95. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Prof. Dr.

NUR Wissenschaftliches Programm/ ONLY Scientific Program

Transnasales Endoskopisches Operieren

Vortrag auf Einladung

Endoskopisches Operieren in der Otologie

Prof. Dr. med.

Transorales Endoskopisches Operieren im Larynx

Dr. med.

Evaluation of a preclinical surgical model for endolaryngeal interventions with a novel hyperangulated 3D printed Laryngoscope

Explorative Beurteilung eines Operationsmodells für endolaryngeale Eingriffe mit einem neuartigen hyperangulierten 3D-gedruckten Laryngoskop

Introduction: This study presents a hybrid model for preclinical testing and surgical training of the novel hyperangulated laryngoscope for surgery (sMAC). In cases where transoral laser microsurgery (TLM) using the conventional Kleinsasser operating laryngoscope faces challenges, such as limited cervical spine mobility or post-radiation changes, the sMAC offers a potential solution. This study aims to create a suitable preclinical model for testing the sMAC instrument, focusing on surgical training. Methods: A hybrid model was developed by integrating a porcine larynx into a plastic airway manikin. Then the sMAC, which design is based on a hyperangulated videolaryngoscope with additional working channels, was used by trained surgeons and residents to perform endolaryngeal cordectomies on the model. Additionally, vocal folds were marked blue to simulate a laryngeal lesion or tumor, and the resection of the blue marked areas were performed. Results: The assembly of the setup was efficient and provided clear visual exposure of the glottic plane. The model allowed the straightforward exchange of porcine larynges. The sMAC system enabled precise surgical interventions, and trained surgeons as well as untrained residents successfully performed cordectomies and biopsies of blue marked areas in the larynx-manikin model. Conclusion: The hybrid model offers a realistic and cost-effective solution for training and testing endolaryngeal surgical procedures, especially with the sMAC laryngoscope. Although there are minor anatomical differences between porcine and human larynges, the model's affordability and similarity to human tissue make it a valuable tool for training and development. Further studies are needed to assess its utility for training inexperienced surgeons.The authors thank Lumendi Ltd. for providing flexible instruments. The study was supported by the German Research Foundation (DFG, #491516763).

Explorative Beurteilung eines Operationsmodells für endolaryngeale Eingriffe mit einem neuartigen hyperangulierten 3D-gedruckten Laryngoskop

Experimentelle Onkologie

Kopf-Hals-Onkologie

Freier Vortrag

Prof.

Sensorised head and neck cancer surgery via biophotonic multimodal imaging

Sensorisierte Kopf-Hals-Tumor Chirurgie mit biophotonischem multimodalem Imaging

Introduction Intraoperative tumour resection is based on the surgeon"s experience, supported by optic or robotic-assisted examination of the tumour. However, this approach does not allow for a precise definition of the tumour borders and can lead to incomplete tumour resection and thus poor survival of the patient. Biophotonic imaging approaches could play a crucial role in addressing this unmet medical need, as they provide besides morphological information also molecular information. Materials / Methods We will report on the investigation of novel multimodal labelfree spectroscopic instrumentation (like e.g. clinically usable microscopes or endospectroscopic probes) in combination with innovative artificial intelligence (AI) approaches. Results Labelfree multimodal spectroscopic imaging visualizes the tissue morphology and molecular structure. The multimodal images can be automatically analyzed using AI-based image analysis approaches into diagnostic information. To take full advantage of these multimodal imaging approaches a major step forward would be the implementation of spectroscopic-guided femtosecond ablation in a "seek and treat manner". We will also introduce a multimodal nonlinear microendoscope, which also allows for the ablation of biological tissue with femtosecond lasers. Discussion The interplay between multimodal imaging in combination with innovative artificial intelligence approaches for real-time spectral analysis and fs-laser ablation opens exciting new ways for an intraoperative histopathological tumor analysis and selective removal. An outlook to also include haptic feedback towards sensorised surgery for precise surgical guidance and intraoperative histopathological examination of tissue under in-vivo or near in-vivo conditions will be given.Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht

Sensorisierte Kopf-Hals-Tumor Chirurgie mit biophotonischem multimodalem Imaging

Endoskopie / Mikroskopie / Optik / Photonik

Sonstiges

PD Dr.

PD Dr. med.

Feasibility of intraoperative optical biopsy during endoscopic sinus surgery with confocal laser endomicroscopy: a pilot study

Intraoperative optische Biopsie mittels konfokaler Laserendomikroskopie in der endoskopischen Nasennebenhöhlenchirurgie: Eine Pilotstudie

