The use of the BrainLAB Kolibri™ navigation system in endoscopic paranasal sinus surgery under local anaesthesia.: An analysis of 35 cases

Background. As a result of technological advances, 3D-navigation systems are playing an increasingly important role in paranasal sinus and anterior skull base surgery. Patients and methods. The BrainLAB Kolibri (TM) navigation system (BrainLAB, Heimstetten, Germany) was used in the surgical management of chronic sinusitis and nasal polyposis in 35 patients. Surgery was performed under local anaesthesia. In order to compare this technique with traditional methods, 35 additional patients underwent conventional surgery. A clinical plausibility test using specific anatomical landmarks was performed to evaluate intraoperative navigation accuracy. In addition, a standardised questionnaire was used to document setup and registration times. Standardised rating scales helped assess whether the system can make surgery safer. Results. It took approximately 5.8 min to set up the navigation system. The time required for system and patient positioning, including the attachment of the headband, was 4.2 min on average. Patient registration with the z-touch system was completed after an average of 4.2 min. It took an average of approximately 8.1 min to register a patient using the soft-touch system. The use of the navigation system increased the total time for preparation and surgery by approximately 50% in comparison to the conventional technique. An average accuracy of 1.5-2.3 mm in all three planes was measured. Participating surgeons felt that the system made surgery considerably safer. Conclusions. The BrainLAB Kolibri navigation system offers good accuracy, a short setup time and an easy registration technique. The combination of these qualities and intuitive operation make this system a suitable option for routine use in paranasal sinus surgery. As a result of its compactness, the BrainLAB Kolibri navigation system can be moved easily between different operating rooms and can also be used in small facilities (e.g. container operating theatres in field hospitals).