The impact of image-guidance systems on sinus surgery

Endoscopic treatment of diseases of the paranasal sinuses provides excellent visualization for minimally invasive surgery, and has evolved into a high-volume procedure with documented navigational risks to surrounding vital structures. Image-guidance systems use the data acquired during CT studies of the sinuses, which is processed through a workstation. Following a registration procedure, the coordinates of the tip of the surgical instrument being used are tracked and displayed in three views. The surgeon is then able to monitor the endoscopic work being done in the operative field and simultaneously document the precise location of the tip of the tracked instrument. Ideally, these systems will allow surgeons to accurately perform surgery with increased safety and improve long-term outcomes. Although the accuracies of these systems have been studied and reported [23,37], further large studies are needed to prove or disprove the impact of navigational systems on reducing surgical risk and improving surgical outcomes.Image-guidance systems employing optical and electromagnetic technologies have been clinically available for nearly 10 years, available during a time when there is an increased awareness of the risks of medical treatment and an emphasis on reducing errors. There is a need to prove that this technology, despite its added costs [39], ultimately improves safety and lowers the surgical risk of endoscopic sinus surgery. Only at that juncture can a mandate be made for including these systems in all procedures. There is universal agreement, however, that the use of this equipment can never bea substitute for surgical skill, training, or judgment.