Position Statement: Intra-Operative Use of Computer Aided Surgery

The American Academy of Otolaryngology – Head and Neck Surgery endorses the intraoperative use of computer-aided surgery in appropriately select cases to assist the surgeon in clarifying complex anatomy during sinus and skull base surgery. There is sufficient expert consensus opinion and literature evidence base to support this position. This technology is used at the discretion of the operating surgeon and is not experimental or investigational. Furthermore, the American Academy of Otolaryngology-Head and Neck Surgery is of the opinion that it is impossible to corroborate this with Level 1 evidence. These appropriate, specialty specific, and surgically indicated procedural services should be reimbursed when used by qualified physicians regardless of the specialty. Examples of indications in which use of computer-aided surgery may be deemed appropriate include:

1. Revision sinus surgery.
2. Distorted sinus anatomy of development, postoperative, or traumatic origin.
3. Extensive sino-nasal polyposis.
4. Pathology involving the frontal, posterior ethmoid or sphenoid sinuses.
5. Disease abutting the skull base, orbit, optic nerve or carotid artery.
6. CSF rhinorrhea or conditions where there is a skull base defect.
7. Benign and malignant Sino-nasal neoplasms.

Related terminology: Image guided sinus surgery, computer-assisted sinus surgery, surgical navigation, computer-guided imaging systems.

Approved 11/4/2002
Revised 9/14/2005
Reaffirmed 12/8/2012
Revised 3/2/2014
Revised 10/3/2023

References:

1. Dalgorf DM, Sacks R, Wormald PJ, Naidoo Y, Panizza B, Uren B, Brown C, Curotta J, Snidvongs K, Harvey RJ. Image-guided surgery influences perioperative morbidity from endoscopic sinus surgery: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2013 Jul;149(1):17-29.
2. Farhadi M, Jalessi M, Sharifi G,Khamesi S, Bahrami E, Hammami MR, Behzadi AH. Use of image guidance inendoscopic endonasal surgeries: a 5-year experience. B-ENT. 2011; 7(4):277-82.
3. Feichtinger M, Pau M, Zemann W, Aigner RM, Kärcher H. Intraoperative control of resection margins in advanced head and neck cancer using a 3D-navigation system based on PET/CT image fusion. J Craniomaxillofac Surg. 2010 Dec; 38(8):589-94.
4. Fried MP, Moharir VM, Shin J, Taylor-Becker M, Morrison P. Comparison of endoscopic sinus surgery with and without image guidance. Am J Rhinol. 2002 Jul-Aug; 16(4):193-7.
5. Hsu W, Kosztowski TA, Zaidi HA, Gokaslan ZL, Wolinsky JP. Image-guided, endoscopic, transcervical resection of cervical chordoma. J Neurosurg Spine. 2010 Apr;12(4):431-5.
6. Justice JM, Orlandi RR. An update on attitudes and use of image-guided surgery. Int Forum Allergy Rhinol. 2012 Mar-Apr; 2(2):155-9.
7. Masterson L, Agalato E, Pearson C. Image-guided sinus surgery: practical and financial experiences from a UK centre 2001-2009. J Laryngol Otol. 2012 Dec;126(12):1224-30.
8. Metson R, Coszena MJ, Gliklich RE, Montgomery WW, “The role of image guided systems for head and neck surgery,”Archives of Otolaryngology—Head and Neck Surgery, 1999, 125:1100-1104.
9. Metson R, Coszena MJ, Cunningham MJ, Randolph GW, “Physician Experience with an optical image guided system for sinus surgery,”Laryngoscope 2000; 110: 972-976.
10. Nakamura M, Stöver T, Rodt T, Majdani O, Lorenz M, Lenarz T, Krauss JK. Neuronavigational guidance in craniofacial approaches for large (para) nasal tumors involving the anterior skull base and upper clival lesions. Eur J Surg Oncol. 2009 Jun; 35(6): 666-72.
11. Neumann AM, Pasquale-Niebles K, Bhuta T., Sillers MJ, “Image-guided transnasal endoscopic surgery of the paranasal sinuses and anterior skull base,” American Journal of Rhinology 1999; 13:449-454.
12. Parikh SR, Cuellar H, Sadoughi B, Aroniadis O, Fried MP. Indications for image-guidance in pediatric sinonasal surgery. Int J Pediatr Otorhinolaryngol. 2009 Mar; 73(3): 351-6.
13. Prulière-Escabasse V, Coste A. Image-guided sinus surgery. Eur Ann Otorhinolaryngol Head Neck Dis. 2010 Mar;127(1):33-9.
14. Ramakrishnan VR, Orlandi RR, Citardi MJ, Smith TL, Fried MP, Kingdom TT. The use of image-guided surgery in endoscopic sinus surgery: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2013 Mar; 3(3): 236-41.
15. Smith TL, Stewart MG, Orlandi RR, Setzen M, Lanza DC. Indications for image-guided sinus surgery: the current evidence. Am J Rhinol. 2007 Jan-Feb; 21(1):80-3. Review.
16. Stelter K, Ledderose G, Hempel JM, Morhard DF, Flatz W, Krause E, Mueller J. Image guided navigation by intraoperative CT scan for cochlear implantation. Comput Aided Surg. 2012; 17(3):153-60.
17. Tabaee A, Hsu AK, Shrime MG, Rickert S, Close LG. Quality of life and complications following image-guided endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2006 Jul; 135(1):76-80.
18. Tabaee A, Kacker A, Kassenoff TL, Anand V. Outcome of computer-assisted sinus surgery: a 5-year study. Am J Rhinol. 2003 Sep-Oct; 17(5):291-7.

Important Disclaimer Notice (Updated 7/31/14)

Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.