report of a new passive, optical surgical navigation system for endoscopic sinus surgery martin j....
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Report of a New Passive, Optical Surgical Navigation
System for Endoscopic Sinus Surgery
Martin J. Citardi, M.D.
Saint Louis University
Department of Otolaryngology
Computer-Aided Sinus Surgery
Anatomic complexityLimitations of endoscopic visualizationSurgical navigation systems
SAVANT
New CAS platformCbyon (Palo Alto, CA)Optical tracking systemWindows NT platformReport of initial FDA
trial
Methods
Prospective trial (FDA protocol)1 mm axial CT transferred to workstation
via networkVisual estimates of registration accuracySurgeon’s questionnaires
SAVANT
Pre-release software version (0.8-0.9)Headset reference frameSemiautomatic registrationPassive (wireless) instruments
Semiautomatic Registration
Headset at time of CT scan and OR
Registration to points on headset
SAVANT Instrumentation
Results
17 patients enrolledIndication: chronic rhinosinusitisFailure to achieve acceptable registration
in 1 instanceSurgery canceled in 1 instance (asthma
exacerbation)15 patients completed protocol
Results
Registration accuracy estimates at 4 points in surgical volume
Distribution of estimates:
0-2 mm. 38 (63.3%)
2-4 mm. 14 (23.3%)
4-6 mm. 3 (5.0%)
>6 mm. 5 (8.3%)
Subjective Evaluation
Relatively easy set-up, especially for a developmental system
Good user interfaceExcellent monitorExcellent technical support
Representative Images
Headset Issues
Modified Anatomark headset (designed for co-registration of MR/CT scans)
DRF designEar piece calibrationFully automatic
registration anticipated
Advantages
Even semiautomatic registration rapidPassive (wireless) trackingExcellent user interfaceAutomatic registration in development
Disadvantages
Headset design issuesSemiautomatic registration
Note: Technical solutions are on the horizon…
Summary
Preliminary report of a new CAS system for sinus surgery
Promising technological platformSystem limitations identified; technical
solutions in early implementation phaseAdditional reports forthcoming…