Face-to-Face

Throughout my time in medicine, I have witnessed several transformative advances that have reshaped the way we practice otolaryngology. One of the first innovations of my time was the introduction of the CT scanner – a computer-generated, image that allows clinicians to visualize structures inside the human body with unprecedented detail. As technology evolved, CT imaging improved dramatically in both resolution and speed. At the same time, surgical navigation systems were developed, functioning almost as a GPS for the surgeon. These systems allow us to map the anatomy in real time during surgery, enabling more precise localization of tumors and safer navigation through complex anatomical variations. Today, we are now witnessing yet another leap forward. With Houston Methodist’s strategic partnership with Apple and KARL STORZ, a pioneer in endoscopic technology, a new platform has been developed that integrates ultra high-resolution imagery with immersive visualization tools. The platform allows surgeons to interact with surgical displays in an entirely new way, creating a highly adaptable operating environment designed to enhance precision, ergonomics, and safety. One of my colleagues in general surgery, Patrick R. Reardon, MD, FACS, has been studying this platform for laparoscopic surgeries. However, until recently, the technology had not yet been used for endoscopic sinus surgeries. We have now become the first institution to establish an Institutional Review Board (IRB)–approved prospective study designed to systematically evaluate and validate the clinical utility of this platform in endoscopic sinus surgery. From a surgeon’s standpoint in a four-hour surgery, ergonomics becomes very important. In long surgical cases, neck strain, posture, and screen placement can all impact both performance and fatigue. With this platform, I can position the endoscopic surgery display anywhere within my visual field – right in front of me, closer to me, higher or lower – creating an optimal setup tailored to my comfort. This system also allows multiple windows to be displayed simultaneously – the image-guided screen in one area, the endoscopic surgery view, pathology microscopy could appear within the same visual environment, along with the endoscopic view from any operating room that may facilitate assisting with any intraoperative consultations. The flexibility of the system is extraordinary. If a structure requires closer examination, the virtual display can be expanded dramatically, essentially creating a floor-to-ceiling surgical monitor. The result is an immersive environment that allows surgeons to maintain intense focus on the procedure. After a successful first surgery using the Apple Vision Pro, I then advanced to a four-hour highly complicated sinus surgery with little room for manipulation. In this virtual platform, you can adjust the virtual environment, helping to lock in your focus. Then, my individual ergonomic adjustments helped me come out feeling great. My neck feels fine; my back is fine; I’m not excessively fatigued. I had many options to play around with the screens and figure out the best comfort for me – up or back, left or right. In addition, we were able to vet and identify issues with the platform but also document all the benefits. In the end, we recommended some tweaking of the platform along with changes to the color saturation of the virtual monitor, but the procedure could not have gone any better. Augmented and virtual reality represent the next major frontier in endoscopic surgical innovation. These technologies create immersive environments that improve focus, ergonomics and create new possibilities for intraoperative visualization. Based on my experience, the potential is extraordinary. My vote for this innovation is a resounding “yes.” It was really exciting to use the new platform, and I look forward to seeing how these technologies continue to transform surgery in the years ahead.