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Augmented Reality with SurgicalTheatre Endoscope Surgical Navigation Advanced Platform (EndoSNAP) in endoscopic transphenoidal skull base surgery: a safety and feasibility preliminary study
EANS Academy. Gambatesa E. 09/26/19; 276150; EP04116
Dr. Enrico Gambatesa
Dr. Enrico Gambatesa

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Abstract
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Introduction: In the last few years a new technology, Augmented Reality, has been introduced to overlap virtual images to the surgical field.
The aim of this study is to analyze feasibility and reliability of AR SurgicalTheatre Endoscope Surgical Navigation Advanced Platform (EndoSNAP) software and image guidance during endoscopic transphenoidal skull base surgery.
Materials and methods: The AR EndoSNAP has been prospectively used by a single surgeon during 10 consecutive endoscopic transphenoidal surgeries for newly diagnosed skull base tumor removal (AR group). Intra-operative and post-operative data about this group were then compared with surgical data and outcome of two other groups of 10 patients operated on by the same surgeon with a 2D (2D group) or a 3D VisionSense endoscope (3D group). The patients included in the control groups were selected by an independent surgeon to match the AR group, based exclusively on the pre-operative features of the lesions.
Results: Mean surgical time in minutes was 164.2 in 2D group, 158.9 in 3D group, and 174.1 in AR group, with no statistically significant difference (p=0.67). Total removal was achieved respectively in 8 patients in 2D and 3D groups, and 6 patients in AR group (p= 0.2). Intra-operative CSF leak occurred in 3 cases in 2D and 3D group and in 6 cases in AR group (p= 0.2).
Conclusions: Based on our preliminary study, EndoSNAP is safe and effective and it could be used without exposing the patient to additional risks. One of the advantages of the EndoSNAP is the contemporary visualization of the surgical field and the neuronavigation on a 3D model at the same time. Furthermore, it seems promising in terms of learning and teaching for younger generations of surgeons.
Effective advantages on surgical outcome compared to 3D techniques or magnetic neuronavigation have yet to be defined.
Introduction: In the last few years a new technology, Augmented Reality, has been introduced to overlap virtual images to the surgical field.
The aim of this study is to analyze feasibility and reliability of AR SurgicalTheatre Endoscope Surgical Navigation Advanced Platform (EndoSNAP) software and image guidance during endoscopic transphenoidal skull base surgery.
Materials and methods: The AR EndoSNAP has been prospectively used by a single surgeon during 10 consecutive endoscopic transphenoidal surgeries for newly diagnosed skull base tumor removal (AR group). Intra-operative and post-operative data about this group were then compared with surgical data and outcome of two other groups of 10 patients operated on by the same surgeon with a 2D (2D group) or a 3D VisionSense endoscope (3D group). The patients included in the control groups were selected by an independent surgeon to match the AR group, based exclusively on the pre-operative features of the lesions.
Results: Mean surgical time in minutes was 164.2 in 2D group, 158.9 in 3D group, and 174.1 in AR group, with no statistically significant difference (p=0.67). Total removal was achieved respectively in 8 patients in 2D and 3D groups, and 6 patients in AR group (p= 0.2). Intra-operative CSF leak occurred in 3 cases in 2D and 3D group and in 6 cases in AR group (p= 0.2).
Conclusions: Based on our preliminary study, EndoSNAP is safe and effective and it could be used without exposing the patient to additional risks. One of the advantages of the EndoSNAP is the contemporary visualization of the surgical field and the neuronavigation on a 3D model at the same time. Furthermore, it seems promising in terms of learning and teaching for younger generations of surgeons.
Effective advantages on surgical outcome compared to 3D techniques or magnetic neuronavigation have yet to be defined.
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