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How Image-Guided Surgery Can Benefit Otolaryngology

by Cheryl Alkon •

Dr. Mirza said he could.

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May 2015

He used the imaging during surgery to locate exactly where the patient’s nerves were, and performed bone removal in six small areas without removing ligaments. “Usually we use indirect measurements with probes to check if the nerves are free when we are finishing up,” he said. “I thought we were done, but when we looked on the CT and MR images after the initial procedure, on one area, one area still looked pinched. We had the ability to fix that.” The entire surgery took four hours, plus an hour for the follow-up CT and MR images, and then another half-hour to fix the final area. As a result, “we were able to remove the minimum amount of bone using the imaging and navigation available, and the patient has been very happy with the results,” he said.

Future Use?

As the technology improves, physicians will likely be able to use intra-operative imaging in more procedures, particularly as research is published showing the results of its use.

Dr. Mirza is eager to see what happens. He cited Dr. Paydarfar’s research on new retractors developed using intra-operative imaging and incorporating validation algorithms that can be developed to determine what kind of pressure is required when using a retractor, and how it affects the look and behavior of a tongue during transoral surgery.

He welcomes other researchers to Dartmouth as well. “We would love to invite projects from anywhere in the country, to build enough of a research core from grants and philanthropy so surgeons, residents, and students who have good ideas to improve surgery don’t have to spend years trying to secure funding, but can come here to do their projects, get their data, and quickly put the good ideas into practice,” said Dr. Mirza. “We also want to work with similar facilities to measure patient outcomes carefully so we can better understand optimal use of this advanced technology in the future.”

Cheryl Alkon is a freelance medical writer based in Massachusetts.

For Further Reading

Intra-Operative Imaging Challenges

While there are clear benefits to intra-operative imaging, challenges exist as well. The first is cost. According to a February 2015 Wall Street Journal article, the scanning system, with two to three rooms containing MRI machines, costs $3 to $7 million; CT scanners cost another $1.5 to $3.5 million. Costs are passed on to third-party payers such as private insurers and, ultimately, are passed on to patients, said Dr. Smith. “But this is no different than any other expensive technology,” he said. “It’s important to continually evaluate whether this technology is adding value, and in my opinion, there is no question that this technology adds value in certain cases.”