There is an exciting new development in endoscopic sinus surgery called Image Guided Surgery, a technique which allows the surgeon to correlate exactly where he or she is operating with a previously performed CT scan. There are several manufacturers now including InstaTrak by GE,, BrainLAB, Medtronic (LandmarX) Fusion, and Stryker iNtellect ENT. . This system allows the surgeon to simultaneously visualize 4 different views on a monitor: the coronal, sagittal and axial CT scan images at the same time as the real time surgical endoscopic view. It is then possible to compare the surgically visualized anatomy with the same anatomy of the CT scans. The unique aspect of these systems is that the surgeon knows by looking at the monitor exactly where his instruments are during surgery on the CT visualization.
The technique works as follows:
Initially, CT scans are obtained of the sinuses. In some cases the patient must wear a special headset. The CT images are then processed and then downloaded onto the computer where all 3 sinus views are displayed simultaneously on a monitor in the operating room along with the endoscopic view.
At the time of surgery, the system is taken to the OR and the CT scan can be viewed on the monitor while the surgeon inserts a special probe into the nose. The position of the probe can be seen on the monitor using standard surgical endoscopic instruments. The position of the probe inside the nose can be pin-pointed exactly and visualized precisely on the system as cross-hairs. As a result the surgeon can precisely orient himself or herself to the anatomy both on the CT scan and with the endoscopic view and can dramatically reduce potential complications during the surgery. In addition, the system is very helpful in teaching cases to residents who may need additional visualization tools.
This exciting new concept has made a dramatic difference in endoscopic sinus surgery, especially in more difficult cases by helping reduce complications. It also may become the standard of practice in endoscopic sinus surgery.
There are an increasing number of otolaryngologists who have started to use the image guided surgery machines. These devices are not interchangable, so it is important that if you are going to have surgery using one of the image guided machines, the CT scan must be done knowing which machine will be used. It is typically possible for the CT scan to be done so that any of the systems can be used, but that must be known at the time of the CT scan. Just as with other forms of endoscopic surgery, however, it is important to realize that the skill of the surgeon is paramount in determining whether you get a good result.
There are certain circumstances when image guided surgery is more important. It is like having a GPS navigational unit when hiking. If landmarks are missing such as when there is a blizzard, it is helpful to have a GPS unit to know exactly where you are. Similarly with image-guided surgery: If previous surgery has been done and much of the tissue has been removed, there may not be clear landmarks to show the surgeon where to operate. Such is the case when operating on the frontal sinus and in some cases on the ethmoid sinuses. Image guided surgery can guide the surgeon to the areas which need to be operated on. If you would like to view a typical image using the Instatrak monitor, please
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