Functional Endoscopic Sinus Surgery (FESS) with VTI (Computer Guidance)
Sinus surgery is indicated when medical therapy has failed to treat sinus problems/ infections. We are careful to evaluate each child individually based on their symptoms and CT scan findings, to determine if surgery is necessary. If surgery is needed, it generally can be performed as an outpatient. The procedure takes about 1 ½ -3 hours depending on the amount of surgery that is needed. It is performed under a general anesthetic (usually with a Pediatric Anesthesiologist). We use small telescopes (similar to the size of a pen) that are passed through the nose to visualize the anatomic structures within the nose and sinuses. Small manual forceps and electric swiveling instruments are used along with suction devices to clean out the sinus cavities and enlarge their openings so that future sinus material can drain out more easily. Generally, no external or visible incisions are necessary. The procedure does involve working close to the eye (orbit) and the brain; so potential for injuries to these areas is possible, but unlikely (less than 5% of the time). Following surgery, some pain can exist for 1-7 days, and sometimes packing may need to be removed from the nose following surgery (at the post operative visit). Occasionally, a second trip to the operating room may be needed about 2- 6 weeks following surgery to clean out the nasal/sinus cavities. The surgery is successful in improving a child’s sinus problems about 85 % of the time. Occasionally, revision sinus surgery is needed years later.
We often utilize technology called VTI or visual tracking instrumentation in the surgical suite. The VTI system involves wearing a headset when the CT scan is performed (prior to surgery). This same headset is then placed on the patient when undergoing surgery. This device allows us to pinpoint the location of our instruments within that particular patient as we work during the surgical procedure. This allows the surgeon to have the greatest accuracy and location of anatomic structures during surgery. It has been a great advance in our field. Our practice was one of the first in the Midwest to start using this technology in about 1994.