Skip to main content
SpringerLink
Log in

Image Guidance in Endoscopic Sinus Surgery: Where Are We Heading?

  • Rhinology: Advances in Endoscopic Sinus Surgery (R Sacks, Section Editor)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this review is to identify new developments in image guided surgery (IGS) for endoscopic sinus surgery (ESS), with a focus on how these innovations will serve to aid the endoscopic sinus surgeon.

Findings

Several developments in both the software and hardware of IGS systems have been introduced or are under development. These include augmented reality and three-dimensional (3D) virtual endoscopy for integrating navigational and endoscopic images. Intraoperative registration can further improve the accuracy within a given operative field. Wireless instrumentation and consolidated IGS workstations can improve operating room logistics. IGS integrated robotic surgery can enhance surgical precision and automate critical portions of the procedure. Emerging evidence suggests that IGS is useful for the avoidance of complications in ESS and improving surgeon workload.

Summary

Numerous developments in IGS for ESS will serve to aid the endoscopic sinus surgeon in avoiding complications and improving patient outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Justice JM, Orlandi RR. An update on attitudes and use of image-guided surgery. Int Forum Allergy Rhinol. 2012;2:155–9.

    Article  PubMed  Google Scholar 

  2. Bhattacharyya N. Contemporary assessment of the disease burden of sinusitis. Am J Rhinol Allergy. 2009;23:392–5.

    PubMed  Google Scholar 

  3. Mattos JL, Woodard CR, Payne SC. Trends in common rhinologic illnesses: analysis of U.S. healthcare surveys 1995-2007. Int Forum All Rhinol. 2011;1:3–12.

    Article  Google Scholar 

  4. Bhattacharyya N, Orlandi RR, Grebner J, Martinson M. Cost burden of chronic rhinosinusitis: a claims-based study. Otolaryngol Head Neck Surg. 2011;144:440–5.

    Article  PubMed  Google Scholar 

  5. Bhattacharyya N. Ambulatory sinus and nasal surgery in the United States: demographic and perioperative outcomes. Laryngoscope. 2010;120:635–8.

    Article  PubMed  Google Scholar 

  6. Schwartz TH, Fraser JF, Brown S, Tabaee A, Kacker A, Anand VK. Endoscopic cranial base surgery: classification of operative approaches. Neurosurgery. 2008;62:991–1002.

    Article  PubMed  Google Scholar 

  7. Ramakrishnan VR, Orlandi RR, Citardi MJ, Smith TL, Fried MP, Kingdom TT. The use of image-guided surgery in endoscopic sinus surgery: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2013;3:236–41.

    Article  PubMed  Google Scholar 

  8. • Dixon BJ, Chan H, Daly MJ, Vescan AD, Witterick IJ, Irish JC. The effect of augmented real-time image guidance on task workload during endoscopic sinus surgery. Int Forum Allergy Rhinol. 2012;2:405–10. Dixon, et al. introduce a feasible model for 3D virtual endoscopy enhanced IGS. This technology may help the development of proximity alerts to critical structures and the intraoperative identification of target structures. This study also demonstrates that IGS may lead to reductions in perceived task load among trainees compared to ESS without image guidance

    Article  PubMed  Google Scholar 

  9. • Citardi MJ, Agbetoba A, Bigcas JL, Luong A. Augmented reality for endoscopic sinus surgery with surgical navigation: a cadaver study. Int Forum Allergy Rhinol. 2016;6:523–8. Citardi, et al. show that augmented reality is possible in ESS. This technology can merge navigational information onto the surgeon’s endoscopic view. The software also provides the surgeon with visual cues when cannulating planned structures, and alerts when entering a defined distance of critical structures

    Article  PubMed  Google Scholar 

  10. Dixon BJ, Chan H, Daly MJ, Qiu J, Vascan A, Witterick IJ, Irish JC. Three-dimensional virtual navigation versus conventional image guidance: a randomized controlled trial. Laryngoscope. 2016;126:1510–5.

    Article  PubMed  Google Scholar 

  11. Ramakrishnan VR, Kingdom TT, Nayak JV, Hwang PH, Orlandi RR. Nationwide incidence of major complication in endoscopic sinus surgery. Int Forum Allergy Rhinol. 2012;2:34–9.

    Article  PubMed  Google Scholar 

  12. Tschopp KP, Thomaser EG. Outcome of functional endonasal sinus surgery with and without CT-navigation. Rhinology. 2008;46:116–20.

