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Selection of patients for surgery.

Patient selection for lumbar laminectomy has been reviewed. The clinical decision for laminectomy depends on the mainstays of history, physical examination, and radiologic examination. A computer model to assist in this difficult task has been presented; the model is yet to be clinically tested. Psychological and psychosocial criteria play an important role in the decision-making process in these patients.

Computer Simulation↗

[Simulated surgery on a 3D model. Technic and applications].

Treatment planning for the correction of dentofacial deformities includes prediction tracing and model surgery. However, these conventional methods provide only limited information concerning the planned spatial displacement of skeletal structures. In cases of severe deformities we add simulated 3D model surgery in an individually processed life size polyurethane skull to our work-up. The basic steps of the 3D model surgery are described, the advantages outlined and the method discussed.

Computer-Aided Design↗

[3D endoscopy].

With the aid of a 6 mm 0 degree stereo-endoscope supplied with a 100 Hz monitor and high-speed liquid crystal shutter, three-dimensional endoscopy of the upper airway was realized for the first time. The equipment used is based on alternating sequential projections of left and right eye images on a single tv screen. Two high-speed liquid crystal stereo switches (LCSS) are integrated in glasses and a rapid switching time of 100 microseconds is used. In a comparative study this innovative endoscopic technique was tested for its practicability in sinus surgery and endoscopy of the upper airway. With this equipment an excellent view was obtained of the pharynx, larynx and trachea. For sinus surgery, however, a stereoendoscope with smaller dimensions has to be developed.

Computer Graphics↗

Isomorphic corneal topography: a clinical approach to 3-D representation of the corneal surface.

BACKGROUND: Newer methods of refractive surgery produce their effect by reshaping the corneal surface. It follows that topographic representations, used primarily to map refractive power, should now emphasize morphology and contour features. METHODS: We introduce a procedure using commercially available instrumentation which provides isomorphic three-dimensional corneal topography. The representations may be displayed either as refractive power, as is conventionally done, or as the more surgically relevant contour configuration. These images contain data points that are continuous rather than stepped as in the familiar color-coded displays. RESULTS: The technique proved easy to execute requiring no special software or mainframe computing. The corneal displays generated were freely rotatable and rescalable. CONCLUSIONS: In addition to producing clear and intuitive three-dimensional representations, the digital graphics environment allows manipulation unavailable in the conventional color-coded format; such representations should be particularly valuable for pre- and postoperative evaluation.

Computer Simulation↗

Medicine in virtual environments.

Virtual Environments allow a human to interact with a (computer) system in such a way that a high level of presence in a computer-synthesised world is experienced. In principle, all human senses are involved with the interaction. Many applications may benefit from this type of human-machine interfacing, however, few have emerged so far for medicine. In this paper we elaborate on some realistic potential applications of Virtual Environment technology in the field of medicine. These applications can be found in education/training, therapy, surgery, rehabilitation, diagnosis, telemedicine and biomechanics. The value to be added to these applications by VE technology lies in the fact that patient data or patient models may be moderated to the physician in a more intuitive and natural manner. Despite these potentials, the short-term feasibility of these applications can be put into question for various reasons. Firstly, the current generation of display devices have a resolution that may show to be too low to achieve a sufficiently high degree of realism for medical applications. Secondly, there are no commercially-available actuators for tactile and force feedback which the physician desperately need for the simulation of the contact with the (virtual) patient. Thirdly, the enormous computing power required for these applications (still) needs a considerable investment. With these limitations in mind, we believe that we are at the cradle of a whole new generation of VE applications in medicine.

Computer Simulation↗

[Indications and use of stereolithographic skull reconstructions in oromaxillofacial surgery].

Stereolithography (SLA), a rapid prototyping technique, was introduced in 1991 at the Clinic for Maxillofacial Surgery in Vienna and was adapted, in cooperation with the company Laserform, for our clinical requirements. As a refinement to physical models milled out of polyurethane, which had been used since 1989, this technique offered new applications for preoperative planning in craniomaxillofacial surgery. The proportions of these 3D models correspond 1:1 to the patients dimensions, with a possible accuracy of 0.25 mm. Since 1992 stereolithography has been used in 124 cases, primarily in traumatology, tumor surgery and in craniofacial surgery.

Adult↗

A formal model for quality assurance in coloproctologic surgery.

In the last 30 years the advanced countries experienced a large growth of financial and social resources devoted to Health Care (HC) [1] The need of better co-ordinating activities of a composite large set of specialists, and the need of avoiding further growth of financial and social resources without reducing benefits, stimulated the growth of Health Care Evaluation (HCE) and Quality Assurance (QA) studies. In this paper we show how system analysis and precise assessment of the clinical process can be largely enhanced by using formal techniques. The proposed methodology takes advantage of positive experiences in computer science. It is based on a formal model of the clinical process that provides the physicians with support for assessing diagnostic procedures in a co-operative surgical environment [7]. Diagnostic, grading, and staging procedures are integrated in a single model that can be formally expressed and analyzed. The approach is exemplified by presenting an elementary model of the diagnosis, grading and staging procedures for the colo-rectal cancer and ulcerative colitis.

