Clinical application of virtual endoscopy as a support system for endoscopic sinus surgery

Conclusions: Computer processing of conventional CT images can provide virtual endoscopic images (VEIs). Surgeons observing these images feel as if they are observing the lesion using an endoscope. Simulation based on animated VEIs before endoscopic sinus surgery (ESS) is useful for the improvement of surgical safety and surgeons' education. Although the production of VEIs requires certain surgical experience, after the production of VEIs, surgeons can repeat simulation of a surgical procedure and have confidence in the actual operation. Objective: We investigated the clinical application of CT-reconstructed VEIs as a support system for ESS. Materials and methods: A GE Light Speed Ultra 16 as a 16-slice CT scanner and Advantage Workstation 4.2 were used. Software called Navigator in this workstation allows the production of CT-reconstructed VEIs. We applied simulation based on VEIs to endoscopic operations for mucocele or sinusitis. Results: In nine cases of mucoceles and sinusitis, simulation based on animated VEIs was applied. According to the simulation, surgeries were performed, and the mucoceles and obstructed sinuses could be opened readily and safely. This system was more effective when there were landmarks such as polyps or irregular mucosal surfaces allowing macroscopic confirmation ahead of the viewpoint.