    PubMed  Google Scholar 

  13. Javer AR, Genoway KA. Patient quality of life improvements with and without computer assistance in sinus surgery: outcomes study. J Otolaryngol. 2006;35:373–9.

    Article  PubMed  Google Scholar 

  14. Masterson L, Agalato E, Pearson C. Image-guided sinus surgery: practical and financial experiences from a UK Centre 2001-2009. J Laryngol Otol. 2012;126:1224–30.

    Article  CAS  PubMed  Google Scholar 

  15. Tabaee A, Hsu AK, Shrime MG, Rickert S, Close LG. Quality of life and complications following image-guided endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2006;135:76–80.

    Article  PubMed  Google Scholar 

  16. Reardon EJ. Navigational risks associated with sinus surgery and the clinical effects of implementing a navigational system for sinus surgery. Laryngoscope. 2002;112:1–19.

    Article  PubMed  Google Scholar 

  17. Fried MP, Moharir VM, Shin J, Taylor-Becker M, Morrison P. Comparison of endoscopic sinus surgery with and without image guidance. Am J Rhinol. 2002;16:193–7.

    PubMed  Google Scholar 

  18. Orlandi RR, Kingdom TT, Hwang PH, et al. International consensus statement on allergy and rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016;S22–S209.

  19. AAO-HNS. Position statement: Intra-operative use of computer aided surgery; 2014. http://www.entnet.org/content/intra-operative-use-computer-aided-surgery. Accessed 14 Aug 2016.

  20. •• Dalgorf DM, Sacks R, Wormwald PJ, et al. Image-guided surgery influences perioperative morbidity from endoscopic sinus surgery: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2013;149:17–29. The meta-analysis by Dalgorf, et al. demonstrates a reduction in major and total complications in ESS performed with image guidance compared to without this technology. This relationship has been difficult to establish previously due to small sample sizes. This important benefit of IGS is a basis for further improvement and development of the emerging technologies discussed in this review

    Article  PubMed  Google Scholar 

  21. Hart SG, Staveland LE. Development of NASA-TLX (Task Load Index): Results of empirical and theoretical research. In: Hancock A, Meshkati N, editors. Human mental workload. Amsterdam: North Holland Press; 1988. p. 139–83.

    Chapter  Google Scholar 

  22. Winne C, Kahn M, Stopp F, Jank E, Keeve E. Overlay visualization in endoscopic ENT surgery. Int J Comput Assist Radiol Surg. 2011;6:401–6.

    Article  PubMed  Google Scholar 

  23. Besharati Tabrizi L, Mahvash M. Augmented reality-guided neurosurgery: accuracy and intraoperative application of an image projection technique. J Neurosurg. 2015;123:206–11.

    Article  PubMed  Google Scholar 

  24. Marino MJ, Riley CA, Kessler RH, McCoul ED. Clinician assessment of paranasal sinus pneumatization is correlated with total sinus volume. Int Forum Allergy Rhinol. 2016; doi:10.1002/alr.21779.

    Google Scholar 

  25. Payne SC, Kennedy JL, Pallanch J, Tustison NJ, Borish LC. Development of a fully automated CT sinus auto-segmentation pipeline. Paper presented at: American Rhinologic Society Annual Meeting; September 17, 2016; San Diego, CA. http:// http://www.american-rhinologic.org/AbstractDetail.cfm?AbstractID=1625. Accessed 17 Aug 2016.

  26. Thomas L, Pallanch JF. Three-dimensional CT reconstruction and virtual endoscopic study of the ostial orientations of the frontal sinus. Am J Rhinol Allergy. 2010;24:378–84.

    Article  PubMed  Google Scholar 

  27. Dearking AC, Pallanch JF. Mapping the frontal sinus ostia using virtual endoscopy. Laryngoscopy. 2012;122:2143–7.

    Article  Google Scholar 

  28. Shahidi R, Bax MR, Maurer CR, et al. Implementation, calibration and accuracy testing of an image-enhanced endoscopy system. IEEE Trans Med Imaging. 2002;21:1524–35.

    Article  PubMed  Google Scholar 

  29. Citardi MJ, Batra PS. Image-guided sinus surgery: current concepts and technology. Otolaryngol Clin N Am. 2005;38:439–52.

    Article  Google Scholar 

  30. Woodworth BA, Davis GW, Schlosser RJ. Comparison of laser versus surface-touch registration for image-guided sinus surgery. Am J Rhinol. 2005;19:623–6.

