The impact of image-guidance systems on sinus surgery.

Endoscopic treatment of diseases of the paranasal sinuses provides excellent visualization for minimally invasive surgery, and has evolved into a high-volume procedure with documented navigational risks to surrounding vital structures. Image-guidance systems use the data acquired during CT studies of the sinuses, which is processed through a workstation. Following a registration procedure, the coordinates of the tip of the surgical instrument being used are tracked and displayed in three views. The surgeon is then able to monitor the endoscopic work being done in the operative field and simultaneously document the precise location of the tip of the tracked instrument. Ideally, these systems will allow surgeons to accurately perform surgery with increased safety and improve long-term outcomes. Although the accuracies of these systems have been studied and reported [23,37], further large studies are needed to prove or disprove the impact of navigational systems on reducing surgical risk and improving surgical outcomes.Image-guidance systems employing optical and electromagnetic technologies have been clinically available for nearly 10 years, available during a time when there is an increased awareness of the risks of medical treatment and an emphasis on reducing errors. There is a need to prove that this technology, despite its added costs [39], ultimately improves safety and lowers the surgical risk of endoscopic sinus surgery. Only at that juncture can a mandate be made for including these systems in all procedures. There is universal agreement, however, that the use of this equipment can never bea substitute for surgical skill, training, or judgment.

Navigational risks associated with sinus surgery and the clinical effects of implementing a navigational system for sinus surgery.

OBJECTIVE: To evaluate the clinical effects of implementing the use of a navigational system in sinus surgery in a community hospital setting. STUDY DESIGN: Retrospective record review. METHODS: The hospital records of 800 patients who had undergone sinus surgery performed by 7 physicians at one institution over 11 years were reviewed and tabulated. The information was recorded in 2 groups of 400 with those in group A being treated before the availability of an electromagnetic sinus navigational system and those in group B being treated after the unit had been installed. The following data were collected: date, age, gender, informed consent, physician, additional procedures, sinuses entered, use of navigational system, revision status, setup time, operative time, and complications. The results of the two groups were analyzed statistically, and comparisons were made. RESULTS/CONCLUSIONS: The patient populations in groups A and B were determined to have similar demographic profiles. Significantly more sinuses, specifically in the frontal location, were entered in group B compared with group A. Adjusted for the number of sinuses treated, the median operative times did not differ significantly between groups. Major and minor complication rates were similar in both groups and were consistent with the published literature. In a community hospital setting, once an electromagnetic guidance system became available, it was used in 92% of the cases performed by sev-eral otolaryngologists.