If you'd like to perform safer, more efficient sinus surgery and improve your outcomes, then image-guided technology might be for you, says Connie Casey, RN, CNOR, LHRM.

The administrator of the Northpoint Surgery and Laser Center in West Palm Beach, Fla., recently invested nearly $160,000 in 2 image-guided systems. Already they're paying big dividends. Sinus surgeries that used to take 3 hours now take a little more than 1 hour. "Surgeons are able to operate a touch faster with the security of being able to track the exact location of their instruments in relation to scans of a patient's specific anatomy," she says.

ENT surgeon Michael Schwartz, MD, likens the intricacies of performing sinus surgery to opening a series of small chambers lined by thin layers of bone. The sinuses sit on one side of that thin layer; the eye sockets and brain cavity sit precariously on the other. One wrong move with an instrument could result in devastating consequences.

"Image-guided systems help you confirm where you're working," says Dr. Schwartz. "That provides another level of security, especially in patients with disease processes or in those who've had previous surgery that may have altered anatomical landmarks."

The technology helps physicians navigate around potential trouble, but it can't eliminate complication risks completely, says Dr. Schwartz. "Surgeons are the ones who ultimately prevent problems. Patients trust physicians, not machines, to perform surgery."

No more headsets
Northpoint bought electromagnetic systems, meaning surgeons don't need to maintain a direct line of sight between instruments and the image processor (images will continue to be transmitted and displayed even if someone walks between the surgeon and the system's unit). Surgeons must use proprietary instruments, however, and surgical teams must keep metal items away from the patient in order to avoid interfering with the system's electromagnetic field. Optical systems, on the other hand, demand a clear line of sight between instruments and the system's imaging unit. Fiducial markers are placed on the patient's forehead and instruments, which send images to the system's transmitter.

The former image-guided system in use at Ms. Casey's center required patients to wear a registration headset during surgery, which they had worn during pre-op CT scans to align captured images with their actual anatomy. Patients were responsible for bringing their headsets on the day of surgery, and as you can well imagine, says Ms. Casey, they would sometimes forget the devices at home, which caused cases to be canceled and frustrations to mount. The new systems work off images uploaded from discs that are simply slid into the unit. No more headsets. No more canceled cases.

"Eliminating the cumbersome headsets has been the primary upgrade of the new system," says Dr. Schwartz.

The system's new generation of instrumentation has also improved dramatically, says Dr. Schwartz, which has put more ergonomic and effective tools in his hands. "Like any other technology, the accuracy, precision and image resolution of the latest image-guided units have been enhanced," he says.

Bang for your buck
Ms. Casey says Medicare reimbursements for ENT procedures have steadily increased, with many commercial payors paying 110% of Medicare's rates. Some payors even pay for the use of image-guided systems. "Insurers know that the technology leads to faster recoveries and fewer complications," she says. "They see those advantages." By securing carveouts for sinus surgery's expensive disposables, Ms. Casey says she's recouped her initial capital investment — and more — within a year.