Algorithm for navigated ESS

Abstract

ENT navigation has given new opportunities in performing Endoscopic Sinus Surgery (ESS) and improving surgical outcome of the patients` treatment. ESS assisted by a navigation system could be called Navigated Endoscopic Sinus Surgery (NESS). As it is generally accepted that the NESS should be performed only in cases of complex anatomy and pathology, it has not yet been established as a state-of-the-art procedure and thus not used on a daily basis. This paper presents an algorithm for use of a navigation system for basic ESS in the treatment of chronic rhinosinusitis (CRS). The algorithm includes five units that should be highlighted using a navigation system. They are as follows: 1) nasal vestibule unit, 2) OMC unit, 3) anterior ethmoid unit, 4) posterior ethmoid unit, and 5) sphenoid unit. Each unit has a shape of a triangular pyramid and consists of at least four reference points or landmarks. As many landmarks as possible should be marked when determining one of the five units. Navigated orientation in each unit should always precede any surgical intervention. The algorithm should improve the learning curve of trainees and enable surgeons to use the navigation system routinely and systematically.

FESS, fingers and other things - you are not alone!

“…Smith et al estimate that nearly 500,000 surgical procedures are performed annually to treat those with chronic rhinosinusitis in the USA (2) . Thorough understanding of complex anatomy and the availability of image-guided navigation systems have pushed the boundaries of endoscopic sinus surgery far beyond what was initially described by Messerklinger and Wigand (3,4) , to include sinonasal tumours (5) and anterior skull base surgery (6,7) with comparative or even better outcomes than those of traditional open surgery (8)(9)(10) .…”

Sphenovomerine Suture

“…These units have triangular pyramids and consist of at least 4 reference points or landmarks. 15 The SVS, sphenopalatine foramen, and sphenoid process of palatine bone can provide a proper orientation about the sphenoethmoid recess during image-guided endoscopic surgery. The endoscopic measurement of this region and the relationship between these anatomic landmarks are provided by this study.…”

Training in ENT; a comprehensive review of existing evidence

“…In 1997, Wiet et al reported about their collaboration in developing a virtual reality system that provides interaction with volume data, by employing real-time volume rendering and haptic feedback (67) . Ecke et al (68) and Rudman et al. (69) published the first studies about VR simulators of endoscopic sinus surgery.…”