A pharyngeal foreign body is a common disease in the otolarygological outpatient setting. Usually it can be removed orally, but there are some cases with difficulty in removing the substance buried beneath pharyngeal mucous membrane. We encountered two cases of the foreign bodies buried beneath the pharyngeal mucous membrane which were successufully removed using navigation system. The case 1 is a 67-year-old woman. Its chief complaint is a throat pain after ingestion of a squid. We couldn't find out the foreign substance which was suspected in CT by using a laryngopharynx fiber and an upper gastrointestinal endoscope. The neck abscess detected on the 8th day. The metal piece-like foreign substance was suspected by CT, and the 24-mm metal wire buried beneath the posterior wall of the pharynx was removed by use of navigation under general anesthesia. The case 2 is a 63-year-old woman. Her chief complaint is a throat pain after ingestion of a barracuda. A foreign body in the oropharynx posterior wall was suspected in CT. We couldn't remove the foreign body by using navigation system. A clip was hooked in the posterior wall of the pharynx as a marking. Next day we were able to identify the position of the fishbone from the position of the CT and, successufully removed the fish bone.
Brainlab introduces “CURVE” as new navigation platform in autumn 2012. It was developed under the product concepts; “Sophisticated ergonomic design”, “Integrated multi-purpose interface”, “Digital HD technology”. CURVE is versatile navigation platform including compatibility with DICOM images and other intraoperative optical instruments in order to enhance functionality in OP room. This is the first introduction to unveil its new features in Japan.
Medtronic has developed and sold various products specialized for ENT surgeries for many years. This time we describe our new product, Fusion® ENT navigation system, releasing on December 2012. We have already introduced hybrid optical-electromagnetic navigation system called “Stealth Station S7®”. Fusion system employs only electromagnetic navigation system dedicated for ENT department and is very simple to use. The electromagnetic navigation system generates a low-energy magnetic field and tracks the location of the patient and instruments with dedicated trackers. Because of this mechanism, Fusion system makes it possible to control instruments more freely compare to optical navigation system. Furthermore the tracker is smaller and lighter so that surgeons and the patients feel less stress during the surgery. Fusion system attracts increasing attention and has already been installed over 1,000 in the world. We will keep developing less invasive and more user-and patient-friendly products for the future.
Now, the navigation system is used in about 80% of university hospital. We have the use experience of several kinds of navigation system such as a magnetic field type, an optical and hybrid (optical+magnetic field) type navigation system. In our department, StealthStation S7 of a hybrid form is used by the “magnetic field type” by most cases. By carrying out comparison navigation systems, it is thought that we can choose the best selection of the navigation system type before an operation.
We introduce our reference antenna for image-guided temporal bone surgery. Our reference antenna was fixed to the tailor-made splint for each patient. The splint secured the accuracy as well as stability throughout the surgery for at least 4 hours. The splint-fixed reference frame was a useful in image-guided temporal bone surgery where invasive head clamp is not always practical.
We introduce our IGS reference frame for easy and rapid registration. we produced dentally affixed reference frame tailored for each patient. This reference frame is detachable and has both fiducial markers and reference markers. So, by taking patient's CT scans with this reference frame, we can finish the registration without patient, before surgery. The only preparation for IGS in the operating room is to attach the reference frame on the patient again. This dentally affixed reference frame is suitable for image guided ENT surgery where invasive or time-consuming registration method is unmatched.
Control of bleeding is mentioned as an important factor which influences the success or failure of ESS. Within a narrow nasal cavity, a conventional bayonet type bipolar often is difficult to even open the tip by interference. In ESS, the mono-body forceps type tools are very useful. In recent years, many very user-friendly instruments, such as a forceps type bipolar with suction and rotation tip bipolar for skull base surgery, have already been released. The endoscopic surgery in a nose is expanded even to not only ESS but the nose sinonasal tumor operation, or the skull base operation in recent years, and an exact arrest of hemorrhage is an important point of an operation. It is also important to gather information in various surgical tools and to choose suitable tools.
Biofilm and Fungi can develop sinusitis refractory to medical treatments, and Hydrodebrider System is invented for these problems. Its powerful irrigation and good flexibility helps us to remove the bacterial infection that causes ongoing sinus problem. At the present we use this system for treating fungus mycetoma. It is useful of complete removing fungus ball that is likely to be persistent in the blind spot of sinuses.
