Region-Specific Objective Signatures of Endoscopic Surgical Instrument Motion: A Cadaveric Exploratory Analysis.
ObjectivesThe objective of this study was to evaluate region-specific surgical instrument kinematics among novice and experienced surgeons performing endoscopic endonasal skull base surgery.DesignCadaveric experimental study.SettingTertiary academic center.ParticipantsTwo novice and two experienced surgeons performed eight endoscopic total ethmoidectomies and sphenoidotomies using an optically tracked microdebrider.Main Outcome MeasuresTime-stamped Euclidian coordinates were recorded. Cumulative instrument travel, mean linear velocity and acceleration, and mean angular velocities were calculated in the anterior ethmoid, posterior ethmoid, and sphenoid sinus regions.ResultsMean cumulative instrument travel (standard deviation) was highest in the posterior ethmoid region for both novice and experienced surgeons (9,795 mm [1,664] vs. 3,833 mm [1,080]). There was a trend in mean linear and angular velocities, and acceleration with increasing magnitudes for experienced surgeons compared with novices. Among experienced surgeons, we observed a trend of decreasing yaw velocity during the approach to the surgical target.ConclusionsWe present a novel method of evaluating surgical instrument motion with respect to anatomical regions of the skull base during endoscopic endonasal skull base surgery. These data may be used in the development of surgical monitoring and training systems to optimize patient safety.
Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States.
R Alex
RA
Harbison
Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States.
Angelique M
AM
Berens
Department of Electrical Engineering, University of Washington, Seattle, Washington, United States.
Yangming
Y
Li
Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, United States.
Randall A
RA
Bly
Department of Electrical Engineering, University of Washington, Seattle, Washington, United States.
Blake
B
Hannaford
Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States; Department of Neurosurgery, University of Washington, Seattle, Washington, United States.
Kris S
KS
Moe
kinematics; skull base; surgical instrument motion; surgical safety; surgical training