Role of computers and robots in future otological surgery

The use of computers and robots in the medical field is no longer a research interest but already a part of clinical routine. In otolaryngology/ head and neck surgery, imageguided surgery (IGS) and robotic surgery are becoming more common. IGS provides the computerized real-time feedback to the surgeon about the location and orientation of the surgical devices along with the anatomical information of surrounding structures. The IGS foresees the hidden anatomical structures before they are exposed. IGS is now widely used in endoscopic sinus surgery where the effectiveness of surgical navigation has been reported [1]. The robotic surgery enhances the fine movement of the surgeon’s hands to achieve the surgical goal with minimal damage to surrounding structures. The Da Vinci series (Intuitive Surgical Inc, USA), the only surgical robots currently available, are employed in laryngeal and pharyngeal surgery through the patient’s mouth, which is now termed the transoral robotic surgery (TORS), with promising clinical outcomes [2]. On the other hand, IGS or robots in the otological field are much less popular and most of the otological procedures are exclusively performed manually, which have basically remained unchanged for decades. The otologists’ concern about IGS and robots has been the balance between the required accuracy and the additional invasiveness. Many otologists demand the registration error of no more than 0.5 mm in otological procedures. This requirement almost reaches the inherent limit of accuracy defined by the physical resolution of the CT dataset, i.e. the pixel size, which is typically 0.2-0.5 mm. To achieve this high degree of accuracy, invasive procedures have often been justified, such as invasive fiducial marking, head clamping, or additional radioexposure by intraoperative CT scanning. This invasiveness, however, has restricted the use of IGS to unusually difficult cases that we rarely encounter. Otological cases that justify the robotic surgery with its underlying invasiveness are even rarer. Thus, Corresponding Author: Nozomu Matsumoto, M.D., Ph.D 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan Tel: +81-92-642-5668 Fax: +81-92-642-5685 E-mail: matunozo@med.kyushu-u.ac.jp