error, precision and safety are paramount for otolaryngologists.
Before the advent of CT image guidance, surgeons couldn't be as thor-
ough as they'd have liked, says Keith Matheny, MD, FARS, who prac-
tices at the Baylor Medical Center in Frisco (Texas). "We just didn't
know exactly where we were in relation to those important struc-
tures," he says. Dr. Matheny believes image guidance "is a breath of
fresh air," because anatomical features don't just vary from person to
person, they often vary from side to side in the same person.
Convenience and efficiency are also key considerations. How long
does the system take to set up and calibrate? How do systems over-
come line-of-sight issues? What kind of OR footprint do they have?
What additional benefits are gained via computer guidance? The 5 lat-
est navigation systems offer a package of benefits that address all of
the above.
Brainlab Kick EM
The Brainlab Kick EM's versatility is a big selling point for David
Edelstein, MD, chief of otolaryngology at the Manhattan (N.Y.) Eye, Ear,
and Throat Hospital. "The beauty of it is that once you learn how to
attach the equipment, you can attach any equipment in a set — as long
as it's calibrated," he says. With some other systems, surgeons are limit-
ed to one right-angle suction device, "but I have about 8 different ver-
sions of right angles depending on the patient, and I can use any one of
them." Calibration is done with a small laser device, which is another
positive, says Dr. Edelstein. "I don't have to touch the patient's face or
skin, which I don't really like to do."
It's also a planning device — "A wonderful tool before the surgery,"
says Dr. Edelstein. "People sometimes forget this, but before the sur-
gery I'll run through the entire anatomy 3-dimensionally (using coro-
nal, axial and sagittal views) and look at the areas that I consider to
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