[Mechatronic in functional endoscopic sinus surgery. First experiences with the daVinci Telemanipulatory System]

Abstract

Background: This study examines the advantages and disadvantages of a commercial telemanipulator system (daVinci, Intuitive Surgical, USA) with computer-guided instruments in functional endoscopic sinus surgery (FESS).

Methods: We performed five different surgical FESS steps on 14 anatomical preparation and compared them with conventional FESS. A total of 140 procedures were examined taking into account the following parameters: degrees of freedom (DOF), duration , learning curve, force feedback, human-machine-interface.

Results: Telemanipulatory instruments have more DOF available then conventional instrumentation in FESS. The average time consumed by configuration of the telemanipulator is around 9+/-2 min. Missing force feedback is evaluated mainly as a disadvantage of the telemanipulator. Scaling was evaluated as helpful. The ergonomic concept seems to be better than the conventional solution.

Discussion: Computer guided instruments showed better results for the available DOF of the instruments. The human-machine-interface is more adaptable and variable then in conventional instrumentation. Motion scaling and indexing are characteristics of the telemanipulator concept which are helpful for FESS in our study.