"Nasal obstruction is currently categorized as one thing, but I'll bet
you the problem is much more diverse," says Dr. Farag. "How do you
identify those differences, and which intervention would make a dif-
ference for which patients? We want to find out."
Patients do best when surgery complements physiology. "Surgical
intervention isn't just about making a hole or opening a sinus, it's about
how and where you open the sinus," explains Dr. Farag. "If you open the
sinus in the wrong area, you could make the patient worse. We currently
do an excellent job in terms of sinus surgery outcomes, but there's
always room for improvement in treating disease processes. When you
understand how the body works, and how patients perceive their dis-
ease process and what drives it, you can better address their specific
issues."
Robotics add safety and precision
No question image-guidance has dramatically improved endo-
scopic sinus surgery, but is it precise enough? "[Image-guidance] has
been incredibly important and revolutionary, but the drawback is that
it's not precise enough to operate directly with the navigation system,
and it doesn't provide an absolute safety envelope," says Masaru Ishii,
MD, PhD, associate professor of otolaryngology: head and neck sur-
gery at Johns Hopkins Medicine in Baltimore, Md. Image-guidance lets
you recall the 3D image of a patient's anatomy in order to reorient
yourself in space, to understand your location with respect to patient
anatomy so you can proceed safely with surgery, says Dr. Ishii. "But if
you don't interpret the information correctly, you can still violate the
confines of the nose and run into trouble," he says. "There's no physi-
cal construct that prevents you from violating the 'safe fly zone.'"
Researchers are looking at ways to make navigation systems incred-
ibly precise by using machine-vision techniques, says Dr. Ishii. He says
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