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investigation into behavioral changes and attention
shifts created through real-time navigation need further
preclinical study.
28
Initial clinical use should be
restricted to surgeons who perform advanced cases and
already have experience with and a good working knowl-
edge of IGS systems and their potential errors.
CONCLUSION
Real-time surgical navigation systems such as our
LIVE-IGS prototype may enhance spatial awareness
while reducing task workload during endoscopic skull
base surgery. High spatial demand, compromised visual
landmarks, and proximity to critical structures combine
to create an environment where such technology may be
beneficial. Multimodal feedback with novel alarms, such
as structure- and proximity-specific auditory icons, could
reduce visual stimuli and enhance awareness while lim-
iting distraction.
Acknowledgments
This study could not have been performed without
assistance from staff at the University of Toronto Surgical
Skills Centre, Mount Sinai Hospital, Toronto. The authors
thank the surgeons (including F. Gentili, D. Sommer,
S. Kilty, J. Lee, and P. Goetz) who made time to participate
in the trial.
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