5 2
O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | N O V E M B E R 2 0 1 4
the rest of the equipment in the room is set up. With electromagnetic
instruments, that's not an issue. Surgeons can move the device as
close to or as far as from the patient as they'd like without losing the
signal, which can be an important factor in ORs with limited space.
Before surgery with either system, patients undergo dedicated pre-op
CT or MRI scans with fiducial markers placed at anatomical landmarks.
Surgeons then use the scans to plot their preferred approaches to tar-
geted pathology. On the day of surgery, the images are loaded into the
image-guided system. The setup, registration and verification of known
anatomical structures take about 5 minutes to complete.
Finding my way
Most of the compartments surgeons work in during sinus surgery are
big air spaces filled by pathology — a polyp or tumor. Is that an air
pocket? Is that soft tissue? Am I in the cranial cavity? Am I in the
orbit? Without image guidance, surgeons probe the sinus cavity with
instruments that put pressure on, but do not injure, anatomy. The
slow and steady approach certainly works, but it's a tedious way to
operate. With image guidance, I know exactly where my instruments
are at all times and can move at a safe, steady pace. Confidence
breeds efficiency.
During sinus and skull base procedures, different approaches work
better for different patients. Image guidance helps with the big-picture
pre-op planning, letting me plot my basic course through the patient's
specific anatomy before entering the OR. For example, during skull
base surgery, it's often preferred to start far posterior and work for-
ward, because blood flows to the back of the skull in patients lying in
the supine position. With image guidance, I can determine if that
approach would be best.
Patients with tumors or inflammatory disease present with chronic tis-
S I N U S S U R G E R Y
