Computer Technology Boosts Rhinologic Surgery, but Poses Choices for Surgeons

That technology will also allow surgeons to mark certain parts of the sinus anatomy so that surgeons, while performing procedures, can be alerted that they are getting close to sensitive areas.

When you take them back into the operating room, as you do in your car navigation system, as you’re approaching the optic nerve, this will start beeping and say, ‘Approaching optic nerve,’ because you’ve already marked it, Dr. Fried said.

I do believe that within five or ten years, you’re going to be seeing this integration of where we’re going to take navigation to the next step.

Choosing the Right System

Dr. Tami took on a topic that might lead to confusion for some surgeons: how to choose an image guidance system in the first place.

He said there are three systems that use infrared technology: the Medtronics LandmarX, BrainLAB’s Kolibri and Vector-Vision, and Stryker Navigation’s iNtellect.

And there are two main systems that use electromagnetic technology: the Medtronics Fusion and the General Electric InstaTrak.

I don’t think there’s a bad system. I don’t think that you can go wrong and say, ‘Oh my God, I got this one and I should have gotten the other one,’ because they’ll all function, Dr. Tami said. It’s a matter of getting used to it.

The advantages of infrared technology are that there is no interference from metallic instruments or from the operating room table, the systems are widely available with a good track record of usage, and they are easily adaptable to multiple instruments. A disadvantage is that the line of sight can be limited by the infrared camera.

For the electromagnetic systems, an advantage is that there are no problems with the line of sight. But a major disadvantage is that it uses wired instruments and there can be electromagnetic metallic interference.

All the systems can use MRI, CT, and PET images; can track several instruments at a time; register patients easily; are highly accurate; are portable; offer multiple views; and all cost about the same.

It depends on who your dealer is, who your rep is, what kind of deal you have with them, but about $100,000 is the range for most of these systems, Dr. Tami said. Some are a little less, some are a little more, but they’re all pretty much in the same ballpark.

Considering all the similarities, which system to buy really depends on the support the surgeon will have once he or she gets it. You need to be able to depend on who you are buying the system from, who’s going to be there servicing it, help you when there are problems, he said.