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Sistemas de navegação : um apoio à cirurgia endoscópica
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Os primeiros sistemas de navegação surgiram há cerca de três décadas, sendo inicialmente utilizados na neurocirurgia onde o seu objetivo primário consistia em auxiliar na abordagem de estruturas intracranianas em locais de difícil acesso e com pouca visibilidade para o cirurgião, no entanto, esta tecnologia foi rapidamente adotada por outras especialidades, de entre as quais a otorrinolaringologia.
A navegação cirúrgica permite combinar imagens recolhidas no pré-operatório com a informação visual a que o cirurgião tem acesso no bloco, tornando-se particularmente útil na cirurgia endoscópica onde a visão a duas dimensões dificulta a manutenção da noção de profundidade, o que se torna ainda mais evidente em zonas anatomicamente complexas, permitindo também a localização, a cada instante, da posição do material cirúrgico, contribuindo para guiar o procedimento até ao alvo e diminuindo o risco de complicações.
A evidência científica atual, com base em estudos comparativos e revisões, não parece demonstrar uma vantagem significativa, em termos de taxas de sucesso e de complicações, em relação à cirurgia sem auxílio da navegação, contudo em casos complexos que requerem cirurgia de revisão ou em que há grande alteração da posição de estruturas, o uso de sistemas evita a necessidade de se recorrerem a métodos abertos e mais invasivos para o doente.
A existência de diferentes tipos de sistemas de navegação que utilizam diferentes técnicas de registo e localização requer que os médicos se mantenham atualizados em relação às indicações, potencialidades e limitações inerentes ao seu uso.
The first navigation systems were developed three decades ago, initially being used in neurosurgery where their main goal was to help approaching intracranial structures in places that were hard to reach and where the surgeon had low visibility, however this technology was readily adopted by other specialties, among which otolaryngology. Surgical navigation allows the merging of pre-operative images of the patient with the information that the surgeon has access to during the procedure, thus making it particularly useful in endoscopic surgery where a two-dimensional view makes the perception of depth hard to keep track, which gets even worse in anatomically complex areas, it also allows to locate the position of the surgical tools in every moment, therefore helping to guide the surgeon to the target and lowering the complication rate. Today’s evidence, based on comparative studies and systematic reviews, doesn’t seem to show a significant advantage, in terms of success and complication rate, when compared to non-guided surgery, however in complex procedures such as revision surgery or when the local anatomy is greatly distorted, the use of navigation avoids the need to use more invasive methods. The existence of different types of navigation systems that use different techniques for registering and tracking requires that the physicians keep updated in relation to the indications, capabilities and limitations associated with their use.
The first navigation systems were developed three decades ago, initially being used in neurosurgery where their main goal was to help approaching intracranial structures in places that were hard to reach and where the surgeon had low visibility, however this technology was readily adopted by other specialties, among which otolaryngology. Surgical navigation allows the merging of pre-operative images of the patient with the information that the surgeon has access to during the procedure, thus making it particularly useful in endoscopic surgery where a two-dimensional view makes the perception of depth hard to keep track, which gets even worse in anatomically complex areas, it also allows to locate the position of the surgical tools in every moment, therefore helping to guide the surgeon to the target and lowering the complication rate. Today’s evidence, based on comparative studies and systematic reviews, doesn’t seem to show a significant advantage, in terms of success and complication rate, when compared to non-guided surgery, however in complex procedures such as revision surgery or when the local anatomy is greatly distorted, the use of navigation avoids the need to use more invasive methods. The existence of different types of navigation systems that use different techniques for registering and tracking requires that the physicians keep updated in relation to the indications, capabilities and limitations associated with their use.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Sistemas de navegação Cirurgia endoscópica Cirurgia naso-sinusal Otorrinolaringologia