Nikki Kean is a freelance medical writer based in New Jersey.
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April 2022Sinus Navigation Systems and Resident Training
There are limited data on the ability of augmented reality (AR) and virtual reality (VR) to enhance resident training in sinus surgery. But early experience with the technology suggests that it has a great deal of promise.
“Most residents and fellows in training now get exposure to [sinus navigation systems],” said Martin J. Citardi, MD, a professor and chair of the department of otolaryngology–head and neck surgery at the University of Texas Health Science Center in Houston. “When someone is ready to go into practice, he or she should be comfortable with it. We’ve done a couple of papers that show that the robustness of the registration process is related to the experience of the person doing the registration.” Based on these findings, noted Dr. Citardi, surgeons may want to reconsider delegating the registration process to their most junior person.
Fellowship-trained surgeons have reported increased confidence operating near critical structures and more complete surgical dissection using this technology, which, in future studies, may translate to increased safety and reduced surgical failure rates, said Waleed M. Abuzeid, MD, an associate professor in the department of otolaryngology–head and neck surgery and a specialist in rhinology and skull base surgery at the University of Washington in Seattle. Furthermore, mental workload and stress during surgery may also improve based on early studies (Laryngoscope Investig Otolaryngol. 2020;5:621-629).
From a training standpoint, AR and VR could facilitate a deeper understanding of anatomic relationships and, importantly, identification of variations in anatomy that could lead to complications in endoscopic sinus surgery. “This technology may also allow for a graduated approach in surgical technique, beginning with the trainee adhering to a preplanned ‘flight path’ or surgical trajectory set by the teacher and progressing through to the trainee demonstrating their own ability to develop and execute a presurgical dissection plan and execution of that plan,” said Dr. Abuzeid.
“For training, you can build a 3D model of the sinus anatomy, particularly with respect to the frontal recess, which can help plan our surgical approaches during endoscopic dissection,” added Jivianne Lee, MD, an associate professor in the department of head and neck surgery at the University of California, Los Angeles David Geffen School of Medicine. “For the frontal sinus, you can color block specific cells and pathways that you anticipate you’ll encounter at the time of surgery [on the scan] and then superimpose those drawings on the endoscopic image at the time of surgery.”