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Mechatronik in der HNO-Chirurgie

Erste Erfahrungen mit dem daVinci-Telemanipulator-System

Mechatronic in functional endoscopic sinus surgery

First experiences with the daVinci Telemanipulatory System

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Zusammenfassung

Hintergrund

An einem kommerziell erhältlichen Telemanipulator (daVinci, Intuitive Surgical, USA) wurden am Beispiel des endonasalen Zuganges zu den Nasennebenhöhlen die potenziellen Vor- und Nachteile computergesteuerter Instrumente untersucht.

Methode

Es wurden fünf unterschiedliche Operationen an den Nasennebenhöhlen an 14 anatomischen Präparaten durchgeführt und mit der konventionellen Op.-Technik verglichen. 140 Eingriffe an den Nasennebenhöhlen wurden unter folgenden Kriterien untersucht: Freiheitsgrade, Zeitaufwand, Lerneffekt, Kraftrückführung, Ergonomie.

Ergebnisse

Die Instrumente des Telemanipulators verfügen in der „region of interest“ über mehr Freiheitsgrade als konventionelle Instrumente. Der durchschnittliche zusätzliche Mehraufwand für die Rüstzeit des Systems lag in unserer Untersuchung bei 9±2 min. Die rhinochirurgisch erfahrenen Chirurgen schätzten den Wegfall der Kraftrückführung als negativ ein und die Bewegungsskalierung als hilfreich. Sie bewerteten die ergonomische Gesamtsituation als besser im Vergleich zur konventionellen Methode.

Fazit

Der Telemanipulator bietet Vorteile bei der Anzahl der verfügbaren Instrumentenfreiheitsgrade, in der Möglichkeit der Instrumenteninteraktion („motion scaling“, „indexing“) und in der Ergonomie.

Abstract

Background

This study examines the advantages and disadvantages of a commercial telemanipulator system (daVinci, Intuitive Surgical, USA) with computer-guided instruments in functional endoscopic sinus surgery (FESS).

Methods

We performed five different surgical FESS steps on 14 anatomical preparation and compared them with conventional FESS. A total of 140 procedures were examined taking into account the following parameters: degrees of freedom (DOF), duration , learning curve, force feedback, human-machine-interface.

Results

Telemanipulatory instruments have more DOF available then conventional instrumentation in FESS. The average time consumed by configuration of the telemanipulator is around 9±2 min. Missing force feedback is evaluated mainly as a disadvantage of the telemanipulator. Scaling was evaluated as helpful. The ergonomic concept seems to be better than the conventional solution.

Discussion

Computer guided instruments showed better results for the available DOF of the instruments. The human-machine-interface is more adaptable and variable then in conventional instrumentation. Motion scaling and indexing are characteristics of the telemanipulator concept which are helpful for FESS in our study.

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Authors and Affiliations

  1. BMBF-InnovationsCentrum Computer-Assistierte Chirurgie ICCAS, Universität Leipzig

    G. Strauß, D. Winkler, S. Jacobs, C. Trantakis, F. Bootz, J. Meixensberger & V. Falk

  2. Klinik und Poliklinik für HNO-Heilkunde/Plastische Operationen, Universität Leipzig

    G. Strauß

  3. Klinik und Poliklinik für Neurochirurgie, Universität Leipzig

    D. Winkler, C. Trantakis & J. Meixensberger

  4. Klinik für Herzchirurgie, Universität Leipzig

    S. Jacobs & V. Falk

  5. Klinik und Poliklinik für HNO-Heilkunde/Plastische Operationen, Universität Leipzig

    A. Dietz

  6. Klinik und Poliklinik für HNO-Heilkunde/Chirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn

    F. Bootz

  7. Klinik und Poliklinik für HNO-Heilkunde/Plastische Operationen, Universität Leipzig, Liebigstraße 18a, 04103, Leipzig

    G. Strauß

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  1. G. Strauß
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  2. D. Winkler
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  3. S. Jacobs
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  8. V. Falk
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Correspondence to G. Strauß.

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Strauß, G., Winkler, D., Jacobs, S. et al. Mechatronik in der HNO-Chirurgie. HNO 53, 623–630 (2005). https://doi.org/10.1007/s00106-005-1242-1

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