[Evaluation of a Micro-Manipulator for Middle Ear Surgery: A Preclinical Trial]. / Evaluation eines Mikromanipulators für die Mittelohrchirurgie: Eine präklinische Studie.

BACKGROUND: Microsurgical preparation is limited by geometric and mechanical constraints. In preparation for clinical use, this study investigates performance, ease of handling and precision of a novel manipulator concept for microsurgery. MATERIAL AND METHODS: A group of 15 ENT experienced doctors, as well as a group of 17 medical students with low/non surgical experience participated in the study. Each of the subjects carried out 4 trials of simulated surgeries on a phantom with built-in force sensors. The task was to apply a defined force between 1.5 and 2 N using a Fisch micro perforator, 16 cm length, 0.4 mm (Storz) targeting holes with a diameter of 0.5 mm. For comparison, the Fisch micro perforator was moved manually or with the manipulator. RESULTS: Assessing the total number of errors proved a significantly lower error number (p<0.0001) and an improvement of the accuracy of 76% with the manipulator. The time requirement for the procedure with the micro manipulator is on average 2-3 times higher than with manual control (p<0.0001). But it is notable that this time requirement significantly decreases with training (p<0.0001). CONCLUSION: The study shows a significant reduction in the number of errors by using a new manipulator concept compared to the non-augmented human hand in an experimental setup. We observed a significant learning effect when subjects applied the micro manipulator, resulting in reduction of the time requirement while maintaining a constant number of errors.

[Clinical experiences with an automatic collision warning system: instrument navigation in endoscopic transnasal surgery]. / Klinische Erfahrungen mit einem Kollisionswarnsystem: Instrumentennavigation in der endo- und transnasalen Chirurgie.

PROBLEM: The goal of this work is the extension of instrument navigation with a collision warning function. With the help of an additional distance display and warning system the performance of surgical navigation systems should be improved. MATERIAL AND METHODS: The collision warning system (DCS) is an extension of an optoelectric navigation system (NPU, Karl Storz GmbH&Co.KG, Tuttlingen, Germany). The measurement of situation awareness was performed on phantom models of functional endoscopic surgery of the paranasal sinuses (FESS; Phacon, Leipzig). Altogether 450 measurement pairs for the analysis of surgical accuracy to the risk structure (frontal skull base, lamina papyracea, internal carotid artery) were available. To examine the influence on the clinical process, a prospective analysis of intraoperative complications was carried out. Of the 104 FESS patients, two groups, one of 56 patients with only navigation (NAV) and one of 48 patients (NAV+DCS), were examined. Efficiency was evaluated on the basis of times for system preparation and intraoperative application. RESULTS: A significant increase in the assumed and actual distance values between instrument tip and risk structure using the collision warning system was seen at 76%. The complication rate was more favorable for the NAV+DCS group. The time needed for preparation of the navigation system with the application of the collision warning system increased on average by 48%, or 1.2 min. However, the relation between preparation time and utilization time was approximately the same at 53.5% in the NAV group and 57.4% in the NAV+DCS group. CONCLUSIONS: This work supports the clinical use and efficiency of a collision warning system as an addition to well-known instrument navigation in endo- and transnasal surgery. The segmenting algorithm is suitable for clinical requirements.

The effects of the use of piezoelectric motors in a 1.5-Tesla high-field magnetic resonance imaging system (MRI).

PURPOSE: This paper presents the results of an experimental investigation with two different rotatory piezomotors in a closed 1.5 Tesla high-field MRI. The focus of the investigation was on testing the functionality of these motors within the MRI and to determining the image interference they caused. MATERIALS AND METHODS: To obtain a differentiated estimate of the interference the motors were tested in both the passive (turned off, i.e. without current flow) and active (turned on, i.e. with current flow) state during MRI scanning. Three different types of sequences were used for the test: Spin-Echo (SE), Gradient-Echo (GE) and Echo-Planar Imaging (EPI). A plastic container filled with a gadolinium-manganese solution was used for representation of the artefacts. The motors investigated were placed parallel to the container at predetermined distances during the experiment. RESULTS AND CONCLUSIONS: The results show that the motors investigated suffered no functional limitations in the magnetic field of the MRI but, depending on the type of motor, the measurement distance and the state of the motor, the motors had different effects on the sequence images. A motor in the off-state placed immediately next to the object to be measured mainly causes artefacts because of its material properties. If, on the other hand, the piezomotor is in the on-state images with strong noise result when the motor is immediately next to the object being measured. The images regain their normal quality when the motor is approximately at a distance of 1 m from the object being investigated. Driving the motor inside the MRI, therefore, is only to be recommended during the pauses in scanning: this delivers artefact-free images if minimal, motor-specific distances are kept to. With regard to the three different types of sequences it was determined that the SE sequence was the least sensitive and the EPI sequence the most sensitive to disturbance. The GE sequence showed only minimal differences to the SE sequence with regard to signal-to-noise ratios. Since it requires considerably shorter scan-times it can be considered to be the most effective type of sequence under these conditions.

[Effects of para- and diamagnetic materials in a 1.5 Tesla high field magnetic resonance tomography system]. / Effekte von para- und diamagnetischen Materialien in einem 1,5-Tesla-Hochfeld-Magnetresonanztomographen (MRT).

This article shows the results of an experimental investigation of the interference by paramagnetic and diamagnetic materials on imaging in a closed 1.5 Tesla high field magnetic resonance imaging system (MRI). For different types of sequences (SE, GE, EPI) the effects of metal and non-metal profiles in producing artefacts were investigated. A phantom (plastic trunk) filled with Gd-Mn-solution was used for representation of the artefacts. The materials analysed were placed parallel to the phantom at predetermined distances. The images were obtained in transverse and sagittal planes and analysed with respect to the resulting artefacts. The results show that aluminum and polymer profiles produce the weakest artefacts, even when the material is positioned close to the phantom. A comparison of the sequence types shows that the SE-sequence has a low sensitivity to artefacts, despite the great profile variation in size and shape. The SE-sequence accordingly showed a higher imaging stability as compared with the GE- and EPI-sequences. Steel and copper produced the strongest artefacts. The examination was begun after an intensive study of the literature (Internet, Medline, Meditec). So far have been few publications on this subject.

A system for respiratory motion detection using optical fibers embedded into textiles.

In this contribution, a first prototype for mobile respiratory motion detection using optical fibers embedded into textiles is presented. The developed system consists of a T-shirt with an integrated fiber sensor and a portable monitoring unit with a wireless communication link enabling the data analysis and visualization on a PC. A great effort is done worldwide to develop mobile solutions for health monitoring of vital signs for patients needing continuous medical care. Wearable, comfortable and smart textiles incorporating sensors are good approaches to solve this problem. In most of the cases, electrical sensors are integrated, showing significant limits such as for the monitoring of anaesthetized patients during Magnetic Resonance Imaging (MRI). OFSETH (Optical Fibre Embedded into technical Textile for Healthcare) uses optical sensor technologies to extend the current capabilities of medical technical textiles.