Ist der Vorteil eines Navigationssystems in der HNO-Chirurgie messbar?

ZusammenfassungHintergrundDas Ziel der Arbeit liegt in der Evaluation eines Navigationssystems (Navibase) für die HNO-Chirurgie. Dafür wurde eine neuartige Methodik zur Beurteilung chirurgischer und ergonomischer Systemeigenschaften entwickelt.Patienten und MethodenDie Auswertung basiert auf 102 HNO-chirurgischen Anwendungen, davon 89 funktionelle endoskopische Nasennebenhöhlenoperationen (FESS). Die Einschätzung der chirurgischen und ergonomischen Leistungsspezifika erfolgte durch 7 HNO-Chirurgen. Um die chirurgischen Systemeigenschaften einzuschätzen, wurde der „level of quality“ (LOQ) bestimmt. Er vergleicht auf einer Skala von 0–100 und einem Mittelwert von 50 die vorhandenen A-priori-Informationen des Chirurgen mit denen des Navigationssystems und setzt sie in eine Beziehung zur klinischen Konsequenz.ErgebnisseBei der Evaluation der chirurgischen Systemeigenschaften ergab sich eine durchschnittliche Bewertung der Qualität der Information als LOQ von 63,59. Knapp jede 2. Anwendung des Navigationssystems (47,9%) führte im Durchschnitt zu einer Änderung der chirurgischen Strategie. Eine Erweiterung der Indikation des endonasalen Zugangs durch den Einsatz des Navigationssystems wurde in 7 von 102 Fällen (6,8%) angegeben. Das Gesamtvertrauen zeigt eine durchschnittliche Bewertung von 3,35. Die wirtschaftliche Bewertung ergab einen durchschnittlichen Mehraufwand von 1,35 min pro Fall.SchlussfolgerungenDie Gesamteinschätzung des Systems vermittelt anwendungsrelevante Informationen über die technischen Details hinaus und erlaubt eine Vergleichbarkeit zwischen verschiedenen Assistenzsystemen.AbstractBackgroundThe aim of this study was to evaluate the Navibase navigation system for ear, nose, and throat (ENT) surgery. A new methodology for evaluating surgical and human factors is developed.Patients and methodsThe evaluation is based on 102 ENT surgical applications, including 89 cases of functional endoscopic sinus surgery (FESS). The evaluation of surgical and human factors was performed by seven ENT surgeons. To evaluate surgical performance, level of quality (LOQ) in the 89 cases of FESS was determined, comparing the surgeon’s own impressions with those of the navigation system on a scale from 0 to 100 and further comparing them with clinical results. Intraoperative changes in surgical strategy were documented. The human factors of total confidence (trust), situation awareness, skill set requirement and workload shift were recorded as level of reliance (LOR).ResultsThe maximum deviation amounted to 1.93 mm. Averaging the quality of information resulted in an LOQ of 63.59. Every second application of the navigation system (47.9%) led to a change in surgical strategy. Total confidence showed a positive evaluation of 3.35 points in LOR.ConclusionApplication-relevant information relevant to the application beyond only technical details permits comparison with other assisting systems.

[1]  Raja Parasuraman,et al.  Automation in Future Air Traffic Management: Effects of Decision Aid Reliability on Controller Performance and Mental Workload , 2005, Hum. Factors.

[2]  P. Gardner,et al.  The Expanded Endonasal Approach: A Fully Endoscopic Transnasal Approach and Resection of the Odontoid Process: Technical Case Report , 2005, Neurosurgery.

[3]  J. Schipper,et al.  Computerassistierte Chirurgie (CAS) zur optimalen Behandlung der kraniofazialen fibrösen Dysplasie , 2005, HNO.

[4]  P. Rombaux,et al.  Computer assisted surgery and endoscopic endonasal approach in 32 procedures. , 2003, Acta oto-rhino-laryngologica Belgica.

[5]  H. Stammberger,et al.  Functional endoscopic sinus surgery * Concept , indications and results of the Messerklinger technique , 2022 .

[6]  H. Stammberger,et al.  Functional endoscopic sinus surgery , 1990, European Archives of Oto-Rhino-Laryngology.

[7]  D. Winkler,et al.  Die Wertigkeit der CT-basierten Navigation für den transsphenoidalen Zugang zur Hypophyse , 2004 .

[8]  Thomas J. Allen,et al.  CAD system use and engineering performance in mechanical design , 1991 .

[9]  G Schlöndorff,et al.  [CAS (computer assisted surgery). A new procedure in head and neck surgery]. , 1989, HNO.

[10]  S. Lavallée,et al.  La chirurgie endonasale sous guidage endoscopique assistée par ordinateur , 2008 .

[11]  David B. Kaber,et al.  Effects of Automation of Information-Processing Functions on Teamwork , 2005, Hum. Factors.

[12]  Martin Styner,et al.  Automatic method to assess local CT-MR imaging registration accuracy on images of the head. , 2005, AJNR. American journal of neuroradiology.

[13]  H. Stammberger.  The Evolution of Functional Endoscopic Sinus Surgery , 1994, Ear, nose, & throat journal.

