Endoscopic Sinus Surgery: Advantages of the Bimanual Technique

Briner, Hans Rudolf; Simmen, Daniel; Jones, Nick

doi:10.1177/194589240501900310

Cited by 44 publications

(36 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Based on improved endoscopes and instruments, the further development of operation techniques (e.g. ''four-hand-technique'') [18] and the routine application of precise navigational systems, the limits of the endoscopic approach could be extended over the last decades [12]. In accordance, the three surgically treated paranasal ossifying fibromas presented here could be removed exclusively endoscopically controlled.…”

Section: Discussionmentioning

confidence: 93%

Paranasal ossifying fibroma: endoscopic resection or wait and scan?

Ledderose

Stelter

Becker

et al. 2011

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

The ossifying fibroma is a fibro-osseous lesion that rarely occurs in the paranasal sinuses. Due to its tendency to behave locally aggressively, complete resection is generally recommended. A subdivision into the aggressive juvenile ossifying fibroma (JOF) and the less aggressive cemento-ossifying fibroma of the adult (COF) is clinically reasonable. The objective of the study was to retrospectively analyze the management and follow-up of the patients diagnosed with ossifying fibroma at our ENT-department from 2006 to 2010. A total of five patients were included, thereby comprising one of the largest case series of paranasal ossifying fibromas. In three patients an exclusively endoscopically controlled resection was performed. Two patients with asymptomatic COF declined surgery. Within the 2-year follow-up, no progression was detected. While the JOF should always be surgically treated, for the asymptomatic paranasal ossifying fibroma of the adult (COF) a wait-and-scan strategy, similar to that recommended for osteomas or fibrous dysplasia, could be an option in selected cases.

show abstract

Section: Discussionmentioning

confidence: 93%

Paranasal ossifying fibroma: endoscopic resection or wait and scan?

Ledderose

Stelter

Becker

et al. 2011

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…Along the way, the active instrument must be kept in the field of vision without touching or even harming the surrounding tissue [2]. During this intervention, additional challenging multitasking may occur like: removal of bone or the control of a bleeding [3]. Thus, the need for the surgeons to operate the instruments with both hands resulted in a strengthened desire.…”

Section: Resultsmentioning

confidence: 99%

Computer Assisted Head and Neck, and ENT Surgery

2009

Int J CARS

View full text Add to dashboard Cite

Keywords Image-guided surgery Á Cone-beam CT Á Mobile C-arm Á Image registration Á Surgical navigation Purpose Intraoperative 3D imaging with sub-millimeter spatial resolution and soft-tissue visibility is an essential next step in the advancement of precision image-guided surgery. To this end, a prototype mobile C-arm for cone-beam CT (CBCT) has been developed and applied in preclinical studies across a broad spectrum of surgical applications. The current work describes the integration of C-arm CBCT with other image guidance subsystems (including surgical planning, deformable registration, real-time tracking, and visualization) and reports implementation in a prospective clinical trial in head and neck surgery. Methods (a) Integration of C-Arm CBCT guidance systems As illustrated in Fig. 1, the prototype is based on a mobile isocentric C-arm (Siemens PowerMobil) developed in collaboration with Siemens Healthcare. The C-arm was modified to include a flat-panel detector, motorized orbit, geometric calibration, and control system. The system demonstrates 3D image quality with sub-mm spatial resolution and soft-tissue visibility at low radiation dose. Fast 3D reconstruction provides volume images within *15 s of completing the scan.Subsystems ranging from surgical planning to tracking and visualization have been integrated with the C-arm in phased implementation for clinical trials. Fast deformable registration using a multi-scale Demons algorithm transforms preoperative images, the surgical plan, and other intraoperative CBCT to the most recent CBCT image. An adaptive convergence criterion provides accurate registration on a timescale consistent with intra-operative use. Novel real-time tracking developments include: (i) automatic registration of CBCT and tracking systems (eliminating manual registration); and (ii) real-time tracking of endoscopes (augmenting endoscopy with image data and/or virtual representation of the endoscope in CBCT). 3D visualization software developed using the IGSTK library provides triplanar/oblique views, surface and MIP renderings, fusion with preop images and surgical plan, fusion with video endoscopy, and real-time tracking/navigation. (b) Clinical trial in head and neck surgery A prospective trial has been conducted involving 12 patients undergoing surgery of the head and neck. Cases include anterior skull base and sinus tumor resection, maxillectomy, mandibulectomy, and maxillofacial reconstruction. Phase 1 of the trial (6 patients) involved Fig. 1 Systems integrated with C-arm CBCT. a C-arm in the OR. b Surgical target volume registered to CBCT. c Deformable registration showing differences associated with jaw flexion in rigid and deformable registration. d Intraoperative 3D visualization

show abstract

“…The endonasal approach has been facilitated by the further development of endoscopes (telescopes with various angles of view) and surgical instruments (drills, ''Clearvision Ò '', Karl Storz GmbH & Co KG, Tuttlingen, Germany), and refinement of surgical techniques (frontal sinus drainage type IIB, mediandrainage type III, ''drill out'', ''modified Lothrop procedure'' [3,20,22]). Particularly when using drills, the bimanual technique (''four hands, two nostrils'') can possibly reduce both surgery time and complications, thanks to the better overview it provides [24]. The navigation system, having shown to offer satisfactory accuracy [25], supplies a further tool to facilitate orientation during the endoscopic osteoma operations.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of osteomas of the frontal recess and sinus: extending the limits of the endoscopic approach

Ledderose

Betz

Stelter

et al. 2010

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Osteomas are among the most common benign tumors of the paranasal sinuses. Symptomatic osteomas are most often found in the frontal recess and the frontal sinus. While the extranasal approach is still a part of the treatment concept for removing osteomas at this localization, over the last years the endoscopically controlled endonasal approach has greatly gained in importance due to the improved surgical equipment. We retrospectively analyzed the surgical indication, surgical approach and outcome of the removal of osteomas of the frontal recess and the frontal sinus performed at our hospital between 1996 and 2010. The exact surgical technique, intra- and postoperative complications, the duration of the hospital stay and the follow-up and subjective contentment of the patients were evaluated. With a total of 24 patients being included, the study comprises one of the largest groups of patients with osteomas of the frontal recess and sinus. Over the study period, the frequency of the endoscopic approach clearly increased. Previously suggested guidelines for the endoscopic resection of a frontal sinus osteoma turned out to be superseded. Endoscopically controlled resection even of large, adversely located osteomas of the frontal recess and the frontal sinus is becoming increasingly possible, but is still naturally limited by the individual anatomic conditions and the need for experienced surgeons.

show abstract

Endoscopic Sinus Surgery: Advantages of the Bimanual Technique

Cited by 44 publications

References 13 publications

Paranasal ossifying fibroma: endoscopic resection or wait and scan?

Paranasal ossifying fibroma: endoscopic resection or wait and scan?

Computer Assisted Head and Neck, and ENT Surgery

Surgical management of osteomas of the frontal recess and sinus: extending the limits of the endoscopic approach

Contact Info

Product

Resources

About