What is the future of minimally invasive surgery in rhinology: marker-based virtual reality simulation with touch free surgeon's commands, 3D-surgical navigation with additional remote visualization in the operating room, or ...?

Frontiers in Otolaryngology-Head and Neck Surgery (FOHNS), October 2017. (in press)

Ivica Klapan1,2, Alen Duspara3, Zlatko Majhen4, Igor Benić5, Milan Kostelac6, Goranka Kubat7,Nedjeljka Berlengi2

Ivica Klapan, Professor of Clinical ORL-Head and Neck Plastic Surgery, Division of Otorhinolaryngology-Head and Neck Plastic Surgery, Klapan Medical Group University Polyclinic, Zagreb; School of Medicine, Josip Juraj Strossmayer University in Osijek, Osijek, Croatia, EU and School of Medicine, University of Zagreb, Zagreb, Croatia, EU
Alen Duspara, Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia, EU
Zlatko Majhen, Director, Avanza d.o.o., Zagreb, Croatia, EU
Igor Benić, Juraj Dobrila University, Pula, Croatia, EU
Milan Kostelac, Professor of Mechanical Engineering and Naval Architecture, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia, EU
Goranka Kubat, Director, Division of Radiology, Sunce Polyclinic, Zagreb, Croatia, EU
Nedjeljka Berlengi, Division of Anesthesiology, Klapan Medical Group University Polyclinic, Zagreb, Croatia, EU


The navigation-Leap Motion-virtual endoscopy and virtual surgery suggests that real and virtual objects definitely need to be integrated by use of real 'in the air' control with simulation of virtual activities that requires real-time visualization of 3D-virtual endoscopy motions, following the action of the surgeon that may be moving in the virtual reality area. It is achievable with simple hand gestures of the surgeon, which do not differ in any way from all other natural everyday hand or body movements. In this way, the surgeon can predict the course of the surgery. He 'travels' through the virtual space, 'plays' without additional body, head and/or hand gesture changes. Simply, solely with his gaze, the surgeon coordinates his right hand movements, thus enabling, with contact free commands, the course of their preference or needs through the world of 3D-model, virtual endoscopy or virtual surgery, without stopping the endoscopic procedure in process (the endoscope is held by the left hand in the real surgery field). With this, all assumptions that the surgeon/telesurgeon is positioned in this virtual world which they entirely control but which realistically does not exist are achieved.