A video-endoscope is a popular device in the ENT clinic. We usually use it only in observation. In case of a hemostasis in the nasal cavity, we use a rigid endoscope, however all clinics do not possess a rigid type because of its high price. In this background, we try to use the video-endoscope using a hard sheath of Endoscrub®. This application makes us easier in stopping the epistaxis in our daily clinic. Also in a treatment after endoscopic sinus surgery and a biopsy from deep lesion of a nasal cavity.
The LigaSureTM vessel sealing system is a bipolar diathermy system that seals vessels with reduced thermal spread. We report on the thyroid tumor operation, and the transnasal vidian neurectomy by using LigaSureTM. Because we can operate it easily and it has strong power to seal vessels, it was thought an extremely useful device when operating on the head and neck region.
The E-Z Clean Bayonet Needle Electrode Modified (Megadyne Medical Products, Inc.) is specialized electrosurgical knife tip for the endoscopic sinus surgery. This products is useful for the sino-nasal tumors. In Bayonet Needle Electrode, it excelled in operativeness in a narrow nasal cavity, and the intricately-designed incision on mucous membrane was excellent feeling. It is easy to interfere with neither surgical instruments nor the endoscope when it uses bayonet type electrode. The E-Z Clean Bayonet Electrodes seemed the introduction comparatively because of being able to use by the general handpiece of the radio-knife used easily, and useful for the sino-nasal tumor endoscopic surgery.
We developed new stereo endoscope systems to perform rhino surgery. New systems have two-eyes endoscope with one high definition camera (1,920×1,080 pixels). It is easy to recognize the target location and the depth of surgical fields. Surgeon can perform operation without attaching special glasses by using 3D viewer. Fatigue of operation was reduced. It is therefore concluded that a new system was useful for rhino surgery.
Since otologic surgery is generally minimally invasive, it has not been easy to employ conventional surgical navigation that necessitates invasive procedures. We introduce our 21 consecutive navigated cochlear implantation using newly developed method for noninvasive navigation.
Now, about 80% University Hospitals have navigation system. The main purpose to use navigation system is to distinguish where the target points are. So, we try to use the navigation system as the purpose of education for Endoscopic Sinus Surgery. When resident level surgeons perform operation, several problems will occur even if they have enough knowledge from textbooks etc. We use the human nasal and paranasal model (M01-SET=ESS1) made by Surge Trainer company as a simulation. The CT data of the model was taken into the navigation system. Some anatomical points are plotted by using navigation system. We examined the problems of this program and the system.
This paper presents a brief overview of surgery assistance systems based on medical image systems. Especially, we show surgical assistance systems that utilize a virtual endoscopy system that can generate endoscopic views from medical images. First, we briefly explain the basic concept of a surgical navigation system and a virtualized endoscopy system. Then, this paper shows some applications of such systems in the laparoscopy, the neurosurgery, and the pulmonary areas.
Magnetic resonance imaging (MRI) is an essential modality in head and neck imaging. Generally, MRI provides lower spatial resolution and takes longer time than computed tomography (CT), however, recently with the various techniques 3D-MRI can be obtained with thin-slice images in a wide range. In addition, contrast-enhanced MRI with gadolinium-based contrast agent can provide images with different contrast from non-contrast MRI and contrast-enhanced CT. In this review, utility of 3D-MRI, contrast-enhanced MRI, and inner ear imaging using these techniques is mainly discussed.
It is well known that the breathing route affects the upper airway morphology. It has been suggested that patients with obstructive sleep apnea (OSA) have narrower pharyngeal airways than non-OSA patients, therefore breathing with mouth open affect the upper airway morphology of OSA patients significantly compared to non-OSA patients. To assess the relationship between pattern of breathing and upper airway morphology in OSA patients, we perform 3D-CT examination and evaluate the changes of upper airway morphology with mouth open and close with DICOM viewer (Osirix). Eight patients were examined 3D-CT with breathing with mouth open, close. Even in awake, upper airway became narrow with oral breathing. It has been reported that the imaging results while awake do not necessarily reflect conditions during sleep, when tone of the upper airway dilating muscles is decreased. But on the standpoint of relationship between breathing routes and upper airway morphology, 3D-CT while awake can be a useful tool for OSA treatment. DICOM viewer Osirix is free software but very useful tool for evaluate the upper airway morphology.
We used the OsiriX software for preoperative and intraoperative CT interpretation in the sinus surgery. It was considered a useful method for understanding the structure of sinus with many anatomical variations at low cost.
The understanding of the anatomy is the most important element in the endoscopic sinus surgery. Inspection before ESS by especially three directions CT is a key to the operation success. However, it is a very difficult thing that CT in three directions is restructured and understands the 3D conformation. As for Aquarius NET (TeraRecon Co.), it is possible to process real time 3D image with all the electronic medical record client terminals in Intranet. We can refer in real time to three directions CT, and do the surgical simulation handily by using Aquarius NET by the thing that 3D restructuring and the arbitrary section slice make. This thing contributes to the patient explanation, the education, and clinical.
