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An Automated Methodology for Assessing Anatomy-Specific Instrument Motion during Endoscopic Endonasal Skull Base Surgery.

ABSTRACT: Objectives ?Describe instrument motion during live endoscopic skull base surgery (ESBS) and evaluate kinematics within anatomic regions. Design ?Case series. Setting ?Tertiary academic center. Participants ?A single skull base surgeon performed six anterior skull base approaches to the pituitary. Main Outcomes and Measures ?Time-stamped instrument coordinates were recorded using an optical tracking system. Kinematics (i.e., mean cumulative instrument travel, velocity, acceleration, and angular velocity) was calculated by anatomic region including nasal vestibule, anterior and posterior ethmoid, sphenoid, and lateral opticocarotid recess (lOCR) regions. Results ?We observed mean (standard deviation, SD) velocities of 6.14 cm/s (1.55) in the nasal vestibule versus 1.65 cm/s (0.34) near the lOCR. Mean (SD) acceleration was 7,480 cm/s ² (5790) in the vestibule versus 928 cm/s ² (662) near the lOCR. Mean (SD) angular velocity was 17.2 degrees/s (8.31) in the vestibule and 5.37 degrees/s (1.09) near the lOCR. We observed a decreasing trend in the geometric mean velocity, acceleration, and angular velocity when approaching the pituitary ( p ?Conclusion ?Using a novel method for analyzing instrument motion during live ESBS, we observed a decreasing trend in kinematics with proximity to the pituitary. Additional characterization of surgical instrument motion is paramount for optimizing patient safety and training.

SUBMITTER: Harbison RA

PROVIDER: S-EPMC5463410 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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An Automated Methodology for Assessing Anatomy-Specific Instrument Motion during Endoscopic Endonasal Skull Base Surgery.

Harbison R Alex RA Li Yangming Y Berens Angelique M AM Bly Randall A RA Hannaford Blake B Moe Kris S KS

Journal of neurological surgery. Part B, Skull base 20161220 3

Objectives Describe instrument motion during live endoscopic skull base surgery (ESBS) and evaluate kinematics within anatomic regions. Design Case series. Setting Tertiary academic center. Participants A single skull base surgeon performed six anterior skull base approaches to the pituitary. Main Outcomes and Measures Time-stamped instrument coordinates were recorded using an optical tracking system. Kinematics (i.e., mean cumulative instrument travel, ve ...[more]

PMID: 28603682

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Project description:ImportanceInjury to the internal carotid artery (ICA) during endoscopic endonasal skull base surgery does not typically occur as an isolated circumstance but often is the result of multiple factors.ObjectiveTo assess the factors associated with ICA injury in an effort to reduce its occurrence.Design, setting, and participantsThis quality improvement study used a multicenter root cause analysis of ICA injuries sustained during endoscopic endonasal skull base surgery performed at 11 tertiary care centers across 4 continents (North America, South America, Europe, and Asia) from January 1, 1993, to December 31, 2018. A fishbone model was built to facilitate the root cause analysis. Patients who underwent an expanded endoscopic endonasal approach that carried a substantial potential risk of an ICA injury were included in the analysis. A questionnaire was completed by surgeons at the centers to assess relevant human, patient, process, technique, instrument, and environmental factors associated with the injury.Main outcomes and measuresRoot cause analysis of demographic, human, patient, process, technique, instrument, and environmental factors as well as mortality and morbidity data.ResultsTwenty-eight cases of ICA injury occurred during 7160 expanded endoscopic endonasal approach procedures (incidence of 0.4%). The mean age of the patients was 49 years, with a female to male predominance ratio of 1.8:1 (18 women to 10 men). Anatomical (23 [82%]), pathological (15 [54%]), and surgical resection (26 [93%]) factors were most frequently reported. The surgeon's mental or physical well-being was reported as inadequate in 4 cases (14%). Suboptimal imaging was reported in 6 cases (21%). The surgeon's experience level was not associated with ICA injury. The ICA injury was associated with use of powered or sharp instruments in 20 cases (71%), and use of new instruments or technology in 7 cases (25%). Two patients (7%) died in the operating room, and 3 (11%) were alive with neurological deficits. Overall, patient-related factors were the most frequently reported risk factors (in 27 of 28 cases [96%]). Factors associated with ICA injury catalyzed a list of preventive recommendations.Conclusions and relevanceThis study found that human factors were associated with intraoperative ICA injuries; however, they were usually accompanied by other deficiencies. These findings suggest that identifying risk factors is crucial for preventing such injuries. Preoperative planning and minimizing the potential for ICA injury also appear to be essential.

Dataset Information

An Automated Methodology for Assessing Anatomy-Specific Instrument Motion during Endoscopic Endonasal Skull Base Surgery.

Publications

An Automated Methodology for Assessing Anatomy-Specific Instrument Motion during Endoscopic Endonasal Skull Base Surgery.

Similar Datasets

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