Introduction: Confocal laser endomicroscopy (CLE) is an optical imaging technique that allows in-vivo, real-time, microscope-like assessment of superficial lesions. While there is substantial data on CLE use in the upper GI tract, there is limited information regarding its application in the nasal cavity and paranasal sinuses. These structures show, however, a wider variety of frequent and concomitant benign and malignant pathologies, which could pose an increased challenge for optical biopsy by CLE. This study aims to assess the feasibility and diagnostic metrics of CLE in the nasal cavity and paranasal sinuses regarding differentiation between healthy/benign and malignant tissue. Materials and methods: We performed CLE between May and September 2023 on 6 patients. 42 sequences (3792 images) from structures in the nasal cavity and/or paranasal sinuses were obtained. Biopsies were taken at corresponding locations and analyzed in H&amp;E staining as a standard of reference. Three independent examiners evaluated the sequences; they were blinded to the histopathological examination. Results: Healthy and inflamed mucosa could be distinguished from malignant lesions with an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 84.1%, 85.4%, 83.1%, 72.5%, and 92.1%, respectively, with a substantial agreement between raters (Fleiss"κ= 0.62). Conclusion/Discussion: The results suggest that this technique is applicable in the nasal cavity and paranasal sinuses. A scoring system based on defined and reproducible features or automatic classification systems based on AI could lead to an improvement in the diagnostic value and clinical utility of CLE.Die Autoren geben an, dass kein Interessenkonflikt besteht

Intraoperative optische Biopsie mittels konfokaler Laserendomikroskopie in der endoskopischen Nasennebenhöhlenchirurgie: Eine Pilotstudie

Endonasal confocal laser rndomicroscopy – real-time characterization and differentiation of malignancies of the nasal cavity, the paranasal sinuses and skull base

Endonasale Konfokale Laserendomikroskopie - Echtzeit- Charakterisierung und Differenzierung von Tumoren der Nasenhaupt- und -Nebenhöhlen sowie der Schädelbasis

Introduction: Endonasal and skull base tumors are challenging due to the complex anatomy and histological heterogeneity. Real-time assessment of tumor margins during resection can support intraoperative decision making. Confocal Laser Endomicroscopy (CLE) has emerged as a valuable tool for in vivo tissue imaging. In this study, we aimed to investigate not only the utility of CLE in examination of tumor margins but also to differentiate between different entities of endonasal malignancies. Material and Methods: We used CLE in endoscopic-endonasal resection of 8 tumors including 4 squamous cell carcinomas, 2 adenocarcinomas and 2 mucosal malignant melanomas. Intraoperatively, CLE imaging was performed to visualize tumor characteristics and surrounding tissue. The CLE images were correlated with histopathological examination for validation and establish identification criteria for the different entities. Results: CLE imaging provided real-time insights into tumor characteristics, enabling differentiation between the malignancies examined. Distinct features such as cellular morphology, microvascular patterns and extracellular matrix alterations were visualized. The imaging allowed for identification of tumor margins, aiding in complete resection while preserving healthy tissue. Conclusion: CLE is a promising tool for advanced real-time examination of endonasal and skull base tumors during resection. It offers the ability to not only to define tumor margins but to differentiate between different tumor entities. The technology's real-time imaging capabilities may enhance surgical decision-making and improve patient outcomes by allowing for more accurate and tailored tumor resections.Einleitung: Endonasale und Schädelbasistumore sind aufgrund der komplexen Anatomie und Heterogenität herausfordernd. Die Echtzeitbeurteilung der Tumorränder während der Resektion kann intraoperative Entscheidungen unterstützen. Die konfokale Laser-Endomikroskopie (CLE) hat sich hierbei als wertvolles Instrument erwiesen. In dieser Studie wollten wir nicht nur den Nutzen der CLE bei der Untersuchung von Tumorrändern sondern auch in der Unterscheidung verschiedener Entitäten untersuchen. Material und Methoden: Wir verwendeten CLE bei der endoskopisch-endonasalen Resektion von 8 Tumoren, darunter 4 Plattenepithelkarzinome, 2 Adenokarzinome und 2 Schleimhautmelanome. Intraoperativ wurde die CLE genutzt, um die unterschiedlichen Tumoreigenschaften und das umgebende Gewebe zu visualisieren und zur Validierung mit der histopathologischen Untersuchung korreliert, um Kriterien für die Identifizierung der verschiedenen Entitäten festzulegen. Ergebnisse: Die CLE lieferte Echtzeiteinblicke in die Tumoreigenschaften und ermöglichte eine Differenzierung zwischen den untersuchten Malignomen. Unterscheidungsmerkmale wie zelluläre Morphologie, mikrovaskuläre Muster und Veränderungen der extrazellulären Matrix konnten dargestellt werden. Sie ermöglichte zudem die Identifizierung von Tumorrändern. Schlussfolgerung: Die CLE ist ein vielversprechendes Instrument für die Echtzeituntersuchung von endonasalen und Schädelbasistumoren. Sie bietet die Möglichkeit, nicht nur Tumorränder zu definieren, sondern auch zwischen verschiedenen Tumorentitäten zu unterscheiden. Durch eine genauere und maßgeschneiderte Tumorresektion besteht so die Möglichkeit, die chirurgische Entscheidungsfindung und das Outcome der Betroffenen zu verbessern.Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Endonasale Konfokale Laserendomikroskopie - Echtzeit- Charakterisierung und Differenzierung von Tumoren der Nasenhaupt- und -Nebenhöhlen sowie der Schädelbasis

Session 45
Crossing Borders – Mit der Endoskopie Grenzen überwinden

Termin

Vorsitzende

Thema

Programm

Session 45Crossing Borders – Mit der Endoskopie Grenzen überwinden

Termin

Vorsitzende

Thema

Programm

Session 45
Crossing Borders – Mit der Endoskopie Grenzen überwinden