Novel Intraoperative Fast Anatomic Mapping as Teaching Adjunct in Endoscopic Sinus Surgery

Introduction: Image-guided surgery (IGS) has become a mainstay of modern endoscopic sinus and skull base surgery (ESS) and has been shown to improve surgical outcomes and reduce complication rates.[1] [2] [3] Specifically, the Acclarent TruDi Navigation System (Acclarent, Johnson & Johnson, New Brunswick, New Jersey, United States) offers a system with a small electromagnetic field generator and distal chip instrument tracking which reduces limitations in room set-up and surgeon positioning. The system is capable of performing fast anatomic mapping (FAM), creating live three-dimensional mapping of the operative field similar to what has been well validated in the interventional cardiology literature. Here, we sought to apply FAM technology as a novel teaching adjunct for resident education in ESS.

Case 1: A 67-year-old male with a history of chronic sinusitis with nasal polyposis (CRSwNP) underwent noncontrast enhanced computed tomography (CT) of the sinuses which demonstrated left maxillary sinus opacification with polypoid changes. The patient was taken to the operating room (OR) for left-sided ESS and Acclarent TruDi IGS was employed. FAM was done after resident performed left maxillary antrostomy, total ethmoidectomy, and sphenoidotomy ([Fig. 1], yellow), and following attending rhinologist completion of the procedure ([Fig. 1], red). Comparison of the FAM reconstructions revealed increased extent of resection following attending involvement, most notably of a retroantral posterior ethmoid air cell, and with increased height and anterior extent of ethmoidectomy. The images and endoscopic correlates were reviewed with the resident to highlight areas for future improvement.

Case 2: A 64-year-old male with history of CRSwNP was taken to the OR for bilateral ESS. Preoperative CT imaging demonstrated near complete pansinus opacification. FAM was performed following resident performed right maxillary antrostomy, total ethmoidectomy, and sphenoidotomy ([Fig. 2], red) and in green following attending completion ([Fig. 2], green). Results showed increased size of maxillary antrostomy and sphenoidotomy, and improved height of anterior and posterior ethmoid air cells which were reviewed with the resident surgeon.

Conclusion: Novel IGS systems introduce enhanced technology and optimized visualization when performing ESS. FAM technology can be applied to the field of otolaryngology to ensure adequacy of resection in inflammatory cases. These live three-dimensional reconstructions present an important opportunity for use as a teaching adjunct for resident education to highlight relevant anatomy and enhance extent of resection for future cases.

Fig. 1

Fig. 2

No conflict of interest has been declared by the author(s).

• References

• 1 Vreugdenburg TD, Lambert RS, Atukorale YN, Cameron AL. Stereotactic anatomical localization in complex sinus surgery: a systematic review and meta-analysis. Laryngoscope 2016; 126 (01) 51-59
• 2 Wittkampf FH, Wever EF, Derksen R. et al. LocaLisa: new technique for real-time 3-dimensional localization of regular intracardiac electrodes. Circulation 1999; 99 (10) 1312-1317
• 3 Gepstein L, Hayam G, Ben-Haim SA. A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart. In vitro and in vivo accuracy results. Circulation 1997; 95 (06) 1611-1622

Publication History

Article published online:
12 February 2021