PCI in Cedar Rapids using augmented reality system for ENT surgeries

CEDAR RAPIDS — Augmented reality and other advancements in navigation systems have allowed Corridor ears, nose and throat surgeons to better approach medical procedures.

These innovations — just one facet of new technologies being developed in the field of medicine — have opened the door for more patients to receive minimally invasive surgeries, local providers say.

“This technology was used in operating room, but now we’re pushing boundaries for what we can do as specialty — especially for sinus surgery — in the office,” said Dr. Thomas Heineman, a surgeon at the Physicians’ Clinic of Iowa.

The Ear, Nose and Throat/Head and Neck Surgery clinic at PCI, a private specialty group in Cedar Rapids, began using an new sinus imaging system earlier this year that employs augmented reality to guide surgical procedures.

Called the Stryker ENT navigation system, the tool uses software to help providers map out patients’ sinus cavities. The anatomy of each individual is different, so the system acts as a GPS to increase surgeons’ accuracy as they work close to the brain, the eye and other sensitive areas in a patient’s skull, Heineman said.

The augmented reality system is the first of its kind in the state of Iowa, according to PCI.

Similar systems are used by ENT providers and other surgeons in health care facilities across the state. But what makes the system at PCI unique is that it superimposes images from previous CT scans of the patient onto the surgical camera view, Heineman said.

At Mercy Medical Center, ENT surgeons have similar navigation technology that involves a patient’s CT scan to build a 3D tracking model that surgeons use as a guide during sinus operations, said Dr. Shane Gailushas, a surgeon at the Mercy Medical ENT clinic.

Called TruDi, Gailushas said their system uses trackers placed on surgical instruments that appear on a screen, allowing surgeons to pinpoint where in the sinuses the tools are located. He said they’ve been using this navigation system for about four years.

"These are the directions these things are going,“ Gailushas said. ”It’s all about safety, and all about minimally invasive technology.“

Tracking technology and navigation systems have been around for at least a decade, and area health care facilities have been using these imaging systems for years, local surgeons say. However, recent updates to these technologies have been a game changer for some surgical procedures.

“Recently, thanks to increases in computer power and 3D technologies, we’re really able to increase ability to use these in an accurate way, which helps us be more minimally invasive,” Gailushas said.

One example is a balloon sinuplasty, a procedure that Gailushas compared to building a ship inside a bottle. The minimally invasive technique uses a small balloon to dilate sinus openings to treat patients with chronic or recurrent sinus infections of sinusitis.

Patients are given local anesthesia during the procedure, so it can be done in an outpatient setting.

“When I first started, there were just a few procedures a year in the office,” Gailushas said. “Now, they’re a good 20 percent of procedures I do in the office, which I was not able to do before until these technologies became available.”

The only option for treatment for patients with chronic sinusitis previously would be being placed under anesthesia so a surgeon manually could remove tissue at the sinus to enlarge the opening.

While the more invasive operation is effective, some patients — such as elderly patients — are at higher risk for negative outcomes if placed under anesthesia, Heineman said.

“With older adults, bouncing back from hour or two of anesthesia can be a big deal. If we can avoid that, it’s a win,” he said.

This trend toward minimally invasive surgeries has pushed other innovations in the ENT space, including an implantable device that could replace CPAP, or continuous positive airway pressure, machines and a minimally invasive balloon septoplasty that can help treat nasal septum deviations.

Medicine has been trending toward more minimally invasive surgical procedures, but COVID-19 may help accelerate that, Heineman said.

As the country continues to experience new surges in coronavirus infections, hospitals are forced to consider delaying elective and other nonemergent procedures to conserve bed space.

Earlier this week, both Cedar Rapids hospitals announced they would delay all non-urgent, elective surgeries through Christmas to preserve capacity as its health care staff grapple with a new surge in new COVID-19 cases.

Augmented reality “is just a new addition to the way we practice, but I think it’s exciting as we’re trying to push the state of medicine forward,” Heineman said.

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