Technology that provides advanced safety in endoscopic sinus surgeries: Surgical Navigation
Following the increasing prevalence of endoscopic sinus surgeries (ESC), which were first performed in 1984, serious complications began to be observed. The realization that most of the problems experienced were due to the inability to fully evaluate the anatomy during surgery for various reasons led to the need for surgical navigation in ESS. As a result, following the first trials of computer-aided surgery (surgical navigation) applications in the field of neurosurgery, it has been developed to be used in ESC since 1990.
The locations of surgical instruments used in endoscopic sinus surgeries within the sinus anatomy during surgical navigation. It is followed in real time with the help of a special device and software in three plans representing three dimensions on the monitor with an error margin of less than 1 mm.
The aim of surgical navigation application is the computed tomography (CT) obtained before the surgery. By establishing a connection between CT images and the anatomy of the surgical site, it is possible to follow surgical instruments within the complex sinus anatomy. With this technology, the locations of critical structures and organs can be determined easily and with very little error, and the existing disease can be completely cleared without damaging these structures.
The first stage in surgical navigation application is the patient's introduction to the system (Registration). At this stage, a 3D connection is created between the CT images obtained before the surgery and the surgical field. First of all, the locations of some known anatomical points on the patient on the tomography image are introduced to the system, and then the system calculates the locations of all other points in the three-dimensional anatomy relative to these recorded points. The registration phase is the most important phase for the accuracy and reliability of surgical navigation.
Before starting the surgery, all instruments that will be monitored (navigated) by the system during the surgery must be introduced to the system and calibrated. In addition, the calibration is checked every 15-20 minutes during the surgery, that is, whether the device shows the correct points in the head without error. It must go down. For this purpose, some obvious anatomical points are checked. The tracking phase means tracking the changing positions of surgical instruments within the anatomy and monitoring their locations simultaneously on previously obtained images.
Magnetic devices or prostheses in the environment may affect the system.
Surgery The most critical point in navigation is "accuracy", that is, the degree of overlap between the point seen on the monitor and the actual point in the sinus anatomy. Reasons such as imaging (tomography technique) error, three-dimensional configuration error, errors due to patient movement and monitoring system error may affect accuracy.
MAIN ADVANTAGES OF SURGICAL NAVIGATION
* Providing a three-dimensional road map in a two-dimensional endoscopic image,
* Providing a safe approach to hard-to-reach anatomical areas,
* Performing precise surgery with less trauma,
* Shortening the surgery time,
* It can be considered as a significant decrease in the possibility of complications,
* An increase in the success rate of surgery,
* A decrease in the possibility of recurrence (recurrence of the disease).
MAIN USE REQUIREMENTS OF SURGICAL NAVIGATION
Today, surgical navigation is used even in the most standard endoscopic surgery cases, especially;
* In forehead sinus, posterior ethmoid and sphenoid sinus diseases
* In fungal sinusitis
* In patients with common polyps
* In skull base interventions
* In surgeries of sinus and skull base tumors
/> * In surgeries involving the eye socket
* In repairing cerebrospinal fluid leaks
It provides critical benefits as it increases the success rate of the surgery and significantly reduces the risk of complications.
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