• Archives of Craniofacial Surgery
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• v.25 no.5
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• pp.209-216
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• 2024

Craniofacial surgery requires comprehensive anatomical knowledge of the head and neck to ensure patient safety and surgical precision. Over recent decades, there have been significant advancements in imaging techniques and the development of real-time surgical navigation systems. Intraoperative navigation technology aligns surgical instruments with imaging-derived information on patient anatomy, enabling surgeons to closely follow preoperative plans. This system functions as a radiologic map, improving the accuracy of instrument placement and minimizing surgical complications. The introduction of first-generation navigation systems in the early 1990s revolutionized surgical procedures by enabling real-time tracking of instruments using preoperative imaging. Initially utilized in neurosurgery, intraoperative navigation has since become standard practice in otolaryngology, cranio-maxillofacial surgery, and orthopedics. Since the 2000s, second-generation navigation systems have been developed to meet the growing demand for precision across various surgical specialties. The adoption of these systems in craniofacial surgery has been slower, but their use is increasing, particularly in procedures such as foreign body removal, facial bone fracture reconstruction, tumor resection, and craniofacial reconstruction and implantation. In Korea, insurance coverage for navigation in craniofacial surgery began in 2021, and new medical technologies for orbital wall fracture treatment were approved in August 2022. These technologies have only recently become clinically available, but are expected to play an increasingly important role in craniofacial surgery. Intraoperative navigation enhances operative insight, improves target localization, and increases surgical safety. Although these systems have a steep learning curve and initially prolong surgery, efficiency improves with experience. Calibration issues, registration errors, and soft tissue deformation can introduce inaccuracies. Nonetheless, navigation technology is evolving, and the integration of intraoperative computed tomography data holds promise for further enhancements of surgical accuracy. This paper discusses the various types and applications of navigation employed in craniofacial surgery, highlighting their benefits and limitations.

• Journal of Institute of Control, Robotics and Systems
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• v.22 no.8
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• pp.579-584
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• 2016

When surgical instruments are tracked in an image-guided surgical navigation system, a stereo vision system with high accuracy is generally used, which is called optical tracker. However, this optical tracker has the disadvantage that a line-of-sight between the tracker and surgical instrument must be maintained. Therefore, to complement the disadvantage of optical tracking systems, an internal vision sensor is attached to a surgical instrument in this paper. Monitoring the target marker pattern attached on patient with this vision sensor, this surgical instrument is possible to be tracked even when the line-of-sight of the optical tracker is occluded. To verify the system's effectiveness, a series of basic experiments is carried out. Lastly, an integration experiment is conducted. The experimental results show that rotational error is bounded to max $1.32^{\circ}$ and mean $0.35^{\circ}$, and translation error is in max 1.72mm and mean 0.58mm. Finally, it is confirmed that the proposed tool tracking method using an internal vision sensor is useful and effective to overcome the occlusion problem of the optical tracker.

• Journal of Biomedical Engineering Research
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• v.26 no.5
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• pp.265-270
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• 2005

A new Computer Integrated Surgical Robot system is composed of a surgical robot, a surgical planning system, and an optical tracking system. The system plays roles of an assisting surgeon and taking the place of surgeons for inserting a pedicle screw in spinal fusion. Compared to pure surgical navigation systems as well as conventional methods for spinal fusion, it is able to achieve better accuracy through compensating for the portending movement of the surgical target area. Furthermore, the robot can position and guide needles, drills, and other surgical instruments or conducts drilling/screwing directly. Preoperatively, the desired entry point, orientation, and depth of surgical tools for pedicle screw insertion are determined by the surgical planning system based on CT/MR images. Intra-operatively, position information on surgical instruments and targeted surgical areas is obtained from the navigation system. Two exemplary experiments employing the developed image-guided surgical robot system are conducted.

