{"doi":"10.1002/alr.23529","title":"Developing a Virtual Endoscopic Surgery Planning System to Optimize Surgical Outcomes","abstract":"Endoscopic nasal sinus surgery [1] has been the procedure of choice for the treatment of nasal obstruction and sinus disease. Nasal endoscopy provides landmark visualization and navigation for small instruments to operate within the nasal airway and sinuses. However, outcomes of these surgeries are highly variable, from short-term favorable outcomes of 60%‒90% to long-term outcomes as low as 30% [2, 3], potentially due to fact that planning and predicting functional outcomes (e.g., airflow) of endoscopic sinus surgeries can be difficult or deceptive based solely on visualizing computerized tomography or endoscopic images. Virtual surgery planning (VSP) has been widely used in many other surgical fields that allow the surgeon to virtually plan the surgery to optimize surgical outcomes. Since previous endoscopic sinus surgery simulators [4-10] mostly serve as surgical skill-training tools, we thus assembled an interdisciplinary team of engineers, computational scientists, and clinicians to develop an endoscopic sinus VSP system for experienced surgeons rather than a training platform—that utilizes state of the art computer graphics and 3D modeling to provide a prospective, preoperative guide that can optimize and improve surgical outcomes. The prototype, running on desktop workstation with Intel Xeon E5-1650 v3 processor and NVIDIA Quadro P5000 graphics card, comprises three synergistic components—a volume renderer to provide 3D endoscopic visualization based on patient's clinical computerized tomography (CT) imaging; a haptic endoscopy tool to navigate and perform the virtual surgery; and the computational fluid dynamic (CFD) system to predict the nasal airflow outcome. The rendering system uses CUDA for direct volume rendering and OpenGL (version 4.0) for graphics rendering. A haptic device (PHANTOM, SensAble Technologies, Inc.) that can apply forces in three degrees of freedoms, provides interaction between virtual endoscopic tools and the 3D CT-based volumetric model during virtual surgery. The combination of 3D visual rendering and the haptic feedback allows the surgeon to remove the virtual obstructive tissue similar to in endoscopic surgery. The developed VSP can load any patient's CT in DICOM format in real-time from various sources, for example, cone beam CTs or conventional spiral CTs, and provide highly detailed 3D visual display of the nasal sinus airway (see Figure 1, Video S1, and Supporting Information Method). The ability to directly load versatile clinical CT images without pre-processing is the key to allow its wide utilization in clinical settings. Pre-calculated airflow resistance, wall shear stress, pressure drop are displayed on the anatomy to identify potential sites of obstruction. In Figure 1, a microdebrider was selected, with available endoscopic tool selections to be expanded in future software versions. The size of the microdebrider can be virtually adjusted. To ease operation, the surgical tool and camera are combined into a single haptic device, so that the surgeon can operate with one hand and toggle between different tools, such as the endoscope and the microdebrider, using buttons accessible by the user's index finger. While the camera view is updated as the virtual endoscope navigates the nasal airway, the angle and distance of the camera to the tool tip can be adjusted. CT image guidance is also supported so that the surgeon can visualize the real-time tool tip location on three orthogonal CT slices, mimicking the operating room (OR) experience. Virtual surgeries can be saved intermittently (“mini save” button) or undone (“restore volume” button) to allow for easy surgical planning. By restoring and saving multiple versions of different surgical approaches, different outcomes on a single patient can be compared and the process is reiterated until an optimal result is reached. As proof-of-concept, we performed a series of isolated or combined procedures on one patient, who had nasal valve obstr","journal":"International Forum of Allergy & Rhinology","year":2025,"id":531814,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9568,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1287607,"name":"Ahmad Odeh","orcid":"0000-0002-6310-5139","position":1,"is_corresponding":false},{"id":1337328,"name":"Guillermo Maza","orcid":"0000-0002-3931-3544","position":2,"is_corresponding":false},{"id":741166,"name":"Brenda Shen","orcid":"0009-0001-7095-7743","position":3,"is_corresponding":false},{"id":922308,"name":"Bradley A. Otto","orcid":null,"position":4,"is_corresponding":false},{"id":130480,"name":"Don Stredney","orcid":null,"position":5,"is_corresponding":false},{"id":1287610,"name":"Gregory J. Wiet","orcid":"0000-0001-6990-3206","position":6,"is_corresponding":false},{"id":509947,"name":"Kai Zhao","orcid":"0000-0003-4805-2689","position":7,"is_corresponding":false},{"id":1055967,"name":"Bradley Hittle","orcid":"0000-0002-7108-2547","position":0,"is_corresponding":true}],"reference_count":12,"raw_metadata":null,"created_at":"2026-07-19T02:51:18.928280Z","pmid":"39811890","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}