ナビゲーションと内視鏡を併用する耳鼻咽喉科領域の手術

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  • NAVIGATION- AND ENDOSCOPE-AIDED SURGERY IN OUR EAR AND NOSE CLINIC

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Navigation system can provide otolaryngologist with an image-guided surgery to avoid damage for important organ of the ear and nose, i.e. the facial nerve or orbital organ. Endoscopic surgery is also important and safe key for difficult ear and nasal surgery. Therefore, navigation and endoscope have been used together in our ear and nose clinic.<br>We have introduced magnetic and optical system of navigation in difficult cases of the ear surgery as well as the nasal surgery to perform a safe operation since 2004. The operation have included a lesion of the petrous apex and inner ear, sphenoid sinus, an unexpected anomaly, severely damaged trauma and multi-operated case. A probe is moved in the operative field and three axial CTs are simultaneously monitored on a workstation to show the tip location. There are several type of probe in size and shape, and so it is very easy to handle the device in narrow space of the ear and nose. Accuracy of the system is within 1.5 mm to identify the point anatomical of probe. With the navigation system, disease like cholesteatoma or paranasal tumor could be thoroughly and safely removed.<br>We can conclude that navigation and endoscope should be used together for safe ear and nasal surgery. When normal anatomy might be missing in difficult cases, identification of operative anatomy in real time is very important surgical cue for a safe operation. Combined use of navigation and endoscope system is now practical and available for surgery of the ear and nose. Problem or disadvantage may be only cost for installing both expensive systems. However, iatrogenic damage needs more expensive compensation.

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