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.

For efficiency's sake
Here are a few tips on using image guidance efficiently.

• Ease of setup. It takes my staff and me no more than 3 minutes to set up our navigation system. When the patient is wheeled into the room, I like to set up the machine myself. The key is for it to be easy to use, for surgeons and staff alike, accurate and reproducible so you always get the same outcomes. Being off by 5mm in the sinus cavity can result in a tragic injury.
• Trained staff. Two of our surgical techs know our navigation machines as well as I do. If I'm busy, I can ask them to set it up for me. If you can, get 1 or 2 key staff members trained on your image-guidance system. Enroll them in courses and ask your reps to instruct them. Surgeons will appreciate a well-trained staff that can set up the machine for them. We call this is no-headache sinus surgery.
• CT scan compatibility. This might seem obvious, but make sure your image-guided system can read the disc that contains the pre-operative CT scan the surgeon brings. Otherwise, you risk having to cancel surgery so you can send the patient out for a new CT scan.
• Go wireless. I prefer a radiofrequency system to cut down on the number of wires that you have to contend with: the instrument used to drive navigation, the navigation probes, the suction devices, the light wand, the camera head. That's a lot of wires to move your fingers around in such a confined space. The downside of RF is that you must maintain a direct line of sight between the navigation system and the navigation instruments. Space is another consideration with RF systems. Some require the patient to be 4 or 5 feet away from the system to orient the image of the patient within the geometry of the operating room. If you don't have enough space in the OR, you can run into trouble.