For surgical training of transnasal pituitary and clivus surgery, we had introduced a three-dimensional model of nasal and paranasal sinus. This model is consist of several segment and different materials are used. Nose and paranasal sinus containing the anterior skull base are basically made by glass and nylon resembling a texture of the bone. On the other hand, lateral structure of the nasal cavity, that is, inferior and middle turbinates are made by silicone rubber. These parts are coupled and finally, the real training model was made. This model has real touches of nasal and paranasal sinus and may facilitates surgical training for both pituitary and clivus surgeries.
We have developed a superimposed image-guided surgery system which extends the conventional system by a function that enables three-dimensional instant and subjective recognition of the patient's nose and sinus cavities. Here, we report application of this system in stereo endoscopic sinus surgery. We have operated 5 cases of paranasal sinus cysts and 6 cases of chronic sinusitis with this system. We consider that the superimposed image-guided surgery system is useful and effective for more precise and safer manipulation.
Minimally invasive surgery has become increasingly popular as expertise in laparoscopy has demonstrated excellent outcomes. The da Vinci surgical system facilitates more delicate and accurate laparoscopic surgery, and almost 70% of radical prostatectomy for prostate cancer is performed as robot assisted laparoscopic radical prostatectomy (RALP) in United States. We introduced the da Vinci system in Nagoya University Hospital, and performed RALP in 12 patients between May and October in 2010. We confirmed that RALP provides less blood loss and improved urinary continence as compared with laparoscopic and open radical prostatectomy.
Historically, advanced oropharyngeal cancer has been treated by surgical excision and postoperative radiotherapy. In this decade, many authors advocate for chemoradiotherapy to avoid impairments after surgery. But it also induced significant impairments in swallowing. Transoral robotic surgery (TORS) provides new benchmarks of function and complication rates, with which other series of treatments for oropharyngeal SCC can be compared. In Japan, we cannot do this procedure now, but we have to prepare.
Recently, robotic technology in the surgical field has widely spread. However, in the field of head and neck surgery, robotic surgery has been limited because of spatial and technical limitations. The technical and optical advantages of new robotic instruments, da Vinci S system, enable us to perform robotic surgery in the field of head and neck. Robotic thyroid surgery using robotic surgery has been developed mainly in Korea. In Korea, robotic thyroidectomy using a gasless, transaxillary approach is a common technique. Another feasible approach in head and neck region is transoral robotic surgery (TORS) for mesopharyngeal and midline skull base tumor. This technique has been developed mainly in the United States.
We introduced our experiences of transoral surgery of the larynx and pharynx, such as resection of early stage hypopharyngeal carcinoma or epiglitoc cysts and removal of foreign body, using Weerda-type videolaryngoscope along with telescope and Hi-vison CCD camera system in Hokkaido University Hospital.
Ultrasonograph guided fine needle aspiration cytology (FNAC) for nodule in thyroid or cervical lymph node is an excellent diagnostic examination. It is difficult to aspirate lymph nodes at cervical area, where is adjacent to carotid artery or the jugular vein. We invented a new assistant device in cooperation with Kanazawa Institute of Technology. This is combined technique with infrared system to measure a length and sonar system to detect subject in order to get accurate and safe aspiration in thyroid disease.
Nerve preservation of the parapharyngeal space tumor resection is one of the most important issues. Because the parapharyngeal space tumor retracts the lower cranial nerve and nerve exists different location than usual, it is often difficult to identify the nerve and to preserve nerve function. The parapharyngeal space tumor causes not only palsy of nerve that occurs in tumor but also compressed by the tumor, so we can not often predict the location of the nerve preoperatively. We report that intraoperative nerve monitorring for hypoglossal nerve and vagus nerve by Nerve Integrity Monitor (NIM) on the parapharyngeal space tumor resection is usefull to identify the nerve and to preserve nerve function.
Medtronic, Inc. has been developing ENT specialized products, such like drill system (XPS), intra operative nerve monitoring system (NIM), and navigation system (StealthStation) toward the ideal of “Best in Class”. In 2010, IPC drill system and NIM3.0 intra operative nerve monitoring system are released in Japan. In this article, we Medtronic introduce these new devices with their functions and values, and the future outlook of our product development in ENT field.
We report here comparison of classical method and microdebrider technique for adenotonsillectomy in pediatric patients with OSAS. The microdebrider group (Group I) were 9 pediatric Japanese OSAS patients of 3 boys and 2 girls. For comparison, 10 children undergoing the classical adenoidectomy (Group II) were selected among the 30 pediatric Japanese OSAS patients. These Group II children were matched in age, sex and Kaup index with the Group I. The results indicate that the microdebrider adenoidectomy could be more effective for bettering sleep apnea than the conventional operation. In conclusion, the microdebrider adenoidectomy for pediatric OSAS patients could be more effective for ameliorating sleep apnea than the standard adenoidectomy.