The State of the Art of Image-Guided Surgery

We can often accept these distortions, but as we’re getting more into neuro-related surgery, distortion can be a problem, he said. For instance, more technology is needed for neurorhinology.

How Much Technology Is Necessary?

But at what point do otolaryngologists really need more technology? It’s tempting to become reliant on technology and imaging, but doctors still need their own clinical judgment.

Trust yourself, don’t trust a machine. Use IGS to confirm what you already know, not to figure out what you don’t know, Dr. Senior said. Indeed, it’s the skill of the endoscopist that determines whether or not a case even is performed endoscopically, not simply because one has IGS.

Dr. Senior provided examples of cases where IGS helped. One was of a 24-year-old man who underwent an endoscopic craniofacial resection for a large benign bony lesion involving the sinuses and skull base with significant intracranial extension. Here, IGS was useful because it allowed endoscopic drilling of the lesion in the setting of very distorted, even absent, landmarks.

A second case was a 62-year-old man who presented with altered mental status and was found to have a large pituitary neoplasm with spurasellar extension and ventricular compression. He underwent minimally invasive pituitary surgery (MIPS). IGS provided an extra level of safety for the procedure by use of intraoperative tracking of the tumor removing curettes on the preoperative MRI, which avoided injury to adjacent neural structures, Dr. Senior told ENToday.

IGS has its greatest advantage at the limits of our (currently used) instrumentation and visualization, Dr. Senior said. It helps with surgery in the skull base, sphenoid sinus, and frontal sinus. Advances in the technology continue, and newer instrumentations are being developed. Eventually, IGS will even be integrated with robotics, he said.

Sinus Surgery Simulators

Going even further and in a slightly different direction, an endoscopic sinus surgery simulator has been developed. Marvin Fried, MD, Professor and Chair of the Department of Otorhinolaryngology at the Albert Einstein College of Medicine, described details of a device that is now available to help train students and residents.

Simulators are going to be seen more frequently in the future because of their usefulness as teaching tools. Indeed, simulators in general have a history going back to the 1920s in aviation, though in recent decades more and more are being developed in the medical arena.

For otolaryngologists, we developed a consortium of [seven medical institutions] to look at endoscopic sinus surgery, Dr. Fried said. Over the years, the group has made progress in the development of the ES3, a surgical simulator that works something like a video game. It has a handheld control arm like the ones used in surgery, and a monitor displaying sinus anatomy along with virtual surgical tools such as microdebriders.