We described the 2 cases with fungal sinusitis. To treat these cases, we did endoscopic sinus surgery with hydrodebrider system. This system has a powerful irrigation and remove the persistent bacterial and fungal infection that causes refractory paranasal sinusitis. We used the standard handpiece to the patient with maxillary sinusitis and used the frontal handpiece to the patient with sphenoidal sinusitis. It is thought that hydrodebrider sysyem is very useful for the patient with fungal sinusitis.
Upper airway collapse several areas in varying degrees, especially during sleep. 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. Then we should evaluate the upper airway morphology both static and dynamic manner, especially when we plan the sleep surgery. We have been performed 3D-CT examination as a static evaluation. Also, with DICOM data, we have been examined the inspiratory airflow simulation with computational fluid dynamics software (Phoenics). In this paper, we showed that the usefulness of the inspiratory airflow simulation with computational fluid dynamics software.
Recently the need to produce surgical simulators has become gradually important. In this background, we reported on the education of the laryngeal surgery and treatment using a simulator which is originally used for intubation's training. The concept of surgical education has changed from the see one, do one, teach one approach to the see one, practice many, do one, and teach one approach. This means that it is important for trainee surgeons to acquire basic skills outside of the operating room before participating in procedures on patients. In this paper, we also described the importance of the training of the microlaryngeal surgery and removal of the pharyngeal foreign body using the simulator.
This paper describes a patient-robot and a humanoid robot that physically grows like human. Recently, the number of people of dentists increases every year. However, the lack of skill of graduates of schools of dentistry is obvious. The problem seems to lie in the fact that the dentists have no sufficient experience of treating human patients. The present study was made in order to develop a patient-robot for use in an actual clinical training. The patient has the possibility of making an unexpected motion while treating. This motion often surprises the dentist. Therefore, it is important to develop a whole body patient-robot. Human grows mentally and physically. This research, aims at reproducing the human physical growth and walking sequence by using physical models. It introduces a growth process of body parameter by physical models and the human walking motion. Growth processes of these models are reproduced using from the average measurement of multiple human data.
The high-resolution, magnified, three-dimensional view of the operative field provided by TORS allows for excellent visualization of the target anatomy. The surgeon's fine hand and finger movements are translated into precise motion-scaled movement of the robotic instruments within the narrow confines of the upper aerodigestive tract. TORS radical tonsillectomy has increased the indications for transoral resection. Additional advantages of TORS procedures may include a low rate of gastrostomy tube dependence, indicative of preservation of swallowing function. High rates of negative surgical margins have been reported, which correlate well with local disease control.
Transoral robotic surgery (TORS) was developed by Weinstein as a minimally invasive surgery mainly for laryngo-pharyngeal cancer. Da Vinci surgical system is a robot which enables to perform surgery safely and precisely under 3D vision. Since TORS had been cleared by FDA in 2009, it has been spreading explosively all over the world. However, it has not been approved by Pharmaceutical and Medical Devices Agency (PMDA) in Japan. We have attended the advanced course of TORS training held in Yonsei University prior to start the clinical trial of TORS and have performed radical tonsillectomy, tongue base resection, supraglottic laryngectomy, and piriform sinus resection for a cadaver. It was easy to adapt the movement of Da Vinci and transoral anatomy was a key to perform TORS safely. PMDA approval is desired in the otolaryngological field.
In thyroid surgery, recurrent laryngeal nerve (RLN) and superior laryngeal nerve external brunch (SLNEB) is the most serious complication. Several procedures of intraoperative neuromonitoring were reported recently. We studied new RLN monitoring procedure in thyroid surgery. Airwayscope® is one of laryngoscope using in general anesthesia. Facial nerve stimulator is commonly used at parotid- and neuro-surgery. In this study, we monitored RLN and SLNEB with these two equipments. In all patients, these nerves were identified and preserved, and then, vocal cord palsy were not occurred. This monitoring method is not only easily and useful but also more cost-effective.
