Stealth Device for Sinus Surgery

B O S T O N, Nov. 20, 2001 -- A new kind of surgery, called "Stealth," is helping to make sinusitis less painful.

More than 30 million Americans suffer from the pain and pressure of the occasional or chronic sinus infection. And though most will find relief in decongestants, hot compresses, non-prescription pain relievers or antibiotics, those with chronic infections will not respond to such remedies.

"Chronic sinusitis can turn into a devastating problem," says ABCNEWS's medical editor, Dr. Timothy Johnson. "In fact, a recent study suggests that chronic sinusitis can cause more pain and disability than congestive heart failure, lung disease and back pain combined."

When sinusitis turns serious, surgery is often the sufferer's only option. Unfortunately, traditional sinus surgery can be a complicated procedure. Closeness of the sinuses to the brain, the eye and major arteries, can make the surgery risky. In addition, the surgery can be disfiguring and painful as it involves making incisions in the mouth and face.

GPS for the Sinuses

But add technology such as infrared optics, electromagnetic beams, "interactive" CT scans and sophisticated computers, and there's reason for the sinus sufferer to breathe easier. Image-guided surgery, also known as stealth surgery, allows physicians to minimize the chances of sinus surgery complications, operate more thoroughly, and perform more difficult procedures. In essence, it allows them to actually see what they couldn't see before.

After taking a special CT, or computed tomography, scan of the patient's sinuses to create a "road map" of the patient's skull, the surgeon can correlate the CT image with the position of a probe. During the procedure, surgeons place a hand-held probe in the patient's nose while correlating their position with the scan on a computer screen. This image-guidance system shows the location of the probe's tip so the surgeon can safely navigate through trouble spots.

"The system in a simplistic way performs [like] a glorified GPS [global positioning system]. It provides the surgeon a "relatively" precise ability to maintain his/her orientation as one operates through the relatively complex anatomy of the sinuses," explains Dr. Roy Casiano, head and neck surgeon at the University of Miami School of Medicine who has been using the technique for several years.

Experts say stealth technology is particularly useful if a patient's sinus anatomy is unusual, or for "revision" surgeries — when a patient has already had one or more sinus procedures. In these cases, there is greater risk due to altered anatomy and loss of landmarks due to scarring left from the previous surgery.

Though the technology has been available since the 1980s, it has only recently become more widespread throughout U.S. medical centers.

Dr. Peter Catalano,, chairman of otolaryngology at Massachusetts' Lahey Clinic explains that lower costs and more user-friendly models have put the technology in more operating rooms. In addition, use of the technology within other disciplines like brain and spine surgery have also made it more appealing for medical institutions.

Surgical Perspective

When considering sinus surgery, experts advise finding a skilled surgeon with a good deal of experience.

"Like other technology, stealth is still operator-dependent. It cannot be relied upon solely to determine one's location in the nose and sinuses. A thorough knowledge of anatomy and experience still remain the most important factors in deciding on a surgeon, and not whether they have a stealth device," says Casiano.

"It gives surgeons greater confidence about where they are so the surgery can be more thorough and theoretically the complications can be lessened," says Dr. Scott Graham, of the Department of Otolaryngology at the University of Iowa, "but it is not a replacement for surgical judgement."

For more information on sinusitis and the stealth procedure, please see the American Academy of Otolaryngology's site.