Charles Stephen Ebert, Jr., MD, MPH, a professor and director of advanced neurorhinology and endoscopic skull base surgery at the University of North Carolina in Chapel Hill, agreed. “The newer systems have the ability to auto-segment structures, such as the orbital contents, brain, and soft tissues. Some systems can allow the surgeon to pick an area of interest, like tumors, to segment. As such, these structures can be used as anti-targets. Surgeons can place points of anti-targets on various structures, like the anterior ethmoid artery, that warn the surgeon when the guided instrument nears that structure,” said Dr. Ebert. (Dr. Ebert is a consultant for Acclarent.)
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April 2022
I can imagine a reality where the surgeon wears AR goggles that serve to highlight key anatomy, surgical targets, surgical trajectory, and relevant imaging as a real-time overlay on the endoscopic view.
—Waleed M Abuzeid, MD
Another innovation of AR has been the development of surgical pathway planning. The surgeon has the option to preplan a route to safely gain access to the tumor target. “All this data can be overlaid on the endoscopic view, augmenting the surgeon’s ability to avoid important anatomy as they navigate a preplanned trajectory to the tumor,” Dr. Abuzeid said. “This allows the surgeon to pick a point in the nasal cavity and another target point in a sinus. The computer picks a path to the target around those structures. Surgeons may follow this path to find the opening of the sinus of interest.”
Virtual Reality. In the context of surgical navigation systems, virtual reality (VR) technology refers to the addition of virtual elements onto a digital model of the sinuses and/or skull base. These customizable elements can include critical anatomic features or, for example, a pathway for surgical dissection into the frontal sinus. The elements can be highlighted on a “virtual endoscopic” view that “is akin to a digital reconstruction of the real endoscopic surgical view, or onto the preoperative CT or MRI,” said Dr. Abuzeid.
With VR, the user adds virtual information to computerized models of the sinuses during surgery. Newer VR systems have the ability to perform “fast-anatomical mapping [FAM],” said Dr. Ebert. “This feature tracks all the points where guided instruments have been during surgery. This is important because, at any point, the surgeon can see where and to what extent surgery has been performed, allowing them to check for completeness of surgery,” he said.