Physician experience with an optical image guidance system for sinus surgery

Objectives/Hypothesis: Intraoperative guidance systems have been developed which use infrared tracking technology to assist with anatomical localizati on during sinus surgery. Although the introduction of this technology is in tended to increase the safety and efficacy of sinus surgery, little is know n about its actual impact in the clinical setting. The objective of this re port was to study the application and utilization of an image guidance syst em shared by multiple sinus surgeons in a specialty hospital. Study Design: Combined prospective case study and retrospective analysis of physician su rveys. Methods: An optical-based image guidance system (LandmarX, Xomed, In c., Jacksonville, FL) was used by 34 physicians to perform 754 sinonasal su rgeries over a 2.5-year period at Massachusetts Eye and Ear Infirmary. In 1 9 cases, system registration was repeated during surgery to measure the eff ect of fiducial placement on system accuracy. Results: The measured accurac y of anatomical localization at the start of surgery (mean value, 1.69 +/- 0.38 mm) was comparable to the perceived accuracy of 1 to 3 mm that was rep orted by 79% of surgeons surveyed. Operating room time (mean period, 130.6 +/- 41.1 min) correlated with the surgical procedure performed (P < .05), b ut not with the disease stage or revision rate. According to a majority of surgeons, use of the image guidance equipment increased operating room time by 15 to 30 minutes during initial cases and by 5 to 15 minutes once exper ience with the equipment had been acquired. More than 90% of surgeons antic ipated their continued use of the image guidance equipment for sinus surger y at a similar or greater level in the future. Conclusion: An optical-based image guidance system can be successfully integrated into a multisurgeon o perating room environment. Use of the system provides accurate anatomical l ocalization during sinus surgery and results in a relatively high level of physician satisfaction.