computer programs that could analyze surgical video, understand
where surgeons are in space and provide real-time feedback would
make navigation systems more accurate and useful.
Robotics takes that potential advancement a step further. "The tech-
nology is interesting, because if you can build a robot that's rigid
enough and understands where it is in space, it could follow along
while surgeons operate and provide complete constraint," says Dr. Ishii.
"In other words, if the robot realizes that you're about to go into the
eye, it could freeze the instruments and prevent you from doing so."
If the navigation is made precise enough, you'd be able to tell the
robot the areas you want to operate in and where you want to avoid,
and it would provide that safety envelope, says Dr. Ishii.
Dr. Ishii is also very interested in how robots can be used as
advanced training modules by recording and calculating what the
expert tool paths are supposed to be for specific procedures, and
showing them to novice surgeons. Improving the skill sets of all sur-
geons would deliver a higher quality of care to a larger number of
patients. "The question is how much of a quality benefit is needed to
justify the increased cost of the technology," says Dr. Ishii.
Robotic technology geared for sinus or skull-based surgery is in
development, especially overseas, but Dr. Ishii says it probably won't
launch in American ORs for at least another 5 years.
The shift to office-based settings
Performing basic sinus surgery in an office-based procedure
room? Why not, asks Nora Perkins, MD, FACS, FAAOA, an ENT-oto-
laryngologist at Albany (N.Y.) ENT and Allergy Services. Dr. Perkins
noticed 2 things: Patients who underwent basic cases in the OR recov-
er quickly and fairly easily, and putting them under general anesthesia
sometimes took longer than the procedures themselves. She first
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