M A R C H 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 5 3
Computer-guided systems work off of pre-op MRI and CT scans of
the patient's sinus anatomy that are loaded into the image-guided
computer system, which projects anatomical landmarks of a patient's
sinus onto a monitor in the OR. As surgeons operate, they can track
how far they're progressing along a pre-planned surgical pathway and
know exactly where their instruments are located as they maneuver
around delicate structures in the sinus cavity.
Computer-guided systems come with 2 basic instrument options:
• Electromagnetic guidance. Surgeons don't need to maintain a
direct line of sight between instruments and the image processor.
They typically must use proprietary instruments, however, and the
surgical team must keep metal items away from the patient in order
to avoid interfering with the system's electromagnetic field.
• Infrared guidance. Passive systems have fiducial markers placed
on the patient and instruments that reflect infrared light back to the
system's camera. Active systems have infrared-emitting diodes on oper-
ating instruments that are actively tracked by an overhanging camera.
With both types of infrared technologies, surgeons must maintain a
clear line of sight between the instruments and the imaging unit.
"Electromagnetic instruments are more plug-and-play," says oto-
laryngologist Brett Scotch, MD, FAOCO, of the Select Physicians
Alliance, a Tampa, Fla.-based practice of ENT docs that opened the
Select Physicians Surgery Center in 2016. That's an important consid-
eration, he says, because surgeons and staff shouldn't have to worry if
the way they set up equipment and instrument tables in the OR
occludes the line of sight that needs to be maintained when you use
infrared systems.
The Select Physicians Surgery Center initially invested in 2 new
computer-navigation units, which Dr. Scotch says are compact and
easy to maneuver from room to room and a cinch to set up and break