An Overview and the use of Navigational Tools

Improving Safety in Endoscopic Sinus Surgery :

October 2014 -1199 Symposium

Lisa Liberatore,MD | Otolaryngologist | Sinus and Sleep Specialist

Manhattan Eye, Ear and Throat HospitalNew York, New York

We perform thousands of sinus surgeries a year and are constantly

advancing our knowledge and our technology.

The goal is to reduce morbidity, complications and to reduce costs.

Chronic Sinusitis | Statistics

• A history of either recurrent sinus infections

requiring antibiotics and steroids and sprays or

persistent sinus infection unresponsive to

medical therapy for more than 6 weeks.

• Millions of Americans suffer from chronic

sinusitis and millions have surgery to help treat

obstructive causes to this condition.

Chronic Sinusitis | Anatomy of Nose and Sinuses

• Nasal septum

• Inferior turbinates

• Middle turbinates

• Osteomeatal complex

• Frontal recess

• Sphenoid recess

• Sphenoid Ostia

• Nasopharyngeal region

• Adenoid

Deviated Septum

• Blocks the flow of air

• Blocks the flow of mucous

drainage

• Contributes to recurrent

infections

• Contributes to poor aerobic

ability

• Contributes to poor sleep

• Easily fixable

• Benefit to surgery has to

outweigh the risks to surgery

Sinuses | Overview

• Frontal

• Ethmoid

• Maxillary

• Sphenoid

Sinuses | Overview – CT Scan

Frontal | Ethmoid | Maxillary | Sphenoid

Sinuses | Overview

• Bony cavities filled with air

• Mucosal lining secrets mucous

• The mucous drains into the nose

• If drainage is blocked, the mucous in the sinus

can get infected and the lining thickens

• The blockage can be from the deviated septum

or the sinus drainage pathway

Chronic Sinusitis | Symptoms

• Nasal congestion

• Recurrent infections

• Post nasal drainage

• Cough

• Headaches

• Decreased sense of smell

• Halitosis

• Dizziness

• Poor sleep

• Poor focus

• Depression

• Change in vision

Tracking Patients Before and After Surgery

Pre-Op Post-Op

Provide culture and pathology

Goals of Surgery | Dilate and/or open blocked sinus

drainage pathways and irrigate sinuses

Functional Endoscopic Sinus Surgery (FESS)

• A surgical procedure which reestablishes the

normal anatomical sinus drainage

• Uses endoscopic techniques

• Usually uses video imaging

• Advanced the success of sinus surgery and

reduced complications and external incisions

• Continues to advance using technology such as

balloon , absorbable packing , smaller

instruments and image guidance

Navigational Systems

Allows the Sinus

surgeon to use the

endoscopic

instruments, while

knowing in real

time where the

instrument is in

the nose or sinus.

Navigational Systems | Convenient & Customizable

Endoscopic View- Video input displayed alongside

navigation

- Full screen video automatically

switches to navigation view when

navigating

Multiple View Options- Choose and customize your image

display based on your preferences

Instrument Status Bar- Conveniently informs you about the

instrument in use (type, status)

When are Navigational Systems helpful?

• Polyposis

• Revision surgeries

• Frontal sinus conditions

• Sphenoid sinus conditions

• Orbital involvement

• Repair of cerebrospinal fluid leaks

• Skull base surgery

• Foreign body removals

• Teaching residents

The Sinus Surgery Team!

• Otolaryngologist

• Surgical

technician

• Circulating nurse

• Anesthesiologist

Lights, Camera, Action

• Anesthesiologist

places pt under

general anesthesia

• Place the

navigation head

device on

• Calibrate the

device

• Accept the

navigation

• Decide which

instruments to pair

with the navigation

• Reconfirm

throughout the

case

Frontal Sinusitis

Revision Sinus Surgery

Sphenoiditis

Orbital Involvement

Lisa A. Liberatore, MD

154 East 85th Street

New York, NY 10028

lisaliberatoremd@yahoo.com

www.lexingtonent.com

Tel: 212.288.2222