Review of Computer-Aided Sinus Surgery

In typical sinus surgery, surgeons use one hand to hold an endoscope and another hand to operate surgical tools. Both are the straight type. Thus, as seen in Fig. 1, there are many blind regions in the sinus area to which any currently existing surgical tools cannot reach and any endoscope cannot visualize. Thus large invasive surgery is inevitable to treat target legions in the blind regions. Current trend in computer-aided surgery is minimally invasive surgery. Using this concept, many surgical robotic systems have been successfully employed in operation room. There are three issues to provide true minimally invasive surgery. i. flexible mechanism that enables surgical endoscope or devices to approach the target legion ii. navigation software with advanced functions To date, research activities in the area of flexible mechanisms have been very active for last 10 years. Burgner-Kahrs et al [1] surveyed most research works related to flexible mechanisms. Among them, Choi et al [2] was the first one who suggested a flexible endoscope. They employed a spring as a backbone of the flexible endoscope. At the distal end of the mechanism, a camera of 3 mm diameter with resolution of 400x400 was installed. This flexible endoscope was able to look inside the maxillary sinus by turning 180 degrees. Its radius of curvature of diameter was designed as 10 mm to fit into the anatomy of the typical maxillary sinus of Korean people. Simaan et al [3] investigated an active compliance control algorithm for sinus surgery. Rather than using any navigation algorithm, their designed flexible mechanism measured the contact force during insertion and was able to comply to the sinus wall not to damage the sinus area. Yoon et al [4] developed a dual robotic system that consists of one flexible endoscope and one flexible Sinus is a cavity within a bone. Most are commonly found in the bones of the face. Specially, paranasal sinuses are air cavities in the cranial bones, especially those near the nose. They include the frontal sinuses, the ethmoid sinuses, the sphenoid sinuses and the maxillary sinuses. There are many types of sinus disease. They are classified as acute (quick onset) and chronic (over a long period of time). Besides, there are several other types of sinus diseases due to fungus and polyps. Sinus tumors also happen although it is relatively uncommon. Navigation software for general sinus surgery has been developed and are being used in the operation room. However, there are still many blind regions in the sinus area by using conventional straight type endoscope and devices. To cope with such a problem, flexible endoscope and devices are being developed along with advanced navigation algorithms. In this review, many research activities associated with computer-aided sinus surgery are discussed.