Presented at the Meeting of the Southern Section of the American Laryngological, Rhinological and Otological Society, Inc., St. Pete Beach, Florida, January 13–15, 2000.
Efficacy of Computed Tomographic Image–Guided Endoscopic Sinus Surgery in Residency Training Programs †
Version of Record online: 2 JAN 2009
Copyright © 2000 The Triological Society
Volume 110, Issue 8, pages 1277–1282, August 2000
How to Cite
Casiano, R. R. and Numa, W. A. (2000), Efficacy of Computed Tomographic Image–Guided Endoscopic Sinus Surgery in Residency Training Programs . The Laryngoscope, 110: 1277–1282. doi: 10.1097/00005537-200008000-00010
- Issue online: 2 JAN 2009
- Version of Record online: 2 JAN 2009
- Manuscript Accepted: 11 APR 2000
- Computed tomography;
- endoscopic sinus surgery;
- computed-assisted surgery.
Objective To determine the efficacy of computed tomographic image-guided endoscopic surgery in the hands of inexperienced surgeons.
Study Design Four second-year otolaryngology residents, with no prior experience performing ethmoidectomies, performed endoscopic sinus surgery (ESS) on formalin-fixed human cadaveric specimens with and without the aid of computer-assisted surgery (CAS).
Methods Each resident was asked to identify critical sinus, orbital, and skull base structures while performing a total ethmoidectomy and multiple sinusotomies. Their surgical accuracy (percentage of correctly identified structures), total operative time, and incidence of major complications were recorded for each side. A total of 16 sides were evaluated (8 with and 8 without CAS). Statistical significance between groups was determined by means of Pearson's χ2 analysis.
Results Statistical analysis showed a significant difference (P = .001) in the mean accuracy of identifying critical anatomical landmarks between the CAS (97%) and non-CAS (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 intracranial complications were documented only in the group not using CAS.
Conclusions Although, unquestionably, a thorough knowledge of the anatomy remains essential for performing ESS, CAS improves surgical accuracy and reduces the risk of major intracranial or intraorbital complications for residents. In additional, our data suggest that this technology may enhance surgical 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.