title: Improved planning of endoscopic sinonasal surgery from 3-dimensional images with Osirix® and stereolithography.
abstract: OBJECTIVE
  The high variability of sinonasal anatomy requires the best knowledge of its three-dimensional (3D) conformation to perform surgery more safely and efficiently. The aim of the study was to validate the utility of Osirix® and stereolithography in improving endoscopic sinonasal surgery planning.
  
  
  METHODS
  Osirix® was used as a viewer and Digital Imaging and Communications in Medicine (DICOM) 3D imaging manager to improve planning for 114 sinonasal endoscopic operations with polyposis (86) and chronic rhinosinusitis (CRS) (28). Stereolithography rapid prototyping was used for 7 frontoethmoidal mucoceles.
  
  
  RESULTS
  Using Osirix® and stereolithography, a greater number of anatomical structures were identified and this was done faster, with a statistically-significant clinical-radiological correlation (P<.01) compared with 2D CT plates. With a share of more than 75% of surgery performed by residents, surgical time was reduced by 38±12.3min in CRS and 42±27.9 in sinonasal polyposis. The fourth-year residents reached 100% surgical competence in critical surgical milestones with 16 surgeries (CI 12-19).
  
  
  CONCLUSIONS
  The systematic use of Osirix® for visualisation and treatment of 3D sinonasal images from DICOM data files, along with the surgical team's ability to manipulate them as virtual reality, allows surgeons to perform endoscopic sinonasal surgery with greater confidence and in less time than using 2D images. Residents also achieve surgical competence faster, more safely and with fewer complications. This beneficial impact is increased when the surgical team has stereolithography rapid prototyping in more complex cases.
authors.affiliation: Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, España. Electronic address: sanchezsg@us.es.
authors.forename: Serafín
authors.initials: S
authors.lastname: Sánchez-Gómez
authors.affiliation: Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: Tomás F
authors.initials: TF
authors.lastname: Herrero-Salado
authors.affiliation: Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Maza-Solano
authors.affiliation: Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ropero-Romero
authors.affiliation: Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: Jaime
authors.initials: J
authors.lastname: González-García
authors.affiliation: Departamento de Anatomía y Embriología Humana, Universidad de Sevilla, Sevilla, España.
authors.forename: Jesús
authors.initials: J
authors.lastname: Ambrosiani-Fernández
mesh_terms: D003658:Decision Making, Computer-Assisted; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D021621:Imaging, Three-Dimensional; D008838:Microcomputers; D008953:Models, Anatomic; D009078:Mucocele / Q000601:surgery; D009298:Nasal Polyps / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D066330:Printing, Three-Dimensional / Q000295:instrumentation; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*; D012984:Software; D014584:User-Computer Interface
keywords: Estereolitografía; Imágenes en 3 dimensiones; Planificación quirúrgica; Realidad virtual; Stereolithography; Surgical planning; Three-dimensional imaging; Virtual reality