Advanced Safety Technology in Endoscopic Sinus Surgery Surgical Navigation

Technology that provides advanced safety in endoscopic sinus surgeries: Surgical Navigation
Serious complications began to be observed following the increasing prevalence of endoscopic sinus surgeries (ESC), which was first applied in 1984. Understanding that a significant part of the problems experienced are due to the inability to fully evaluate the anatomy during surgery for various reasons has led to the need for surgical navigation in ESC. As a result, computer-assisted surgery (surgical navigation) applications, which started in the field of neurosurgery, have been developed to be used in ESC since 1990, following the first trials.

During the surgical navigation, the locations of the surgical instruments used in endoscopic sinus surgeries in the sinus anatomy are followed in real time with the help of a special device and software in three planes representing three dimensions on the monitor with less than 1 mm margin of error.

The aim of the surgical navigation application is to follow the surgical instruments within the complex sinus anatomy by establishing a connection between the computerized tomography (CT) images obtained before the operation and the anatomy of the operation area. With this technology, the locations of critical structures and organs can be determined easily and with very little error, and the existing disease can be completely cleared without damaging these structures.

The first step in surgical navigation is to introduce the patient to the system (Registration). At this stage, a 3-dimensional connection is created between the CT images obtained before the surgery and the surgical field. First, the locations of some known anatomical points on the patient’s tomography image are introduced to the system, and then the system calculates the locations of all other points in the three-dimensional anatomy relative to these recorded points. The recording phase is the most important step for the accuracy and reliability of surgical navigation.

Before starting the operation, all instruments to be monitored (navigated) by the system during the operation must be introduced to the system and calibrated. In addition, it is necessary to check the calibration every 15-20 minutes during the surgery, that is, whether the device shows the correct points in the head without any errors. For this purpose, control is made over some obvious anatomical points. Tracking stage means following the changing positions of the surgical instruments in the anatomy and simultaneously monitoring the points they are on on the previously obtained images.

Magnetic devices or prostheses in the environment can affect the system.
The most critical point in surgical navigation is “accuracy”, that is, the degree of overlap between the point seen on the monitor and the actual point in the sinus anatomy. Causes such as imaging (tomography technique) error, three-dimensional configuration error, errors due to patient movement, and monitoring system error can affect accuracy.

MAIN ADVANTAGES OF SURGICAL NAVIGATION

* Providing a three-dimensional roadmap in two-dimensional endoscopic images,
* Providing a safe approach to hard-to-reach anatomical areas,
* Precise surgery with less trauma,
* Shortening of the operation time,
* Severe reduction in the possibility of complications,
* Increasing the success rate of the surgery,
* It can be counted as a decrease in the probability of recurrence (recurrence of the disease).

MAJOR USE REQUIREMENTS OF SURGICAL NAVIGATION

Surgical navigation, which is now used even in the most standard endoscopic surgery cases;
* In surgeries of patients with congenital anomalies
* In patients with impaired anatomy due to previous surgery or trauma
* Forehead sinus, posterior ethmoid and sphenoid sinus diseases
* In fungal sinusitis
* In patients with extensive polyps
* In skull base attempts
* In surgeries of tumors in the sinus and skull base
* In surgeries involving the eye socket
* In the repair of cerebrospinal fluid leaks

It provides very critical benefits as it increases the success rate of the surgery and significantly reduces the risk of complications.

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