Stereotactic navigation is a technology that is used by Dr. Rubinstein in polyp cases and in some revision sinus surgery where natural anatomic landmarks such as the turbinates have been removed by prior surgeons. He uses the Fusion ENT Navigation system that was developed by Medtronic. This system offers reliable accuracy, expandability, and ease of use. This system allows Dr. Rubinstein make more informed decisions as it effectively provides the most accurate and maximum amount of information about a patient’s anatomy. This results in a safer and more effective procedure in treating your sinus problems. It is has been recognized by many in the industry as one of the most accurate and is comparable to optical image-guided surgery systems. Dr. Rubinstein was the first ENT sinus surgeon to introduce this technology to the Hudson Valley back in 2001. The technology has evolved over the years making some higher risk sinus surgeries safer and more effective. Dr. Rubinstein teaches future ENT sinus surgeons at New York Presbyterian Hospital and cautions the residents that navigation is not a replacement for sound knowledge in anatomy of the head and neck. Machines can malfunction and give a false sense of security.
How it Works
Stereotactic navigation acts much in the same way as a GPS system works in your car to help you navigate. It provides 3-D navigation during surgery using two cameras positioned about six feet apart. The cameras have infrared sensors that determine the location of the tip of the probe that is being used in the surgical procedure. Using rapid trigonometry to measure the angles, information is sent in real time so that the surgeons have a perfectly clear image of the precise location of where they are working within the body.
Stereotactic surgery for sinusitis has emerged as a major advance in sinus surgery technology. During this non-invasive procedure, the sinus cavities and related structures are three-dimensional diagrammed as fixed points on a sinus CAT scan. This enables Dr. Rubinstein to make better decisions in real-time and perform surgical procedures with increased precision. Furthermore, Dr. Rubinstein can monitor his progress in three dimensions on a computer screen during the procedure by associating magnetic probes with surgical tools and endoscopes. He is afforded a tremendous amount of information by comparing the live endoscopic view of the anatomy with three different patient CAT scan views.
I had a balloon Sinuplasty with Dr. Rubinstein on July 30th. I have been a patient here for two to three years and I’m always happy with my results. I have already recommended Dr. Rubinstein to several people. He’s wonderful and competent, always going above and beyond. He also remembers who you are and what your case is, which is kind of unusual. There was not really any downtime after my balloon Sinuplasty. Dr. Rubinstein is wonderful.
What to Expect
When undergoing a procedure with Stereotactic navigation, anesthesia is induced in the operating room. The image guided head frame is placed on the patient’s forehead and their anatomy is calibrated to within 2 mm accuracy. The system first addresses the right side of the nose. By using a trans ethmoid approach, a sphenoidotomy is created. Polyps are then found within the sinus. The microdebrider (mini shaving instrument) is next used to remove polyps and diseased mucosa. The pus is also irrigated from the nasal cavity. Navigation can also be coupled to balloons helping placement in scared sinus cavities scarred by previous overly aggressive surgery such as in the frontal sinus. The left side of the nose is then addressed and the same procedures are carried out on the left side as were done on the right side. Finally, the sinus cavity is irrigated with dilute antibiotic solution and suctioned clear.
Image-guided instruments such as Stereotactic navigation are accurate to within 2mm. The sinuses provide the perfect stage for image-guidance probes due to their natural bony borders. Image-guided sinusitis surgery allows Dr. Rubinstein to avoid the most common cause of intracranial injury and complication, which is human error. Head and breathing movements are also tracked, which is similar to stereotactic radiosurgery procedures developed for cancer treatments.