TRENDS AND PERSPECTIVES IN MINIMALLY INVASIVE SURGERY IN OTORHINOLARYNGOLOGY HEAD AND NECK-SURGERY

The roots of minimally invasive surgery (MIS) in otolaryngology-head a nd neck surgery (ORL-HNS) can be traced to the 1950s. Today, endonasal sinus surgery and endolaryngeal surgery already fulfill the principle s of MIS. To widen its spectrum of indications, however, MIS must be a ble to offer three advantages that conventional macrosurgery and micro surgery already have: free maneuverability for the instrument, sensory feedback, and three-dimensional imaging. Every anatomical region (e.g ., paranasal sinuses, upper aerodigestive tract, cerebellopontine angl e) requires specific surgical instrumentation. Here, the authors prese nt recently developed steerable instruments that allow two additional degrees of freedom not attainable with conventional instruments. These instruments may permit access to problem zones (e.g., laterally exten ding frontal and ethmoidal sinus recesses) in the near future. For bet ter control of the instrument and the operative procedure, tactile fee dback can be achieved with appropriate microsensor systems. Three-dime nsional vision can be realized by three-dimensional video-endoscopes a nd sequential image processing.