Understanding Use of Image Guidance Technology in Endoscopic Sinus Surgery

by Linda Kossoff •

How is image guidance in endoscopic sinus surgery use associated with surgical outcomes, complications, and surgeon factors?

Bottom Line: The choice to use image-guided surgery (IGS) in any endoscopic procedure is best determined by the operating surgeon, based on case complexity, surgeon comfort, and other factors.

BACKGROUND: Most endoscopic surgeons use image-guided systems as an adjunct during sinus surgery in certain situations. Despite the increased use of IGS technology, however, few studies on the association of IGS with surgical outcomes have been published in recent years, with limited data on the influence of IGS on surgeon satisfaction and stress level.

STUDY DESIGN: Narrative review.

SETTING: Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colo.

SYNOPSIS: Researchers analyzed three review articles to determine potential associations between IGS and surgical outcomes, surgical complications, and surgeon stress, satisfactions, and decision making: a 2013 evidence-based review evaluating five studies; a 2013 systematic review and meta-analysis evaluating 11 studies; and a 2016 systematic review and meta-analysis analyzing seven studies. Considered together, the reviews showed favorable results with respect to IGS and surgical outcomes. Two of the three reviews associated IGS with decreased overall major and orbital complication but no benefit for minor complications or severe hemorrhage; the third review showed mixed results. Investigators found that the mental demands of IGS technology and time pressure may tend to affect younger, less-experienced surgeons more negatively, although training level is also likely a factor. In performance overall, IGS was associated with reductions in mental demand, effort, and frustration, as well as increases in performance perception and satisfaction. Authors conclude that the choice to employ IGS is best determined by the operating surgeon. Limitations included the lack of properly powered studies and potential for numerous types of bias.

CITATION: Beswick DM, Ramakrishnan VR. The utility of image guidance in endoscopic sinus surgery: a narrative review [published online ahead of print January 9, 2020]. JAMA Otolaryngol Head Neck Surg. doi:10.1001/jamaoto.2019.4161.