Connie Casey recently splurged on a state-of-the-art image-guidance system for the Northpoint Surgery & Laser Center in West Palm Beach, Fla. The upgrade took a big bite out of her capital budget (the unit runs between $75,000 and $100,000), but she says the expense was worth every penny in terms of surgeon satisfaction and improved sinus surgery outcomes. Her docs rave about how much easier and faster it is to work with. "Now," says Ms. Casey, "they won't perform surgery without it." Is an image-guided system right for you?

Risk reduction
Christopher Chang, MD, an otolaryngologist at Fauquier Ear, Nose and Throat Consultants in Warrenton, Va., was thrilled when his hospital included an ENT platform on the image-guided system bought for the ortho docs. He says the technology gives him an extra level of comfort as he navigates in and around the sinus cavity, much like a GPS system might keep you from getting lost on unfamiliar back roads.

Surgical dangers during sinus surgery aren't necessarily limited to the sinus tract, points out Dr. Chang, who says potentially devastating complications lay just outside the intended surgical path. "Even the slightest slip of the hand can send instruments into the neighboring orbital socket to damage the eye, or worse, cause permanent blindness," he says. Wayward surgeons can also crack the ceiling of the sphenoid sinus cavity, exposing the brain to unintended harm. Image-guided technology helps reduce those risks by letting surgeons track the placement and movement of surgical instruments in real time, improving sinus surgery's level of precision and safety.

More accuracy, but longer case times?
Ms. Casey says her surgeons rave about the new system's improved accuracy, which gives them confidence in knowing exactly where their instruments are being placed. The new system is also easier to set up before cases. She says disks containing CT scans are easy to load and quickly produce reliable, clearer, more accurate images. Gone are the plastic imaging headsets patients were forced to wear during pre-op CT scans and surgery. Patients would inevitably forget the headsets at home, forcing cases to be cancelled or postponed and tearing her carefully planned surgical schedule to pieces.

A report in the June 2005 issue of Otolaryngologic Clinics of North America that analyzed the cost and performance of newer ENT image-guided technology states, "The vast majority of sinus surgeons have been pleased with the systems' ease of use and accuracy" and have experienced increased confidence in precisely locating anatomical structures, which the study's authors report as the technology's primary benefit. On the other hand, they point to slower operative times as a potential drawback. (Although they also admit the cases they reviewed could have been overly complex and procedure times might have been even longer without image-guided technology.)

Dr. Chang says case times might actually be longer if surgeons use image-guidance as a crutch instead of as a security blanket. "The technology doesn't necessarily let me go faster, but it does give me the confidence to access certain parts of the sinus cavity that demand extreme precision," he says. His cases last about 45 minutes, partly because he learned to perform sinus procedures without the assistance of image guidance. "Instead of relying on the technology to tell me where to go, I use it as confirmation during the procedure," he says. "Some surgeons doubt themselves and use image guidance to constantly confirm what they're doing instead of just doing it."

Nearly all the surgeons that researchers questioned for the Otolaryngologic Clinics of North America report said they expected to increase their use of image-guided surgery in the future. The researchers add that the technology could have major implications for difficult surgeries in which distorted anatomy or extensive disease might otherwise result in incomplete eradication of the problems demanding surgical removal. "Although image guidance cannot make a bad surgeon good," the researchers point out, "it can make a good surgeon better."