Consideration of ergonomic aspects in the development of a new endoscopic navigation system

Ergonomics of Endoscopic Skull Base Surgery: A Systematic Review

OBJECTIVE

There has been a significant expansion in endonasal endoscopic skull base surgery (EES) that has been used to address a wide range of intracranial and sinonasal pathologies. Although there exists a large amount of literature on approaches and patient outcomes, there is a paucity of data describing ergonomics in this field. Our goal was to evaluate and summarize the literature on ergonomics in EES.

METHODS

We systematically reviewed all published, peer-reviewed, English language literature in the PubMed and Web of Science databases as screened by multiple reviewers describing ergonomics as related to EES.

RESULTS

A total of 50 articles were found that described significant conclusions and descriptions on ergonomics in EES. We found and summarized the different technical aspects of ergonomics as pertaining to EES and provided evidence-based suggestions on operating room and surgeon setup.

CONCLUSIONS

There are several improvements in EES ergonomics that can decrease fatigue, improve efficiency, and overall surgeon well-being.

Neuronavigational neuroendoscopy--to be or not to be? An international pilot questionnaire-based study

OBJECTIVE

The almost age-old neuroendoscopy (NE) and neuronavigation (NN) in its twenties independently and indisputably have proved their high value as neurosurgical armamentarium and became even indispensable in some pathologies. However, nowadays the effectiveness of their simultaneous and combined application still is a matter of debate. The purpose of our pilot international, questionnaire-based survey was to assess the position of the opinion leaders in the field of neuroendoscopy worldwide toward the neuronavigational neuroendoscopy (NNNE).

METHODS

Within 3 months, a questionnaire with 17 questions was emailed repeatedly to 55 leading academic neuroendoscopic neurosurgeons from 50 institutions in 24 countries. The questionnaire covered aspects of personal and institutional experience in NE, NN, and NNNE, the most frequently treated pathologies by NNNE as well as inquiring the neurosurgeons' opinion for the importance and future of NNNE.

RESULTS

Forty-one questionnaires were returned (response rate = 74.6%). Six questionnaires were excluded because of incomplete or incorrect answers, leaving in the survey 35 respondents from 35 institutions in 18 countries. The less experienced neurosurgeons rely in higher degree on NNNE. Most frequently, NNNE is performed for hydrocephalus (procedures other than third ventriculostomy), transsphenoidal surgery, tumor biopsy, and cyst fenestration. Regardless their neurosurgical and NE experience, more than 75% of the respondents state that NNNE extends the range of neuroendoscopic procedures in their neurosurgical departments.

CONCLUSION

NNNE represents a valuable operative technique with excellent future prospects. NNNE extends the range of neuroendoscopic procedures, transforming some number of patients from "nonoperable" neuroendoscopically to suitable for neuroendoscopy.

Robust registration procedures for endoscopic imaging

This paper presents a robust algorithm for calibration and system registration of endoscopic imaging devices. The system registration allows us to map accurately each point in the world coordinate system into the endoscope image and vice versa to obtain the world line of sight for each image pixel. The key point of our system is a robust linear algorithm based on singular value decomposition (SVD) for estimating simultaneously two unknown coordinate transformations. We show that our algorithm is superior in terms of robustness and computing efficiency to iterative procedures based on Levenberg-Marquardt optimization or on quaternion approaches. The algorithm does not require the calibration pattern to be tracked. Experimental results and simulations verify the robustness and usefulness of our approach. They give an accuracy of less than 0.7 mm and a success rate >99%. We apply the calibrated endoscope to the neurosurgical relevant case of red out, where in spite of the complete loss of vision the surgeon gets visual aids in the endoscope image at the actual position, allowing him/her to manoeuvre a coagulation fibre into the right position. Finally, we outline how our registration algorithm can be used also for standard registration applications (establish the mapping between two sets of points). We propose our algorithm as a linear, non-iterative algorithm also for projective transformations and for 2D-3D-mappings. Thus, it can be seen as a generalization of the well-known Umeyama registration algorithm.