Efficient rendering of a changing volumetric data-set is central to the development of effective medical simulations that incorporate haptic feedback. A new method referred to as real-time interactive isosurfacing (RTII) is described in this paper. RTII is an algorithm that can be applied to output from Marching Cubes-like algorithms to improve performance for real-time applications. The approach minimises processing by re-evaluating the isosurface around changing sub-volumes resulting from user interactions. It includes innovations that significantly reduce mesh complexity and improve mesh quality as triangles are created from the Marching Tetrahedra isosurfacing algorithm. Rendering efficiency is further improved over other marching isosurfacing algorithm outputs by maintaining an indexed triangle representation of the mesh. The effectiveness of RTII is discussed within the context of an endoscopic sinus surgery simulation currently being developed by the authors.