Research & Application Of The Key Techniques Of Integrating Orbital Surgery Endoscopy-Navigation System

PURPOSEThis study is to research the key technique of combining endoscope system and navigation system,to design the digital surgical simulation software matching the demanding of orbital surgery and to develop the prototype of the endoscope-navigation system(ENS).After the safety inspection,the ENS was applied in clinical surgery.METHODS1.Establish the prototype of the ENS based on researching and development of the key technique of combining optic orientation system and endoscope system,the complete equipment and special instruments.The accuracy and stability were examined and analyzed afterwards.2.Apply the ENS in orbital morphology measurement,the reduction of delayed complex orbital fractures and orbital decompression to research the influential factors of global projection and differential of orbital shape,to guide the surgery,and to analyze the difference of orbital morphology between men and women and the influential factor of the global projection.RESULTS1.Successfully achieve R&D of the endoscope-navigation system(ENS)whose accuracy and reliability meet with orbital surgery demanding,which could fulfill measurement,analysis,stimulation and prediction for orbital surgery.2.Orbital soft tissue volume(OSTV),index of orbital soft tissue volume/bony orbital volume(OSTV/BOV),orbital breadth,orbital height and global diameter(GD)were positive correlated with global projection.Orbital middle length(OML)was negative correlated with global projection.3.50 patients with delayed complex orbital fractures were received orbital fracture reduction with the help of ENS.Both the orbital rim and the orbital wall realized the anatomical reduction with a relief of diplopia.4.11 Graves’ disease patients with proptosis received orbital decompression with the help of ENS.All patients had a great improvement in appearance.Before surgery,OSTV,OSTV/BOV and OML were positive correlated with global projection.ΔBOV and ΔOML were positive correlated with the regression of global projection.Lateral decompression could gain the most decompression space.In 9 patients with decreasing visual acuity,visual acuity was negative correlated with OSTV/BOV.In 5 patients with visual acuity improving,visual acuity improvement was positive correlated with augment area and space of orbital floor decompression.CONCLUSION1.The ENS integrated the endoscope system with the navigation system,which achieved locating endoscope video and visualizing deep structures and realized the function of “symmetry and matching of image and video,visualization and recognition of deep tissue,alert of vital structures”.The ENS could supply important parameters,which made the evaluation objectively and directly.2.The most influential factor of global projection is OSTV/BOV.The shape of the orbit like orbital foramen shape and OML is in the next place.The shape of orbital apex makes a little influence on global projection.3.The digital orbital surgery technique could protect important tissue and guide the operation according to pre-operative plan,which increased the safety and efficacy.