engleski

Telesurgery with 3D-CAS Support in Otorhinolaryngology - New Experience in the Development of the Head and Neck Surgery

What do experts think about additional support per viam computer assisted reconstruction of the anatomy and pathology of the head and neck ; what is the truth and level of reliability of the computer reconstruction of CT images in telesurgery transmission ; the question of availability and very expensive equipment ; 3D image reality ; control parameters ; what is the use of computer 3D image of the surgical field and isn't a real live video image much better for telesurgery? Sinus CT scan in coronal projection is a term familiar to every radiologist dealing with CT in the world. Layer thickness, shift, gantry, and window are internationally standardized and accepted values, thus being reproducible all over the world. The method is standardized, reproducible and distinctly defined, and it is by no means contradictory. But on the other side, the basic CT diagnostics has also limited possibilities, first of all because it presents summation images in a single plane (layer) but cannot present the continuity of structures. This has been solved by 3D reconstruction which is now available on PCs equipped with Pentium III or IV processors/1, 4 GHz. By presenting the continuity of structures (0.5-1 mm sections), this reconstruction allows visualization of the region as a whole, avoiding the loss of images by use of the standard approach in sinus CT imaging (3-5 mm sections). During the telesurgery, 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. Using intraoperative records, animated images of the real tele-procedure performed can be designed. By means of computer records labeled coordinate shifts of 3D digitalizer during the surgery, an animated image of the course of operation in the form of journey, i.e. operative field fly-through in the real patient, 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. The complex software systems allow tele-visualization of CT or MRI section in its natural course (the course of examination performed), or in an imaginary, arbitrary course. Particular images can be transferred, processed and deleted, or can be presented in animated images, as it was done during our 1st TS. Multiple series of images can be simultaneously observed in different color tables and at various magnification, with various grades of transparency, observing them as a unique 3D model system. The work with such models allows different views, shifts, cuts, separations, labeling, and animation. The series of images can be changed, or images can be generated in different projections through the volume recorded, as we have showed in our OR. Before the development of 3D spatial model, each individual image or the whole series of images have to be segmented, in order to single out the image parts of interest. Thus, separate models of bones, healthy tissue, affected tissue, and all significant anatomic entities of the operative field are developed. The complete tele-procedure planned can be developed on computer models and a series of animations describing the procedure can be produced. It has become a routine mode of action in a number of centers worldwide when necessary.

Telesurgery; 3D; CAS; otorhinolaryngology; head and neck surgery

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