Efficacy of computed tomographic image-guided endoscopic sinus surgery in residency training programs

Objective: To determine the efficacy of computed tomographic image-guided e ndoscopic surgery in the hands of inexperienced surgeons, Study Design: Fou r second-year otolaryngology residents, with no prior experience performing ethmoidectomies, performed endoscopic sinus surgery (ESS) on formalin-fixe d human cadaveric specimens with and without the aid of computer-assisted s urgery (CAS). Methods: Each resident was asked to identify critical sinus, orbital, and skull base structures while performing a total ethmoidectomy a nd multiple sinusotomies, Their surgical accuracy (percentage of correctly identified structures), total operative time, and incidence of major compli cations were recorded for each side. A total of 16 sides were evaluated (8 with and 8 without CAS). Statistical significance between groups was determ ined by means of Pearson's chi(2) analysis, Results: Statistical analysis s howed a significant difference (P = .001) in the mean accuracy of identifyi ng critical anatomical landmarks between the CAS (97%) and non-GAS (76.8%) groups. Although not statistically significant, operative time appeared to be longer in the group using CAS (average of 67 vs. 80 min). Three major in tracranial complications were documented only in the group not using CAS. C onclusions: Although, unquestionably, a thorough knowledge of the anatomy r emains essential for performing ESS, CAS improves surgical accuracy and red uces the risk of major intracranial or intraorbital complications for resid ents. In additional, our data suggest that this technology may enhance surg ical efficiency and improve the learning curve by reducing operative time ( below one's normal baseline) while maintaining a greater than 90% accuracy in identifying critical anatomical landmarks.