Comparison of Endoscopic Sinus Surgery with and without Image Guidance

TLDR

Image guidance based on preacquired computed tomography scans assists physicians during endoscopic sinus surgery (ESS). The study compares ESS performed with versus without image guidance, evaluating parameters that influence surgical efficacy. A retrospective chart review at a tertiary referral center compared 97 patients undergoing ESS with an electromagnetic image guidance system to 61 patients who had ESS before the system was available, assessing patient characteristics, sinus involvement, complications, estimated blood loss, operative time, and repeat surgery rates. Use of image guidance was linked to fewer major complications and a more extensive operation but resulted in longer operative times and greater blood loss compared to non‑guided ESS.

Abstract

Background Image guidance based on preacquired computed tomography scans of the patient is a technique used to assist the physician during endoscopic sinus surgery (ESS). This study seeks to compare ESS with and without image guidance, analyzing a number of parameters that can impact on efficacy. Methods Retrospective chart review took place at a tertiary care referral center. The study group consisted of 97 consecutive patients confirmed to have undergone ESS using an electromagnetic intraoperative image guidance system (IGS). The control group consisted of 61 consecutive patients who underwent ESS, before the IGS was available at the study hospital. The main outcomes measured were analysis of patient profile, including coexisting conditions such as asthma and polyposis, assessment of which specific sinuses underwent surgical treatment; major and minor complications; estimated blood loss (EBL); operative time; and the need for repeat surgery. Results The IGS group had 74% of patients with polyposis; more sinuses, on average, which underwent surgical revision; one major and three minor complications; an average EBL of 134 cc, an average procedure time of 154 minutes; and one patient who needed repeat surgery in a 3-month follow-up period. The non-IGS group had 40% of patients with polyposis; seven major complications and one minor complication; an average EBL of 94 cc; and three patients who needed repeat surgery within 3 months. Conclusions The use of an IGS for endoscopic sinus surgery may reduce the complications associated with the procedure and allow for a more thorough operation. However, operative time and EBL may be increased.