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OSM560-April_DIGITAL_Layout 1 4/5/13 2:29 PM Page 72 E N T N A V I G A T I O N ASSESSING YOUR OPTIONS Which Image-Guided ENT System Is Right for You? (continued from previous page) ing. That's especially important when working deep in the skull base, which demands intricate maneuvers that draw the hands tight together as you move deeper into the surgical cavity. • Infrared guidance. Passive systems have fiducial markers placed on the patient and instruments that reflect infrared light back to the system's camera. Active systems have infraredemitting diodes on operating instruments that are actively tracked by an overhanging camera. With both types of technology, you must maintain a clear line of sight between instruments and imaging unit. These systems are highly accurate and especially helpful and convenient during routine sinus cases because the small markers placed on the distal ends of individual instruments easily track their locations during dissection. Passive systems do not require wiring of instruments to the machine, giving surgeons freedom of movement in the surgical cavity. It's a definite plus if you can rapidly and effectively adapt surgeons' preferred instrumentation for use with a navigation system. However, surgeons using these systems must learn how to hold instruments — particularly the endoscope — in such a way that the system can always read the markers. — Brent A. Senior, MD images, giving them tremendous amounts of information they'd normally have to mentally piece together from separate imaging sources and computer screens. Working off of superimposed images helps surgeons truly understand the anatomy and relationships of anatomical landmarks they're working around. Proving that the technology reduces complications is difficult to do because standard complication rates of routine sinus surgery are already exceedingly low — around 1%, and much less than that for major mishaps. Conducting research that demonstrates the technology's direct impact on improved safety would require such a large number of patients that it's near impossible to study. Anecdotally, however, surgeons 7 2 | O U T PAT I E N T S U R G E R Y M A G A Z I N E | A P R I L 2 013