Colitis, Ulcerative↗

[Value of image guided neurosurgery in neuro-oncology].

Brain tumor surgery, stereotactic or by resection, is based on the precise knowledge of the spatial position of the target and of their relationships with the normal brain structures. Modern computed neuroimaging allows image guidance of neurosurgical procedures, using robots driven by the coordinates of the target and of the entry point. We have developped a stereotactic robot as well as a robotized microscope which are guided from digitized images. They are used in routine daily practice and will become part of the standard neurosurgical equipment.

Brain Mapping↗

Computer-based patient education: observations on effective communication in the clinical setting.

Computer-based patient education materials are becoming more widely used in an attempt to increase the efficacy and efficiency of the delivery of health care. This paper discusses the authors' experiences in designing and implementing interactive multimedia presentations for patient education in an orthopaedic surgery office setting. Content must be chosen carefully to effectively educate without alienating the patient; simple graphics and animation are best for conveying complex medical and surgical concepts. The interface must be simple; both mouse input and touchscreen have proven acceptable and require minimal instruction. Improvements in program design will result in task-oriented evaluation systems that allow the patient to use the information gained to demonstrate understanding.

Communication↗

Image-guided spine surgery.

Conventional imaging techniques are of limited usefulness in spinal navigation, due to their lack of a "three-dimensional perspective." An interactive image-guided approach has been developed that provides a three-dimensional image-space representation of surgical space, using a specially designed referencing system and computer workstation. The system is described and results from laboratory tests and clinical cases are reported. It is concluded that interactive image-guided stereotaxis can be a valuable tool in spinal localization because of its degree of precision and the increased margin of safety it can offer.

Bone Screws↗

A technique for interactive image-guided neurosurgical intervention in primary brain tumors.

Interactive image-guided neurosurgical techniques allow safer and more complete cytoreduction of gliomas. This is most significant for low-grade tumors, whose configurations and margins are perhaps better appreciated by reference to registered MR images rather than by reliance on direct visualization using microscopic illumination. Spatially registered electro-physiologic recordings of intraoperative cortical stimulation to map language and motor function can increase the margin of safety for performing radical resections. By individualizing approaches and optimizing results, these technologies promise a new degree of standardization of outcome after resective surgery for all glial tumors.

Brain Mapping↗

Intraoperative navigation during resection of brain metastases.

This article reviews the authors' experience with image-guided surgery for brain metastases and discusses specifically the impact of the frameless viewing wand system on standard craniotomy techniques for this disorder. Topics discussed include patient selection, interactive image-guided neurosurgical resection of brain metastases, and other image-guided neurosurgical systems.

Brain Mapping↗

Surgical management of convexity and falcine meningiomas using interactive image-guided surgery systems.

Interactive image-guided surgery systems can provide useful navigation information to assist craniotomy for meningiomas of the convexity and falx. When using MR imaging for navigation, interactive image-guided surgery can provide visualization of the relationship of tumor to venous anatomy, which may reduce the risk of debilitating infarction. Cortical surface anatomy can also be assessed, helping to estimate risk to functionally expressive areas.

Adult↗

Image-guided surgery for skull base neoplasms using the ISG viewing wand. Anatomic and technical considerations.

Image-guided surgery of the cranial base requires a knowledge of both surgical anatomy and the technical aspects of the particular system being used. The authors report on their experience using the ISG Viewing Wand over the last two years, concentrating on the technical considerations for the use of the system and lessons learned. Image-guided surgical systems may well replace the current forms of intraoperative imaging used for anatomic orientation and localization and are considered a valuable addition to the armamentarium of the skull base surgeon.

Brain Neoplasms↗

[Computers in a private surgeon's office. "Do it yourself" or "one is never served better than by oneself"].

In an attempt to minimise the administrative work involved in private surgical practice, the author naturally considered the use of computers. After studying the medical software market, he was convinced that most software was better adapted to general practice than to surgery. He concluded that the best person to design a surgical software would be the surgeon himself, provided he was prepared to spend some of his leisure time to develop a computer application. The software developed is a large integrated application facilitating all of the functions necessary to good functioning of the surgical office. It therefore ensures filing of medical records, correspondence, accounts, management of salaries, and appointments, as all of these sectors are related to the surgical activity itself. This approach led to the design of an application, and its functioning and the possibilities provided are described.

Humans↗

Development of computer systems for endoscopic surgery.

The use of computer technology in endoscopic surgery is a necessity if more advanced and high quality minimal invasive operations are to be performed. Since safety and reliability are a major issue in medical applications, the development of computer systems has to follow a systematic procedure including quality assurance and be supervised by project management as employed in such safety-relevant areas as aerospace and nuclear energy. An overview of the early phases of this development process and of the major tests during the process is presented.

Computer Simulation↗