Tsuchida Keisuke, Takahashi Masahiro, Nakazawa Takara, Kurihara Sho, Yamamoto Kazuhisa, Yamamoto Yutaka, Kojima Hiromi
Department of Otorhinolaryngology, Jikei University School of Medicine, Minato-ku, Tokyo 105-8461, Japan.
J Clin Med. 2024 Mar 20;13(6):1780. doi: 10.3390/jcm13061780.
The indications for transcanal endoscopic ear surgery (TEES) for middle ear cholesteatoma have expanded for cases involving mastoid extension. However, TEES is not indicated for all cases with mastoid extension. In addition, predicting the extent of external auditory canal (EAC) removal needed for cholesteatoma resection is not always easy. The purpose of this study was to use augmented reality (AR) to project the lesion onto an intraoperative endoscopic image to predict EAC removal requirements and select an appropriate surgical approach. In this study, patients showing mastoid extension were operated on using a navigation system with an AR function (Stryker). The results showed that some cases with lesions slightly extending into the antrum required extensive resection of the EAC, while cases with lesions extending throughout the antrum required smaller resection of the EAC, indicating TEES. By predicting the extent of the needed EAC removal, it is possible to determine whether TEES (a retrograde approach) or canal wall-up mastoidectomy, which preserves as much of the EAC as possible, should be performed. We believe that our findings will contribute to the success of middle ear surgeries and the implementation of robotic surgery in the future.
经耳道内镜中耳手术（TEES）治疗中耳胆脂瘤的适应证已扩展至累及乳突扩展的病例。然而，TEES并非适用于所有乳突扩展的病例。此外，预测胆脂瘤切除所需外耳道（EAC）切除范围并非总是容易的。本研究的目的是使用增强现实（AR）将病变投射到术中内镜图像上，以预测EAC切除需求并选择合适的手术方法。在本研究中，对表现出乳突扩展的患者使用具有AR功能的导航系统（史赛克）进行手术。结果表明，一些病变轻微延伸至鼓窦的病例需要广泛切除EAC，而病变延伸至整个鼓窦的病例需要较小范围切除EAC，提示可行TEES。通过预测所需EAC切除范围，可以确定应进行TEES（逆行入路）还是尽可能保留EAC的开放式乳突根治术。我们相信我们的研究结果将有助于未来中耳手术的成功以及机器人手术的实施。
