合，它们的作用可以得到扩展。本研究聚焦于在完全数字化环境中实现手术虚拟化的技术之间的紧密结合，这种环境可以通过术中导航传输给患者，或者通过AR传输给打印模型用于术前分析。因此，不同软件包和平台之间的交互提供了手术场景的高度预测性预览，有助于提高在内镜引导下进行操作的方向性、意识和有效性，并且可以随时使用手术导航进行检查。在本文中，作者通过现代技术探索经鼻窦入路切除眶下间隙肿物。作者将该技术应用于位于眶下的肿物，并分享了他们的临床结果，阐述了为什么技术创新，特别是计算机规划、虚拟内镜、导航和AR能够有助于增强微创眼眶手术的能力，同时为术前分析和培训提供一个有价值且不可或缺的工具。
