The merging of the CT and MRI has been very useful when performing skull base surgery and tumor resections, Dr. Lee said. “You have the benefit of dual information: The CT scan tells you the areas of bony erosion, for example, and the MRI tells you the extent of the tumor. The surgeon can toggle back and forth between the two images as they are navigating,” she said.
Explore This Issue
April 2022The implementation of AR and VR technology in surgical navigation systems has the potential to “increase the safety, efficiency, and completeness of surgery while reducing the surgeon’s mental workload,” said Dr. Abuzeid.
Office-Based Systems
The smaller footprint of the newer sinus navigation systems has made it possible to move this technology from the operating room to the office, said Dr. Lee. In that office setting, other benefits accrue, including the ability to navigate flexible tips, she said. Previously, Dr. Lee explained, surgeons had the option only to navigate with rigid instrumentation. “But that has changed. You can now track a flexible tip, a flexible balloon, or a guidewire, and more. In addition, we now have distal tip tracking available, compared with the traditional tracker located on the mid-shaft or proximal end of the instrument. Both of these, the distal tip and flexible tip tracking, are now available in the office setting.”
The Future of Sinus Navigation
“Ultimately, I expect this technology to allow for real-time updates to the preoperative imaging as surgery progresses,” said Dr. Abuzeid. “In currently available systems, the anatomy displayed on the preoperatively acquired imaging uploaded into the navigation system and the patient’s true anatomy diverge. The divergence gets worse the further the surgery progresses. VR technology will eventually allow anatomy to be ‘deleted’ in real-time from the imaging as the surgery progresses so that the imaging and reality are a better reflection of one another. We have already developed and continue to refine surgical navigation technology that allows us to achieve real-time updates to the ‘virtual CT’ with our team of surgeons and engineers at the University of Washington.”
“I see the technology advancing more toward real-time feedback methods like the FAM,” said Dr. Ebert. “The ability to navigate angled drills and debriders is on the horizon. I also think that the ability to autosegment vascular structures and tumors will aid in the endoscopic skull base surgery area.”
Dr. Abuzeid can also see AR becoming a means of combining the many streams of data that a surgeon has to process simultaneously during surgery—including the preoperative imaging, the endoscopic view, a constant situational awareness as it relates to critical anatomy—into a more efficient, combined view akin to the data aggregation that a fighter pilot gets through their heads-up display. “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. This could be game changing from a mental workload, safety, and efficiency standpoint,” he said.