In the field of otolaryngology–head and neck surgery, precision is everything. But with so many delicate organs and systems standing between surgeons and their target, precision has often proven elusive and difficult to gauge.

Now, hoping to obtain more accurate measurements and exact locations of the structures on which they operate, physicians in the Johns Hopkins Department of Otolaryngology–Head and Neck Surgery are examining a new concept in robotic surgery called quantitative endoscopy. The department recently received a grant for a clinical trial testing the use of robotics in measuring and treating pediatric airway obstructions, and researchers are examining the possibility of incorporating the technique into skull-base surgery as well.

Masaru Ishii believes endoscopy
is the solution to offering better
head and neck surgery

“Right now, all the information we’re able to get from endoscopes comes from looking with our eyes, and we’re not really able to analyze that information at all,” says head and neck surgeon Masaru Ishii, a lead investigator on the grant and research. “But, by using a camera attached to an endoscope, we can take pictures that allow us to derive quantitative information, including exact measurements.”

Such precision is important to all surgeons, but especially those operating on delicate places like the base of the skull or a child’s obstructed airway. Until the emergence of quantitative endoscopy, Ishii says, physicians have possessed few clinical methods for determining whether airways are too narrow and require surgical intervention. “Being able to get a good understanding of airway size allows us to develop systems for better repairing these defects and for determining whether we’re successful,” Ishii says.

The benefits of quantitative endoscopy apply also to skull base surgery. “The base of the skull is a difficult place to reach,” he says, “because a lot of structures come out of the brain or run through it.” In the past, surgeons were forced to operate on skull-base tumors by performing a craniotomy—a procedure that requires a portion of the skull to be removed and the brain to literally be lifted up so that the surgeon can reach the tumor. Now, developments in minimally invasive robotic surgery and endoscopy allow surgeons to approach skull-base tumors through the nose, subsequently avoiding  the dangers of a highly invasive cranial procedure.

“Quantitative endoscopy allows you to understand the position of objects to a very high level of precision,” Ishii says. “It allows you to drill precisely through bone to find structures and make openings in a very accurate fashion. It’s more accurate than any other system we’ve had for doing this.”