CT System May Reduce Number of Revision Sinus Surgeries

In the operating room (OR), a surgeon's assessment of disease is limited without access to sophisticated imaging techniques. A decision of whether revision surgery may be necessary occurs post-surgery with the assistance of diagnostic images, or computed tomography (CT) scans. While the possibility of multiple surgeries may be disturbing to sinus patients, the risk of those revision surgeries is about to be dramatically reduced.

A team of ear, nose, and throat surgeons (ENT) at the University of Pennsylvania (UPenn; Philadelphia, PA, USA) set out to demonstrate that the use of a unique, small and literally mobile CT scanner, called xCAT ENT, will decrease those percentages significantly, making them a statistic of the past. Those surgeons revealed that use of xCAT ENT in the OR led to alteration in the surgical plan in 30% of patients.

Tailoring this to an individual, without xCAT ENT, there is a 30% chance of some disease being left, even in the hands of the most experienced surgeons, and therefore a greater chance of needing to undergo additional surgery. "We believe that it is very important to avoid leaving pockets of disease during sinus surgery and this is a significant advance in terms of making sure the surgery is complete,” said David W. Kennedy, M.D. a professor in the UPenn department of otorhinolaryngology: head and neck surgery. The study was published in the April 2008 issue of the American Journal of Rhinology.

Surgeries are performed using CT scans of the patient taken days or weeks before the operation. Since the anatomy of the patient is changing during surgery and the surgery is performed close to the eye and to the brain, surgeons walk a fine line between leaving disease, and at the same time, minimizing the risks to these vital areas. The surgery itself reduces the accuracy and usefulness of those CT scans as blueprints for the surgeon. The result is that surgeons who are unable to see beyond the surgically explored area may frequently leave disease during the surgery.

To see beyond the region, the surgeon needs real-time updated images of surgical anatomy, specifically in complex surgeries close to the brain, which require extreme accuracy. Before the development of this system, there was almost no way to CT scan during surgery. Big immobile hospital scanners could not be used in the operating room and patients could not be wheeled down to central imaging in the middle of a surgery. xCAT ENT supplied surgeons that all-desirable updated CT scan while in surgery.

The team of researchers at U Penn began to see a pattern. The uniquely designed mobile xCAT ENT has a surgical advantage: it became an extra set of eyes for the surgeon in the operating room, allowing the surgeon to see beyond those areas surgically explored. With a set of fresh blueprints, the surgeons were able to make final surgical corrections instead of prematurely closing patients.

The mobile xCAT was developed by Xoran Technologies (Ann Arbor, MI, USA), a biotechnology company founded in 2001 by two University of Michigan (An Arbor, USA) research scientists. Xoran is a developer of ultra compact, low-dose CT scanners for imaging highly specific areas of a patient's head.

To develop xCAT ENT, Xoran shrunk CT technology into an ultra portable device, a fraction of the size of a full-body scanner and about 1/10 the weight. The distinctive scanner is very compact, easily wheeled directly to the patient on the operating table, and quickly provides CT images in the OR. Because ORs are tight, the size, turning radius, and ease of use are vital.

The study by the ENT surgeons at UPenn established that the ability to perform a "report card” scan at the end of surgery allowed the surgeon to make final surgical corrections instead of prematurely closing the patient. Even in the hands of those surgeons who are the most skilled in performing this surgery, xCAT ENT presented a pathway to performing additional necessary surgery before the patient awoke in 30% of operations.

This study should affect a sizable percentage of those individuals troubled with sinus disease that requires surgery, potentially allowing them to move on with their lives--instead of returning to hospitals for additional and painful operations. The investigators concluded that this currently available technology has the potential to improve the extent of surgery in patients with complicated anatomy and extensive disease.


Related Links:
University of Pennsylvania
Xoran Technologies