engleski

Tele-3D-CAS Surgery: Croatian Experience

The first kind of our public Tele 3D C-FESS, developed as a part of the Tele-3D-CAS project, took place between two locations in the city of Zagreb, 10 km apart, with interactive collaboration from a third location. A surgical team carrying out an operative procedure at the Šalata ENT Department, Zagreb University School of Medicine and Zagreb Clinical Hospital Center, received instructions, suggestions and guidance through the procedure by an expert surgeon from an expert center. The third active point was the Faculty of Electrical Engineering and Computing, where ENT specialists, students and residents took an active part in the entire surgical procedure. This Tele 3D C-FESS surgery, performed as described above, was successfully completed in 15 minutes. The surgeon and consultants view four split video signals (quad split video processing) on the primary video display: one from the endocamera, one from the OR camera, one from the first remote site and one from the second remote site. However, during real surgery, all locations involved in the telesurgery usually view only the video signal from the endocamera procedure on their primary displays. In real surgery, there is one patient at one location included in the "Telesurgical Procedure", with one or more consultants at one or more remote locations (the local location is where the surgery is performed, and remote locations are the other locations included in the telesurgery procedure). Thus, two video streams (the endocamera and the conference camera) have to be transferred from the local location (patient location), and one video stream (the conference camera) has to be transferred from each remote location (consultants). At each location, video monitors are needed for video streams from any other location included in the telesurgery procedure (up to four video streams on one large video monitor, quad-split, can be used). An LCD/TFT video projector can be put in the OR. Definitely, the possibility of exact preoperative, non-invasive visualization of the spatial relationships of anatomic and pathologic structures, including extremely fragile ones, size and extent of pathologic process, and to precisely predict the course of surgical procedure, allows the surgeon in any 3D-CAS or Tele-CAS procedure to achieve considerable advantage in the preoperative examination of the patient, and to reduce the risk of intraoperative complications, all this by use of VS21 or diagnosis. With the use of 3D model, the surgeon's orientation in the operative field is considerably facilitated (“ patient location” as well as the “ location of the tele-expert consultant” ), and all procedures and manipulations are performed with higher certainty and safety. As it can be seen, one of their main applications of Tele-3D C-FESS is 3D-navigation (VE) in the study of anatomy and surgery (“ computed journey through the nose and paranasal sinuses” ). From this point of view this approach can be compared with similar simulator systems for the training of endoscopic sinus surgery presently available on the market, but definitely we have to be aware that it is not the study of or training in anatomy or surgery, but pure implementation of live surgical procedure with computer support in real time, the prime and foremost aim being the achievement of faster and safer procedure. So, it should be made clear that the main message of our Tele-3D-C-FESS surgery, as differentiated from the standard tele-surgeries worldwide, is the use of the 3D-model operative field, and thus of ” VS” , which in addition to higher safety allows for successful course of operation, especially in small, detached medical institutions where advanced endoscopic techniques are not available. This is of paramount importance for emergency surgical interventions which have to be performed in distant medical institutions where the service of “ well known surgical experts” (e.g., skull base surgery) is not available. Our telesurgical approach allows surgeons not only to see and 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. The new video encoders using MPEG2 standards and ATM computer networks using inverse multiplexing greatly improve the safety of surgical procedures, especially in endoscopic surgery. The best results were obtained using ATM-OC3 technologies, with the most acceptable price-performance using inverse multiplexing method across 4-8 E1 lines. Considering the specificities and basic features of Tele-3D C-FESS, we believe that this type of surgery would be acceptable to many surgeons all over the world for the following reasons: • the technology is readily available in collaboration with any telecom worldwide ; • the improved safety and reduced cost will allow the inclusion of a greater number of patients from distant hospital institutions in such a telesurgical expert system, • the “ presence” of leading international surgical experts as tele-consultants in any OR in the world will thus be possible in the near future, which will additionally stimulate the development of surgery in all settings ; and • the results obtained in the Tele-3D C-FESS project in Croatia are encouraging and favor the further development of the method.

Tele CAS; 3D; CAS: Croatian telemedicine; Croatian telesurgery

nije evidentirano