title: [First clinical experiences with an endoscope manipulator system in endo- and transnasal surgery].
abstract: BACKGROUND
  Endo- and transnasal surgery needs optical support. The use of a microscope allows bimanual manipulation. More often the endoscopic technique is used which needs one hand for endoscope guidance "loosing" it for manipulation or demanding an assistant for endoscope guidance. In this work the use of a miniature endoscope manipulator system for endonasal and transnasal surgery was evaluated.
  
  
  METHODS
  31 FESS with manipulator-assisted endoscope guidance were performed. The used endoscope positions, the number of position changes and conditional interruptions were documented. In addition, a transsphenoidal approach to the pituitary gland was performed in a cadaver trial.
  
  
  RESULTS
  Non-inferiority was shown for the use of the endoscope manipulator with reference to time and accuracy of manipulator-assisted endoscope guidance. There were 6.4 position changes for each side. Bimanual manipulation was possible in all cases. In the region of high-risk structures (lamina papyracea, frontal recess) we conceptual switched to manual endoscope guidance.
  
  
  CONCLUSIONS
  The evaluated endoscope manipulator fulfills the minimum requirements to be integrated into the surgical workflow of endo- and transnasal surgery. The number of required endoscope position changes is small allowing bimanual instrumentation. Still a disadvantage is the need for interrupting the workflow to remote the endoscope manipulator with the joystick console. Further development potential would be a forced-feedback function and hands-free navigated-controlled guidance.
authors.affiliation: Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig AöR, Leipzig, Germany. milos.fischer@medizin.uni-leipzig.de
authors.forename: M
authors.initials: M
authors.lastname: Fischer
authors.forename: C
authors.initials: C
authors.lastname: Gröbner
authors.forename: A
authors.initials: A
authors.lastname: Dietz
authors.forename: T C
authors.initials: TC
authors.lastname: Lueth
authors.forename: G
authors.initials: G
authors.lastname: Strauss
mesh_terms: D002102:Cadaver; D004724:Endoscopy / Q000295:instrumentation*; D004867:Equipment Design; D005004:Ethmoid Bone / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation; D008866:Microsurgery / Q000295:instrumentation*; D009666:Nose / Q000601:surgery*; D019047:Phantoms, Imaging; D010902:Pituitary Gland / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*; D013101:Sphenoid Sinus / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D013996:Time and Motion Studies; D016896:Treatment Outcome; D014741:Video Recording / Q000295:instrumentation*