Ljubimko Šimičić

Dynamic 3D computer-assisted reconstruction of a metallic retrobulbar foreign body for diagnostic and surgical purposes. [Case report of orbital injury with ethmoid bone involvement]

The main goal of our dynamic 3D computer-assisted reconstruction of a metallic retrobulbar foreign body following orbital injury with ethmoid bone involvement was to use 3D-information obtained from standard computed tomography (CT) data to explore and evaluate the nasal cavity, ethmoidal sinuses, retrobulbar region, and the foreign body itself by simulated dynamic computed visualization of the human head. A foreign body, 10 × 30 mm in size, partially protruded into the posterior ethmoidal cells and partially into the orbit, causing dislocation and compression of the medial rectus muscle and inferior rectus muscle. The other muscles and the optic nerve were intact. Various steps were taken to further the ultimate diagnosis and surgery. Thin CT sections of the nasal cavity, orbit and paranasal sinuses were made on a conventional CT device at a regional medical center, CT scans were transmitted via a computer network to different locations, and special views very similar to those seen on standard endoscopy were created. Special software for 3D modeling, specially designed and modified for 3D C-FESS purposes, was used, as well as a 3D-digitizer connected to the computer and multimedia navigation through the computer during 3D C-FESS. Our approach achieves the visualization of very delicate anatomical structures within the orbit in unconventional (non-standard) sections and angles of viewing, which cannot be obtained by standard endoscopy or 2D CT scanning. Finally, virtual endoscopy (VE) or a ‘computed journey’ through the anatomical spaces of the paranasal sinuses and orbit substantially improves the 3D C-FESS procedure by simulating the surgical procedure prior to real surgery.

Tele-3-dimensional computer-assisted functional endoscopic sinus surgery: new dimension in the surgery of the nose and paranasal sinuses.

One of the main objectives of our 3-dimensional (3D) computer-assisted functional endoscopic sinus surgery was to design a computer-assisted 3D approach to the presurgical planning, intraoperative guidance, and postoperative analysis of the anatomic regions of the nose and paranasal sinuses. Such an extremely powerful approach should allow better insight into the operating field, thereby significantly increasing the safety of the procedure. The last step to implementing the technology in the operating room was to connect the computer workstations and video equipment to remote locations by using a high-speed, wide-bandwidth computer network. During patient preparation, the surgeon in the operating room consulted remote experienced and skillful surgeons by viewing CT images and 3D models on computer workstations. The surgeon and consultants used software for CT image previews and 3D model manipulations on top of collaboration tools to define the pathosis, produce an optimal path to the pathosis, and decide how to perform the real surgical procedure. With tele-flythrough or tele-virtual endoscopy rendered through the use of 3D models, both surgeons can preview all the characteristics of the region (ie, anatomy, pathosis) and so predict and determine the next steps of the operation. This ensures greater safety thanks to the operation guidance and reduces the possibility of intraoperative error. The duration of the teleconsultation is thus shortened, which may prove the greatest benefit of tele-3D computer-assisted surgery. If this method were used, clinical institutions would spend less money for telesurgical consultation.

Tele-3D-C-FESS approach with high-quality video transmission

Image-Guided Functional Endoscopic Sinus Surgery GARTH T OLSON MD (presenter); MARTIN J CITARDI MD; Saint Louis MO Introduction: Although rhinologic surgeons are increasingly applying image-guided surgery (IGS) technology for endonasal procedures, the ultimate utility of IGS for endoscopic sinus surgery has been the subject of considerable discussion. Objective: (1) To provide the framework for the application of IGS (including software-based CT image analysis) into preoperative planning so that specific anatomic assessments may be performed. (2) To develop intraoperative strategies for the execution of this preoperative planning. Study Design: Retrospective review. Methods: Between October 1, 1997, and December 31, 1998, the StealthStation (Sofamor Danek, Memphis, TN) was employed in 61 functional endoscopic sinus surgery cases. The indication for surgery in all instances was chronic rhinosinusitis refractory to medical management. Preoperative CT scans were obtained according to a specific protocol. The StealthStation software package was used to review all CT scans prior to surgery. Registration with anatomic fiducials, supplemented by contour mapping registration, was employed. Specific cases serve to illustrate the utility of IGS. Results: In all cases, localization accuracy was estimated to be within 2 nun or better. The StealthStation was utilized for both CT image review and intraoperative localization. From a surgical anatomy viewpoint, IGS was especially useful in the frontal recess, in the sphenoethmoid region, in the posterior ethmoid system, and at the skull base. In addition, IGS was deemed helpful in situations where the surgical anatomy was altered by previous surgery and extensive inflammatory disease {such as sinonasal polyposis, allergic fungal sinusitis, and pansinusitis). Conclusion: IGS technology should be routinely integrated into functional endoscopic sinus surgery. The resultant paradigm of image-guided functional endoscopic sinus surgery will serve to increase surgical effectiveness and decrease overall surgical morbidity.

Realtime transfer of live video images in parallel with three-dimensional modelling of the surgical field in computer-assisted telesurgery

We have carried out three-dimensional, computer-assisted, functional endoscopic sinus telesurgery. Surgeons at different locations up to 300 km apart could not only see and transfer video images but also transfer three-dimensional computer models and manipulate them in realtime during surgery. Two different approaches were used. In the first telesurgery procedure we used M-JPEG compression and transmitted the data using fibre optic connections (ATM OC-3) at a bandwidth of 155 Mbit/s. In the second telesurgery procedure video images were transmitted over four E1 digital lines, amounting to about 8 Mbit/s of bandwidth, with better compression standards, such as MPEG1 and 2. We found that MPEG2 video compression produced the best picture quality for the operating field and endoscopic cameras. For conferencing and consultation between two or more connected sites during the surgery, we used JPEG and MPEG1 video compression with audio. The main feature of our three-dimensional telesurgery was the use of three-dimensional modelling of the operative field. This is important for emergency surgical interventions. We do not advocate that inexperienced surgeons operate on patients, not even with the guidance of a remote surgeon. However, three-dimensional telesurgery may become very valuable for experienced surgeons in the future.

Application of Advanced Virtual Reality and 3D Computer Assisted Technologies in Computer Assisted Surgery and Tele-3D-Computer Assisted Surgery in Rhinology

The contribution deals vith application of virtual reality technology and computer assisted surgery in rhinology