[14]  W. Freysinger.  A Passive‐Marker‐Based Optical System for Computer‐Aided Surgery in Otorhinolaryngology: Development and First Clinical Experiences , 2002, The Laryngoscope.

[15]  Joachim Meyer,et al.  Effects of Warning Validity and Proximity on Responses to Warnings , 2001, Hum. Factors.

[16]  Gero Strauß,et al.  Definition of accuracy and precision—evaluating CAS-systems , 2005 .

[17]  Program Nasa Scientific and Technical Information.  Failure Modes and Effects Analysis (FMEA) - A Bibliography , 2000 .

[18]  P. Goillau,et al.  Guidelines for Trust in Future ATM Systems: Measures , 2003 .

[19]  Hubertus Feussner,et al.  Ergonomic assessment of the static stress confronted by surgeons during laparoscopic cholecystectomy , 2004, Surgical Endoscopy And Other Interventional Techniques.

[20]  L. Nolte,et al.  Present state and future perspectives of computer aided surgery in the field of ENT and skull base. , 2002, Acta oto-rhino-laryngologica Belgica.

[21]  Thomas Klenzner,et al.  Navigation as a quality management tool in cochlear implant surgery , 2004, The Journal of Laryngology & Otology.

[22]  J Maurer,et al.  Comparison of Different Computer-Aided Surgery Systems in Skull Base Surgery. , 2003, Skull base : official journal of North American Skull Base Society ... [et al.].

[23]  F L Wuyts,et al.  Accuracy of computer navigation in ear, nose, throat surgery: the influence of matching strategy. , 2000, Archives of otolaryngology--head & neck surgery.

[24]  W Freysinger,et al.  Computer‐Aided Surgery in the Petrous Bone , 1999, The Laryngoscope.

[25]  Andreas Lackner,et al.  Image guided surgery of paranasal sinuses and anterior skull base--five years experience with the InstaTrak-System. , 2002, Rhinology.

[26]  Christopher D. Wickens,et al.  A model for types and levels of human interaction with automation , 2000, IEEE Trans. Syst. Man Cybern. Part A.

[27]  S. Durham,et al.  Functional endoscopic sinus surgery: 5 year follow up and results of a prospective, randomised, stratified, double-blind, placebo controlled study of postoperative fluticasone propionate aqueous nasal spray. , 2005, Rhinology.

[28]  John D. Lee,et al.  Trust in Automation: Designing for Appropriate Reliance , 2004 .

[29]  J. Schipper,et al.  Computerassistierte Verfahren in der rekonstruktiven funktionserhaltenden Orbitachirugie , 2005, HNO.

[30]  Tim Lüth,et al.  A new metric for drill location for Navigated Control in navigated dental implantology , 2004, CARS.

[31]  Gero Strauß,et al.  Workflow analysis for mechatronic and imaging assistance in head surgery , 2004, CARS.

[32]  V. Seifert,et al.  Laser Surface Scanning for Patient Registration in Intracranial Image-guided Surgery , 2002, Neurosurgery.

[33]  C. Maurer,et al.  The Impact of Fiducial Distribution on Headset-Based Registration in Image-Guided Sinus Surgery , 2003, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[34]  Regina A. Pomranky,et al.  The role of trust in automation reliance , 2003, Int. J. Hum. Comput. Stud..

[35]  J. Meixensberger,et al.  Genauigkeit und Präzision in der Bewertung von chirurgischen Navigations- und Assistenzsystemen , 2006, HNO.

[36]  M J Citardi,et al.  Image-Guided Functional Endoscopic Sinus Surgery , 2000, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[37]  S. Reinert,et al.  [Registration using three-dimensional laser surface scanning for navigation in oral and craniomaxillofacial surgery]. , 2003, Zentralblatt fur Chirurgie.

[38]  U. Ecke,et al.  Der Einsatz eines optischen Navigationssystem in der Nasennebenhöhlenchirurgie , 2003, HNO.

[39]  Heinz U Lemke.  Workflow in the operating room. , 2005, Biomedizinische Technik. Biomedical engineering.

[40]  Cleotilde Gonzalez,et al.  Task Workload and Cognitive Abilities in Dynamic Decision Making , 2005, Hum. Factors.

[41]  U. Ecke,et al.  A Passive‐Marker‐Based Optical System for Computer‐Aided Surgery in Otorhinolaryngology: Development and First Clinical Experiences , 1999, The Laryngoscope.

[42]  Cost Analysis of Computer-Aided Endoscopic Sinus Surgery , 2001, American journal of rhinology.

[43]  Mathias Hofer,et al.  Verbesserte Umsetzung der Resektionsgrenzen in der Nasennebenhöhlenchirurgie mit dem navigiert-kontrollierten Shaver , 2006 .

[44]  G. Strauß,et al.  [Navigated control: a new concept in computer assisted ENT-surgery]. , 2005, Laryngo- rhino- otologie.

[45]  T. Lenarz,et al.  Schädelbasischirurgie mit einem optoelektrischen Navigationssystem , 2001, HNO.