• KSII Transactions on Internet and Information Systems (TIIS)
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• v.6 no.10
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• pp.2679-2691
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• 2012

In this paper, a high accuracy stereo reconstruction method for surgery instruments positioning is proposed. Usually, the problem of surgical instruments reconstruction is considered as a basic task in computer vision to estimate the 3-D position of each marker on a surgery instrument from three pairs of image points. However, the existing methods considered the 3-D reconstruction of the points separately thus ignore the structure information. Meanwhile, the errors from light variation, imaging noise and quantization still affect the reconstruction accuracy. This paper proposes a method which takes the structure information of surgical instruments as constraints, and reconstructs the whole markers on one surgical instrument together. Firstly, we calibrate the instruments before navigation to get the structure parameters. The structure parameters consist of markers' number, distances between each markers and a linearity sign of each instrument. Then, the structure constraints are added to stereo reconstruction. Finally, weighted filter is used to reduce the jitter. Experiments conducted on surgery navigation system showed that our method not only improve accuracy effectively but also reduce the jitter of surgical instrument greatly.

• Journal of Gastric Cancer
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• v.23 no.3
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• pp.400-409
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• 2023

Artificial intelligence (AI) has made significant progress in recent years, and many medical fields are attempting to introduce AI technology into clinical practice. Currently, much research is being conducted to evaluate that AI can be incorporated into surgical procedures to make them safer and more efficient, subsequently to obtain better outcomes for patients. In this paper, we review basic AI research regarding surgery and discuss the potential for implementing AI technology in gastric cancer surgery. At present, research and development is focused on AI technologies that assist the surgeon's understandings and judgment during surgery, such as anatomical navigation. AI systems are also being developed to recognize in which the surgical phase is ongoing. Such a surgical phase recognition systems is considered for effective storage of surgical videos and education, in the future, for use in systems to objectively evaluate the skill of surgeons. At this time, it is not considered practical to let AI make intraoperative decisions or move forceps automatically from an ethical standpoint, too. At present, AI research on surgery has various limitations, and it is desirable to develop practical systems that will truly benefit clinical practice in the future.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.25 no.4
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• pp.403-410
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• 2023

Objective: While patients with medically intractable acute cerebellar infarction typically undergo suboccipital craniectomy and removal of the infarcted tissue, this procedure is associated with long operating times and postoperative complications. This study aimed to investigate the effectiveness of minimally invasive navigation-guided burr hole aspiration surgery for the treatment of acute cerebellar infarction. Methods: Between January 2015 and December 2021, 14 patients with acute cerebellar infarction, who underwent navigation-guided burr hole aspiration surgery, were enrolled in this study. Results: The preoperative mean Glasgow Coma Scale (GCS) score was 12.7, and the postoperative mean GCS score was 14.3. The mean infarction volume was 34.3 cc at admission and 23.5 cc immediately following surgery. Seven days after surgery, the mean infarction volume was 15.6 cc. There were no surgery-related complications during the 6-month follow-up period and no evidence of clinical deterioration. The mean operation time from skin incision to catheter insertion was 28 min, with approximately an additional 13 min for extra-ventricular drainage. The mean Glasgow Outcome Scale score after 6 months was 4.8. Conclusions: Navigation-guided burr hole aspiration surgery is less time-consuming and invasive than conventional craniectomy, and is a safe and effective treatment option for acute cerebellar infarction in selected cases, with no surgery-related complication.

• Archives of Craniofacial Surgery
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• v.25 no.4
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• pp.161-170
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• 2024

