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t m c » p u l s e | m a y 2 0 1 8 30 Gaming Tech and 3-D Reach the OR State-of-the-art technology can streamline surgical procedures B y S h a n l e y P i e r c e A 72-year-old man suffering from nasal polyps and chronic sinus inflammation lay uncon- scious on the operating table. Blue surgical towels veiled nearly every inch of his body, but his face was exposed—his head tilted back and nose pointed toward the ceiling. Martin Citardi, M.D., inserted a long endo- scope through the patient's nasal passage. The glow of a monitor illuminated the darkened room. Everyone's eyes were glued to the video camera feed on the screen, which looked more like a video game than a real-time view of the winding journey through the patient's sinus cavity. Citardi and his team at Memorial Hermann- Texas Medical Center are the first in the country to use augmented reality (AR) technology for minimally invasive sinus procedures. AR technology, which overlays computer- generated images onto a user's view of the real world, gained mainstream popularity after Pokémon Go first launched two years ago. At its peak, 45 million users were hooked on the gaming app. But AR isn't just for gamers anymore. Medical device companies are beginning to use AR technology to superimpose preoperative medical imaging over real-time video of a patient's anat- omy, creating a composite view for surgeons. Typically, Citardi would simultaneously ana- lyze a 2-D CT scan on a light box prior to surgery and mentally visualize the patient's 3-D anatomy, going back and forth between the two. But when Citardi uses Stryker's Scopis Target Guided Surgery (TGS), an AR navigation system, all the relevant imaging is combined into a single field. Rhinologists at Memorial Hermann-TMC perform endoscopic sinus surgery on a patient with the assistance of augmented reality technology. Surgeons are visual creatures. Putting everything together on one screen is appealing. A big part of minimally invasive surgery is getting directly to the target and avoiding collateral damage. — MARTIN CITARDI, M.D., Memorial Hermann-TMC physician, chair of the Department of Otorhinolaryngology- Head and Neck surgery at UTHealth