Using Surgical Navigation to Capture Objective Metrics During Endoscopic Sinus Surgery: A Proof-of-Concept Study

Evaluation of otolaryngology resident technical performance has historically relied on subjective perioperative feedback. Despite various assessment tools attempting to provide consistent surgical skill evaluations, current methods remain inherently subjective.

This proof-of-concept pilot study aimed to assess if a 3-dimensional surgical navigation system could capture objective surgical data during endoscopic sinus surgery (ESS). A secondary aim was to analyze if there were any differences between novice and practiced trainees.

Otolaryngology residents performed supervised ESS on patients while their instrument (microdebrider, suction) motion was recorded using a TruDi^® Navigation System. Prior to the surgery, surgical landmarks were defined with sensory beacons in the navigation system using the patient's preoperative computed tomography (CT) scan. Metrics included time to reach beacons, number of alerts at each beacon, and instrument speed.

Fifteen otolaryngology residents performed 87 ESS. The navigation system successfully obtained "time to reach sinus X" data for 64% of sinuses/ case, velocity data in 93% of cases, and number of beacon "alerts" per minute in 93% of cases. We found a significant difference between PGY 3 residents and PGY 4/PGY5 residents in the number of sphenoid sinus alerts per minute (P = .01) and the percentage of cases in which the resident accessed the maxillary sinus via the natural os (P < .001).

This study demonstrates the feasibility of collecting objective, navigation-based intraoperative metrics during live surgery and is a first step toward building a comprehensive objective assessment tool in ESS. We hope this report encourages further research into this technology's application in objective resident skill assessment and correlation with concurrent faculty assessments.