Archive April 2014 XV, No. 4

What's New in ENT Navigation Systems?

These GPS-like devices help surgeons navigate through the nose using a 3D map created from CT scans.

Mani Zadeh, MD, FACS


image-guided surgery GPS SYSTEM Image-guided surgery "lets the surgeon see exactly what needs to be repaired or removed," says Dr. Zadeh.

Performing sinus surgery without a navigation system is like looking down a dark alley with a flashlight. Yes, you removed the polyps from the patient's sinus cavity, but you'll never know exactly how many millimeters your instruments may have come from causing a catastrophic brain injury or blinding the patient. That is why I use my image-guided system on most sinus surgeries I do. For me, operating with GPS-like guidance is all about safety and efficiency, about seeing precisely where I'm at in real time.

Breathe easier
Some doctors reserve image guidance for revision or more complex surgeries where the anatomy has changed (see "Criteria for Image-Guided Surgery"), others argue why ration a device that helps you make more informed decisions in the OR? Let me stress that navigation is by no means a replacement for experience. Navigation is a tool to help with surgery, not a teacher and not a mentor.

Here's a perfect case in point. Recently I performed a sinus surgery on a patient with chronic sinusitis, who as a result of a prior surgery over a decade ago had a skull base defect. Before I looked into the nostril, I knew to stay away from the defect between the brain and sinus because we had mapped that region and I could see it clearly on the monitor. Using image guidance while operating, you'll know exactly where you are — and where not to go. I see the septum and a very large turbinate that's blocking the nasal cavity. I shrink the turbinate down so he can breathe better and remove the polyps that are blocking the sinus openings. Thanks to image guidance, my patient can breathe clearer and I can breathe a little easier.

Certainly, you'll spend extra time and costs setting up image-guided sinus surgery, but I ask myself this: If my loved one were having sinus surgery, you want the best technology out there. Sometimes only I'll use image guidance at the end of a case to make sure I removed everything I wanted to.

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