Sentinel lymph node navigation surgery (SNNS) would provide information to perform individualized selective neck dissection in patients with head and neck squamous cell carcinoma. We here show a technique of gamma probe localization of radiolabelled lymph nodes to identify the sentinel node in early oral cancer. We also report chemotherapy targeting sentinel lymph node with CDDP-incorporating polymeric micellar nanoparticle (NC-6004) in the mouse model. In an orthotopic tongue cancer model, NC-6004 reduced the rate of sentinel lymph node metastasis to lower than that with CDDP. Key words: sentinel lymph node, cisplatin, micelles
In the Sentinel Node Navigation Surgery (SNNS), radioisotope method is probably the most widely used as it allows one to quantify the radioactivity picked up on the gamma probe and further to have a pre-operative picture of the identified SLN. However, this method has some problems, which was caused by using radioisotope. The aim of this study was to evaluate the clinical application of Indocyanin green (ICG) fluorescence in the mapping and detection of sentinel lymph nodes in cancers of the head and neck. A total of five patients with tongue or pharyngeal cancer and N0 neck status and where resection of the primary tumor was planned were used to evaluate the ICG fluorescence in the identification of the sentinel lymph node. 0.5ml of ICG solution was injected with at least four injection points along the circumference of the tumor. The infrared video camera was then directed toward the cervical area to identify the sentinel lymph node. In four cases the sentinel nodes could be identified, however in one case we could not detect the SN percutaneously with ICG fluorescent method. One case where identification was attempted through the skin were unsuccessful. In one case, sentinel node was pathological positive. Then the elective neck dissection was performed. ICG fluorescence is a potential valuable tool in the detection of SLN in patients with head and neck cancer. Further investigation is warranted.
Secondary placement of a voice prosthesis is often difficult to perform due to inability in flexing the neck after total laryngectomy and radiation therapy. We report a technique of secondary voice prosthesis placement using a curved rigid esophagoscope. An endotracheal tube and a flexible endoscope are inserted into the esophagus. In creating a tracheoesophageal puncture, a sharp forceps is inserted through the tip of esophagoscope. Then, a guide wire is introduced through the esophagoscope and the voice prosthesis is placed by back-loading method. This method is safe and easy because there is no risk of perforation through the posterior esophageal wall.
Using commercially available products, images including surgical findings can be recorded with higher quality. To define an appropriate folder name which include patient's name, ID, diagnosis and corresponding data, data retrieval is easily accomplished. This digital data management is useful not only in clinical use but in educational or research purpose.
We developed transoral videolaryngoscopic surgery (TOVS) as a minimally invasive surgical procedure for supraglottic, laryngeal, oropharyngeal, and hypopharyngeal cancers. TOVS is a novel, easy-to-use surgical procedure for transoral en bloc resection and involves use of a laryngopharyngeal retractor or distending laryngoscope, a rigid or deflectable videoendoscope, and laparoscopic surgical instruments. The advantages of this procedure are as follows. In transoral surgery, it can provide advantages similar to those of robotic surgery, such as wide field of view and working space. It is an easy procedure for otolaryngologists to perform without special training because it is an extension of well-known surgeries such as tonsillectomy or laryngomicrosurgery. Tactile sensation is retained during surgery; this is important for safe and reliable resection. Finally, this procedure can be performed at a low cost. Thus far, transoral oropharyngeal cancer resection using TOVS has been performed for 28 patients (29 lesions) in our institution. The resected lesions consisted of 8 T1 lesions, 14 T2 lesions, and 7 T3 lesions. There were no T4 tumors in this series. Sixteen patients (55.2%) had no nodal metastasis, while 13 patients (44.8%) were positive for nodal metastasis. Seventeen patients (58.6%) underwent neck dissection with TOVS. One patient underwent tracheotomy, and 9 (32.1%) received TOVS followed by conventional radiotherapy. None of the patients underwent reconstructive surgery. The median follow-up period in all the cases was 42 months. The 3-year crude survival rate, 3-year disease-free survival rate, and 3-year local control rate were 94.1%, 100%, and 95.5%, respectively. Postoperative swallowing function in the patients was satisfactory. TOVS for T1, T2, and some T3 oropharyngeal cancers contributed to functional preservation while maintaining cancer curability.