Using Augmented Reality to Improve Precision in Sinus Surgeries

In addition to enhancing surgical navigation that benefits both patients and surgical teams, Martin J. Citardi, MD, believes technologies like Scopis can also serve as a teaching tool for other surgeons. From left to right, rhinology fellow Alok Sain, MD, chief resident Matthew Tyler, MD, and Dr. Citardi. (Photo courtesy UT Physicians)

Seeing is believing when it comes to the new augmented reality technology being used for the first time in the U.S. for sinus procedures at Memorial Hermann-Texas Medical Center in Houston.

Martin J. Citardi, MD, chair of the Department of Otorhinolaryngology-Head and Neck Surgery at McGovern Medical School at UTHealth, has been a vigorous proponent of emerging surgical technologies for years—a fact that is now benefiting patients and surgical teams at Memorial Hermann-TMC.

UTHealth surgeons affiliated with Memorial Hermann-TMC are using the augmented reality technology during minimally invasive sinus procedures.

“Augmented reality uses three-dimensional mapping and imagery to enhance our understanding of complex anatomy so surgical procedures are more precise,” said Dr. Citardi, “This technology serves as a GPS-like surgical navigation system and offers patients the benefits of minimally invasive surgery with lower risks and better outcomes.”

Citardi believes augmented reality technology has the potential to improve many sinus procedures, including those performed for inflammatory disease, chronic sinus conditions, sinonasal polyps, skull-based repairs and tumors.

UTHealth sinus surgeons affiliated with Memorial Hermann-Texas Medical Center are the first in the U.S. to use augmented reality technology in minimally invasive sinus surgeries, allowing them to better navigate complex anatomy. (Photo courtesy M. Citardi)

“Augmented reality has moved surgical navigation to another level,” Dr. Citardi said. “We can be more precise, go directly to our surgical target and really simplify what we’re trying to do.”

Augmented Reality in Action

Using Stryker’s Scopis Target Guided Surgery (TGS) augmented reality technology, Dr. Citardi performed an endoscopic resection of a benign vascular tumor of the nose and sinuses on Feb. 23.

It was the first use of the technology for sinus surgery in the U.S. following its FDA approval. Scopis TGS has previously been used in Europe and Canada.

Using the system, it took Dr. Citardi only minutes to accomplish the sometimes cumbersome task of marking and annotating preoperative images during surgical planning, which includes identifying critical structures to avoid and surgical targets to reach. The markings were overlaid on real-time video of the patient’s anatomy that was visible from the surgical field.

“During surgery, we can see how close we are to our surgical target in millimeters or see our path along a trajectory,” Dr. Citardi said. “This enhances our surgical precision and minimizes potential damage to structures nearby and reduces some of the mental gymnastics needed to navigate complex anatomy.”

Scopis TGS was used the following week to assist a revision image-guided functional endoscopic sinus surgery for recurrent chronic rhinosinusitis that was further complicated by a lesion blocking drainage from the patient’s left frontal sinus.

“By using this technology, we were able to plan a pathway to drain that blocked frontal sinus and avoid the need for a more extensive procedure,” Dr. Citardi said.

Paying It Forward to Patients

Scopis TGS also records surgery and surgical planning, making it a valuable teaching tool with far-reaching potential, according to Dr. Citardi, who sees patients at UT Physicians Otorhinolaryngology – Texas Medical Center, in addition to teaching new surgeons.

“This technology will support the training of surgeons, both our trainees and eventually surgeons in other institutions,” Dr. Citardi said. “That ability to document and annotate what we’re doing is going to improve the care of patients, even for those who are not receiving the technology.”

Staying at the forefront of surgical technology, Memorial Hermann continues to invest in innovative modalities that advance patient care.

“Being able to offer patients the latest and greatest technologies is part of what we do,” Dr. Citardi said. “We need to provide cutting-edge care to patients with complicated problems to improve what we do every day and serve our patients better.”

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