Navigation in Endoscopic Sinus Surgery: The First Indian Experience
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ORIGINAL ARTICLE
Navigation in Endoscopic Sinus Surgery: The First Indian Experience Devinder Rai • Manish Munjal • Varun Rai
Received: 14 September 2011 / Accepted: 1 December 2012 / Published online: 9 February 2013 Association of Otolaryngologists of India 2013
Abstract Although the use of image guidance surgery (IGS) is standard practice in developed countries, it has not been in use in Indian Otolaryngology ever since its clinical inception in 1994. Some clinically interesting applications, relevant indications, practical tips and results in the Indian context are presented. Usage technique and data presentation. Indications based on AAO-HNS 2002 guidelines seem valid, and though the accuracy parameters remain still guarded, in line with the best technology available, based on the evidences of scattered reports and expert opinions, the use of navigation can be recommended as state of the art. IGS provides reliable information to a sinus surgeon in difficult circumstances. Its adaptation fortunately does not require a significant learning curve as it does not change the methodology of the surgical procedure. It can be an excellent teaching tool, but its use does not replace proper surgical training. Keywords Image guided IGS NIGS Endoscopic Computer assisted Sinus surgery Navigation
Introduction The need of minimally invasive surgery of the head and neck to be precise and safe has prompted the development of image-guidance systems to assist the surgeon with
intraoperative anatomical localization. These systems use computerized tracking devices to monitor the position of endoscopic instruments relative to the patient’s anatomical landmarks. The location of these instruments is depicted on a 3-dimensional video display of the preoperative computed tomographic (CT) or magnetic resonance imaging (MRI) scan in axial, coronal and sagittal frames simultaneously. Initially developed for neurosurgical procedures that required head fixation in a stereotaxic frame, imageguidance systems have recently been introduced that allow for free head movement during surgery. Owing to the better resolution of CT scans in a bony anatomy, and little possibility of tissue shift intraoperatively, these systems have been used for procedures involving the paranasal sinuses, skull base, and temporal bone. Also surgery in these regions is particularly well suited for image-guidance applications because of the proximity to the orbit and cranial cavities, which demands a high degree of anatomical precision [1]. The usefulness of this technology, first developed in Germany in 1994 can also be ascertained from the fact that more than 400 units in the United States alone at the turn of the century are functional and actively using Image guided surgery (IGS) [2]. The American academy of Otolaryngology-Head and neck Surgery has adopted by consensus the following set of classical indications for IGS that include [3]: • •
D. Rai M. Munjal V. Rai Sir Ganga Ram Hospital, New Delhi, India M. Munjal (&) C/704, Plot # 3, Vimal Apart
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