    PubMed  Google Scholar 

  31. Wengert C, Cattin PC, Duff JM, Baur C, Szekely G. Markerless endoscopic registration and referencing. Med Image Comput Comput Assist Interv. 2006;9:816–23.

    PubMed  Google Scholar 

  32. Schoffel PJ, Harms W, Sroka-Perez G, Schlegel W, Karger CP. Accuracy of a commercial optical 3D surface imaging system for realignment of patients for radiotherapy of the thorax. Phys Med Biol. 2006;52:3949–63.

    Article  Google Scholar 

  33. Fiagon. Tracey; 2016. http://www.fiagon.com/tracey. Accessed 12 Sept 2016.

  34. Suwelack S, Rohl S, Bodenstedt S, et al. Physics-based shape matching for intraoperative image guidance. Med Phys. 2014;41:111901.

    Article  PubMed  Google Scholar 

  35. Bluetooth SIG. What is Bluetooth technology? 2016. https://www.bluetooth.com/what-is-bluetooth-technology/bluetooth. Accessed 18 Aug 2016.

  36. Wallin MK, Waintraub S. Evaluation of Bluetooth as a replacement for cables in intensive care and surgery. Anesth Analg. 2004;98:763–7.

    Article  PubMed  Google Scholar 

  37. Saito Y, Suzuki R, Torikai H, Hasegawa T, Sakamaki T. Efficiency and safety of new radiofrequency identification system in a hospital. Stud Health Technol Inform. 2013;192:1032.

    PubMed  Google Scholar 

  38. Rosenbaum BP. Radio frequency identification (RFID) in health care: privacy and security concerns limiting adoption. J Med Syst. 2014;38:19.

    Article  PubMed  Google Scholar 

  39. DelGaudio JM, Ochsner MC. Office surgery for paranasal sinus recirculation. Int Forum Allergy Rhinol. 2015;5:326–8.

    Article  PubMed  Google Scholar 

  40. Barrow EM, DelGaudio JM. In-office drainage of sinus mucoceles: An alternative to operating room drainage. Laryngoscope. 2015;125:1043–7.

    Article  PubMed  Google Scholar 

  41. Forwith KD, Han JK, Stolovitzky JP, et al. RESOLVE: bioabsorbable steroid-eluting sinus implants for in-office treatment of recurrent sinonasal polyposis after sinus surgery: 6-month outcomes from a randomized, controlled, blinded study. Int Forum Allergy Rhinol. 2016;6:573–81.

    Article  PubMed  Google Scholar 

  42. Steinhart H, Bumm K, Wurm J, Vogele M, Iro H. Surgical application of a new robotic system for paranasal sinus surgery. Ann Otol Rhinol Laryngol. 2004;113:303–9.

    Article  PubMed  Google Scholar 

  43. Schneider JS, Burgner J, Webster 3rd RJ, Russell 3rd PT. Robotic surgery for the sinuses and skull base: What are the possibilities and what are the obstacles? Curr Opin Otolaryngol Head Neck Surg. 2013;21:11–6.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology – Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin St., MSB 5.036, Houston, TX, 77030, USA

    Michael J. Marino, Martin J. Citardi, William C. Yao & Amber Luong

  2. Center for Immunology and Autoimmune Diseases at the Institute of Molecular Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA

    Amber Luong

Authors
  1. Michael J. Marino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin J. Citardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William C. Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amber Luong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amber Luong.

Ethics declarations

Conflict of Interest

Dr. Martin Citardi serves as a consultant for Acclarent (Irvine, CA), Medical Metrics (Houston, TX) and Medtronic (Jacksonville, FL). Dr. Amber Luong serves as a consultant for 480 Biomedical (Boston, MA), Aerin Medical (Sunnyvale, CA), ENTvantage DX (Austin, TX), Laurimed LLC (Redwood City, CA), Medical Metrics (Houston, TX) and Medtronic (Jacksonville, FL). The Department received research funding from Allakos, ENTvantage Dx, and Intersect ENT. Dr. Michael J. Marino and Dr. William C. Yao declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Rhinology: Advances in Endoscopic Sinus Surgery

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marino, M.J., Citardi, M.J., Yao, W.C. et al. Image Guidance in Endoscopic Sinus Surgery: Where Are We Heading?. Curr Otorhinolaryngol Rep 5, 8–15 (2017). https://doi.org/10.1007/s40136-017-0140-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40136-017-0140-x

Keywords

Search

Navigation