engleski

Tele-3D-Computer assisted surgery: new approach in the surgery of the nose and paranasal sinuses

During 3D-CAS as well as Tele-3D-CAS (computer assisted surgery), the computer with its operative field image allows the surgeon, by means of up-to-date technologies, to connect the operative instrumentarium to spatial digitalizers connected to the computer. Upon the completion of the tele-operation, the surgeon compares the preoperative and postoperative images and models of the operative field, and studies video records of the procedure itself (www.mef.hr/3D-CFESS). The surgeon and consultants use software for CT image previews and 3D-model manipulations on top of collaboration tools to define the pathology, to produce an optimal path to the pathology and to decide how to perform the real surgery. Using tele-fly-through or tele-VE through 3D-models, both surgeons can preview all the characteristics of the region, and so predict and determine the next steps of the operation (www.mef.hr/warwounds). My team used several standards to encode live video signals in telesurgery, such as M-JPEG, MPEG1, MPEG2 and MPEG4. It has been definitely concluded that MPEG4 streams, without audio, have the best picture quality for the operating field/endo camera. For conferencing/consultation cameras used between two or more connected sites during the surgery, we used JPEG and MPEG1 stream with audio. ORs were connected using several computer network technologies with different bandwidths, from T1, E1 and multiple E1 to ATM-OC3 (from 1Mb/s to 155Mb/s). For computer communications using X-protocol for image/3D-models manipulations, we needed an additional 4Mb/s of bandwidth, instead of the 1Mb/s when we used our own communication tools for the transfer of surgical instrument movements. The final step of this project is to create an extremely large uncompressed database (2x47 TB), where all multimedia content will be saved into a massive database with a maximum resolution, and in a format not depending on a resolution. In a case when this is impossible, e.g. with video content (movies), then the compression is as small as possible so that the content is able to maintain the highest quality accessible. For instance, audio data are saved on media for data in a linear format, without any loss in quality (www.mef.hr/orbit). Using intraoperative records, animated images of the real tele-procedure performed can be designed. Beside otorhinolaryngology, this has also been used in other fields. The more so, in addition to educational applications, VS offers the possibility of preoperative planning in sinus surgery, and has become a very important segment in surgical training and planning of each individual surgical or telesurgical intervention, not only in the reigon of paranasal sinuses. Our tele-3Dsurgery allows surgeons not only to see and to transfer video signals, but also to transfer 3D computer models and surgical instrument movements with image/3D-model manipulations, in real time during the surgery (www.mef.hr/MODERNRHINOLOGY).

telemedicine; 3D; computer assisted surgery; nose; paranasal sinuses

doi:10.1016/S0194-5998(03)01211-7