MINIMALLY INVASIVE EAR, NOSE AND THROAT SURGERY - ADVANCES THROUGH MODERN TECHNOLOGIES

Three fundamentals have to be fulfilled to optimize minimally, invasiv e surgery: three-dimensional imaging, free maneuverability of the inst ruments, sensorial feedback. Projection of two pictures from a stereoe ndoscope and subsequent separation with a LCD shutter allows three-dim ensional videoendoscopy to be performed. A high-frequency shutter tech nique (100/120 Hz) presents pictures from the two video cameras to the right and left eye, respectively, so that the surgeon has spatial vis ion of the operative field. Steerable instruments have four components : a control unit, rigid shaft, steerable multijoint, distal effector. The steerable multi-joints give two additional degrees of freedom comp ared to conventional rigid instruments in endoscopic surgery. For intu itive movements, however, an electronic control system is necessary th at is comparable to the ''master-slave'' principle in remote technolog y. A remote manipulator system with six degrees of freedom is now avai lable. Additionally, a multifunctional distal tip permits different su rgical steps to be performed without changing the instrument. For bett er control of the instrument and the operative procedure tactile feedb ack can be achieved with appropriate microsensor systems. Recent proje cts suggest that an artificial sensor system can be established within the foreseeable future.