Improving Safety in Endoscopic Sinus Surgery Presented at Functional Endoscopic Sinus Surgery (F.E.S.S) Lisa Liberatore M.D. F.A.C.S., Chief Medical Director Lexington ENT; Attending Physician, Lenox Hill Hospital; Attending Physician, Manhattan Eye, Ear & Throat Hospital Overview of chronic sinusitis. Anatomy and radiology of sinusitis. Rationale for surgery. Indications and reasons for using navigation.

1. Improving Safety in Endoscopic Sinus Surgery :
An Overview and the use of Navigational Tools
October 2014 -1199 Symposium
Lisa Liberatore,MD | Otolaryngologist | Sinus and Sleep Specialist

2. Manhattan Eye, Ear and Throat Hospital
New York, New York
We perform thousands of sinus surgeries a year and are constantly
advancing our knowledge and our technology.
The goal is to reduce morbidity, complications and to reduce costs.

3. Chronic Sinusitis | Statistics
• A history of either recurrent sinus infections
requiring antibiotics and steroids and sprays or
persistent sinus infection unresponsive to
medical therapy for more than 6 weeks.
• Millions of Americans suffer from chronic
sinusitis and millions have surgery to help treat
obstructive causes to this condition.

4. Chronic Sinusitis | Anatomy of Nose and Sinuses
• Nasal septum
• Inferior turbinates
• Middle turbinates
• Osteomeatal complex
• Frontal recess
• Sphenoid recess
• Sphenoid Ostia
• Nasopharyngeal region
• Adenoid

5. Deviated Septum
• Blocks the flow of air
• Blocks the flow of mucous
drainage
• Contributes to recurrent
infections
• Contributes to poor aerobic
ability
• Contributes to poor sleep
• Easily fixable
• Benefit to surgery has to
outweigh the risks to surgery

6. Sinuses | Overview
• Frontal
• Ethmoid
• Maxillary
• Sphenoid

7. Sinuses | Overview – CT Scan
Frontal | Ethmoid | Maxillary | Sphenoid

8. Sinuses | Overview
• Bony cavities filled with air
• Mucosal lining secrets mucous
• The mucous drains into the nose
• If drainage is blocked, the mucous in the sinus
can get infected and the lining thickens
• The blockage can be from the deviated septum
or the sinus drainage pathway

9. Chronic Sinusitis | Symptoms
• Nasal congestion
• Recurrent infections
• Post nasal drainage
• Cough
• Headaches
• Decreased sense of smell
• Halitosis
• Dizziness
• Poor sleep
• Poor focus
• Depression
• Change in vision

10. Tracking Patients Before and After Surgery
Pre-Op Post-Op

11. Goals of Surgery | Dilate and/or open blocked sinus
drainage pathways and irrigate sinuses
Provide culture and pathology

12. Functional Endoscopic Sinus Surgery (FESS)
• A surgical procedure which reestablishes the
normal anatomical sinus drainage
• Uses endoscopic techniques
• Usually uses video imaging
• Advanced the success of sinus surgery and
reduced complications and external incisions
• Continues to advance using technology such as
balloon , absorbable packing , smaller
instruments and image guidance

13. Navigational Systems
Allows the Sinus
surgeon to use the
endoscopic
instruments, while
knowing in real
time where the
instrument is in
the nose or sinus.

14. Navigational Systems | Convenient & Customizable
Endoscopic View
- Video input displayed alongside
navigation
- Full screen video automatically
switches to navigation view when
navigating
Multiple View Options
- Choose and customize your image
display based on your preferences
Instrument Status Bar
- Conveniently informs you about the
instrument in use (type, status)

15. When are Navigational Systems helpful?
• Polyposis
• Revision surgeries
• Frontal sinus conditions
• Sphenoid sinus conditions
• Orbital involvement
• Repair of cerebrospinal fluid leaks
• Skull base surgery
• Foreign body removals
• Teaching residents

16. The Sinus Surgery Team!
• Otolaryngologist
• Surgical
technician
• Circulating nurse
• Anesthesiologist

17. Lights, Camera, Action
• Anesthesiologist
places pt under
general anesthesia
• Place the
navigation head
device on
• Calibrate the
device
• Accept the
navigation
• Decide which
instruments to pair
with the navigation
• Reconfirm
throughout the
case

18. Frontal Sinusitis

19. Revision Sinus Surgery

20. Sphenoiditis

21. Orbital Involvement

22. Lisa A. Liberatore, MD
154 East 85th Street
New York, NY 10028
lisaliberatoremd@yahoo.com
www.lexingtonent.com
Tel: 212.288.2222