Video-guided Imagery Makes Sinus Surgery Safer

A new development in sinus surgery is giving otolaryngologists more confidence and making the procedure safer for patients as well. Video-guided imagery allows surgeons to correlate what they see on the scope in real time during surgery with a CAT scan image. "For well over 20 years now the majority of sinus surgery has been done using endoscopes, which allows you to go up through the nostril, find the natural openings to the sinuses, widen them, drain fluids, and minimize the trauma compared to traditional sinus surgery of 30 to 40 years ago," says E. Scott Elledge, MD, FACS. "This new system allows you to correlate the patient's CAT scan, which we use for diagnostic purposes to analyze where the disease is, and it allows you to use a probe to identify structures on the patient. That probe will then show you on the video image where you are based on the CAT scan. It's very important when doing revision surgery. With sinus surgery so close to the brain and the eye, what this system does is allow you to be a lot more comfortable about the anatomy." Patients have a CAT scan in the morning, and that scan is placed on a CD for use during the surgery later that day. A headset sends a signal from a wireless probe to the screen displaying the CAT scan results. "I can touch the tip of your nose and see that I'm touching the tip of your nose on the screen," Elledge explains. "It's amazing technology. It doesn't replace using the scopes or following the landmarks, but it does give you a tremendous amount of confidence, particularly when you are dealing with revision cases where there might be scar tissue or the anatomy is altered. It adds a tremendous amount of safety, and it allows you to do a more thorough job a lot of times." Many otolaryngologists caution that this procedure should not be considered a standard of care for every sinus surgery. "I don't feel it's indicated for every sinus case," says Jack Aland, MD, ENT Associates of Alabama. "It's very helpful and gives you much more confidence when you're doing surgery. It's just another tool that helps you be successful." "It would not be correct that it is standard of care," says Elledge, "in that no one should be forced to use it. And certainly with more straightforward, simpler procedures, it's really not needed. But is sure is nice to have for revision surgeries and certain sinus cavities that are deeper and closer to the brain and eye structure." Dr. David Halvorson, MD, FACS, Shelby ENT, says he uses video-guided imagery for all sinus surgery, however. "I use it for every case. The rationale is, if I have an adverse problem and I'm not using it, it would be difficult to say, 'I'm too good not to need it.' Any time you have technology that is going to assist you and make you a better surgeon and improve the quality of care for patients…when it's available, I think you should use it." "We always get in this bind in medicine when we get a new technology," Elledge points out. "We get the question, 'well is it better to use it?' Well it is better, but it isn't always necessary because there is a cost factor. If you had a complication and wished you had used it, what is the value there? " Whether it is used for every sinus surgery or selected ones, doctors do agree that this new technology is a significant development for otolaryngology. "In my field, endoscopy for sinus was a huge breakthrough," says Elledge. "There really hasn't been that kind of revolution in technology until this came along. In my mind, it is really that dramatic. You feel like you are practicing Star Trek medicine sometimes."