Background: The eyes are the central aesthetic unit of the face. Maxillofacial trauma can alter facial proportions and affect visual function with varying degrees of severity. Conventional approaches to reconstruction have numerous limitations, making the process challenging. The primary objective of this study was to evaluate the application of three-dimensional (3D) navigation in complex unilateral orbital reconstruction. Methods: A prospective cohort study was conducted over 19 months (January 2020 to July 2021), with consecutive enrollment of 12 patients who met the inclusion criteria. Each patient was followed for a minimum period of 6 months. The principal investigator carried out a comparative analysis of several factors, including fracture morphology, orbital volume, globe projection, diplopia, facial morphic changes, lid retraction, and infraorbital nerve hypoesthesia. Results: Nine patients had impure orbital fractures, while the remainder had pure fractures. The median orbital volume on the normal side (30.12 cm³; interquartile range [IQR], 28.45-30.64) was comparable to that of the reconstructed orbit (29.67 cm³; IQR, 27.92-31.52). Diplopia improved significantly (T(10)= 2.667, p= 0.02), although there was no statistically significant improvement in globe projection. Gross symmetry of facial landmarks was achieved, with comparable facial width-to-height ratio and palpebral fissure lengths. Two patients reported infraorbital hypoesthesia at presentation, which persisted at the 6-month follow-up. Additionally, five patients developed lower lid retraction (1-2 mm), and one experienced implant impingement at the infraorbital border. Conclusion: Our study provides level II evidence supporting the use of 3D navigation to improve surgical outcomes in complex orbital reconstruction.

• International Journal of Control, Automation, and Systems
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• v.4 no.1
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• pp.30-41
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• 2006

The goal of this work is to develop and test a robot-assisted surgery system for spinal fusion. The system is composed of a robot, a surgical planning system, and a navigation system. It plays the role of assisting surgeons for inserting a pedicle screw in the spinal fusion procedure. Compared to conventional methods for spinal fusion, the proposed surgical procedure ensures minimum invasion and better accuracy by using robot and image information. The robot plays the role of positioning and guiding needles, drills, and other surgical instruments or conducts automatic boring and screwing. Pre-operative CT images intra-operative fluoroscopic images are integrated to provide the surgeon with information for surgical planning. Some experiments employing the developed robotic surgery system are conducted. The experimental results confirm that the system is not only able to guide the surgical tools by accurately pointing and orienting the specified location, but also successfully compensate the movement of the patient due to respiration.

• Journal of Korean Neurosurgical Society
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• v.62 no.1
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• pp.35-45
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• 2019

Objective : To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR). Methods : A single-plane DSA system with 3-dimensional rotational angiography, cone-beam computed tomography (CBCT), and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of cerebrovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorized into three subcategorical procedures : combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, and frameless stereotaxic operation. Results : Forty-nine of 191 procedures were performed using hybrid techniques. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial hemorrhage (ICH) were treated by partial embolization and surgical clipping. Six cases of ruptured arteriovenous malformation with ICH were treated by Onyx embolization of nidus and subsequent surgical removal of nidus and ICH. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolization. In one (0.8%) complicated case of 103 intra-arterial thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. In 27 cases of ICH, frameless stereotaxic hematoma aspiration was performed using $XperGuide^{(R)}$ system (Philips Medical Systems, Best, the Netherlands). All procedures were performed in single sessions without any procedural complications. Conclusion : Hybrid OR with a fully equipped DSA system could provide precise and safe treatment strategies for cerebrovascular diseases. Especially, we could suggest a strategy to cope flexibly in complex lesions or unexpected situations in hybrid OR. CBCT with real-time navigation software could augment the usefulness of hybrid OR.

• Journal of Biomedical Engineering Research
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• v.40 no.5
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• pp.206-214
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• 2019

Surgical methods and associated precision systems have been developed, but surgical procedures that require precise location and fine manipulation of the lesion remain a limitation. The combination of precision robot manipulation technology and 3D medical image navigation technology overcomes the limitations of minimally invasive surgery (MIS) and enables a more stable and successful operation. Surgical robots are surgical robots such as da Vince, and surgical robots using industrial robotic arms. There are various developments and researches of medical robots. In recent medical robot development, a new type of surgical robot based on an industrial robot arm capable of easily replacing the end effector according to the user's needs is being actively developed at home and abroad. Therefore, in this study, we developed safety and performance evaluation guideline for micro - surgical robots based on open robot platform using general purpose robot arm to help quality control of the medical device.