naa a22 4500 510807275 CHVBK 20180411083424.0 cr unu---uuuuu 180411e20130501xx s 000 0 eng 10.1007/s11548-012-0797-z doi (NATIONALLICENCE)springer-10.1007/s11548-012-0797-z Warning navigation system using real-time safe region monitoring for otologic surgery [Elektronische Daten] [Byunghyun Cho, Masamichi Oka, Nozomu Matsumoto, Riichi Ouchida, Jaesung Hong, Makoto Hashizume] Purpose We developed a surgical navigation system that warns the surgeon with auditory and visual feedback to protect the facial nerve with real-time monitoring of the safe region during drilling. Methods Warning navigation modules were developed and integrated into a free open source software platform. To obtain high registration accuracy, we used a high-precision laser-sintered template of the patient's bone surface to register the computed tomography (CT) images. We calculated the closest distance between the drill tip and the surface of the facial nerve during drilling. When the drill tip entered the safe regions, the navigation system provided an auditory and visual signal which differed in each safe region. To evaluate the effectiveness of the system, we performed phantom experiments for maintaining a given safe margin from the facial nerve when drilling bone models, with and without the navigation system. The error of the safe margin was measured on postoperative CT images. In real surgery, we evaluated the feasibility of the system in comparison with conventional facial nerve monitoring. Results The navigation accuracy was submillimeter for the target registration error. In the phantom study, the task with navigation ( $$0.7 \pm 0.25$$ mm) was more successful with smaller error, than the task without navigation ( $$1.37 \pm 0.39$$ mm, $$P<0.05$$ ). The clinical feasibility of the system was confirmed in three real surgeries. Conclusions This system could assist surgeons in preserving the facial nerve and potentially contribute to enhanced patient safety in the surgery. CARS, 2012 Otologic surgery nationallicence Surgical navigation nationallicence Warning system nationallicence Auditory feedback nationallicence Visual feedback nationallicence Cho Byunghyun Department of Advanced medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan aut Oka Masamichi Department of Otorhinolaryngology, Kyushu University, Fukuoka, Japan aut Matsumoto Nozomu Department of Otorhinolaryngology, Kyushu University, Fukuoka, Japan aut Ouchida Riichi Division of Fixed Prosthodontics, Faculty of Denstal Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, 812-8582, Fukuoka, Japan aut Hong Jaesung Department of Advanced medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan aut Hashizume Makoto Department of Advanced medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan aut International Journal of Computer Assisted Radiology and Surgery Springer-Verlag 8/3(2013-05-01), 395-405 1861-6410 8:3<395 2013 8 11548 https://doi.org/10.1007/s11548-012-0797-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11548-012-0797-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Cho Byunghyun Department of Advanced medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan aut NATIONALLICENCE 700 1- Oka Masamichi Department of Otorhinolaryngology, Kyushu University, Fukuoka, Japan aut NATIONALLICENCE 700 1- Matsumoto Nozomu Department of Otorhinolaryngology, Kyushu University, Fukuoka, Japan aut NATIONALLICENCE 700 1- Ouchida Riichi Division of Fixed Prosthodontics, Faculty of Denstal Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, 812-8582, Fukuoka, Japan aut NATIONALLICENCE 700 1- Hong Jaesung Department of Advanced medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan aut NATIONALLICENCE 700 1- Hashizume Makoto Department of Advanced medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan aut NATIONALLICENCE 773 0- International Journal of Computer Assisted Radiology and Surgery Springer-Verlag 8/3(2013-05-01), 395-405 1861-6410 8:3<395 2013 8 11548 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer