Computer-aided endoscopic sinus surgery: a retrospective comparative study

ABSTRACT

Endoscopic sinus surgery [ESS], markedly improved with the introduction of new preoperative imaging techniques, intraoperative visualization tools, and the use of surgical navigation systems. In this retrospective study we evaluated the usefulness of CT-guided endscopic sinus surgery and studied its advantages over conventional endscopic sinus surgery. We retrospectively reviewed the records of 60 randomly chosen patients with chronic rhinosinusitis [CRS] and moderate-to-severe sinonasal polyposis, undergoing endoscopic sinus surgery with surgical navigation [n=30] and without navigation [n=30]. Data on the operative note, time of surgery, complications, and recurrence rate were collected and analyzed. Of the 60 patients, 40 [66.7%] were diagnosed with CRS and 20 [33.3%] had allergic fungal sinusitis. Primary surgery was performed in 37 [61.7%] and revision surgery was performed in 23 [38.3%] cases. The computer-aided surgery [CAS] group included 28 [93.3%] patients with extensive disease and 12 [40%] with bone erosions, with intraorbital or extradural extension, while the non-CAS group included 24 [80%] patients with extensive disease and seven [23.3%] with bone erosions, with intraorbital or extradural extension. The average operative time was approximately 13 minutes greater in the navigation group, with significant improvement in the recurrence rate [n=11, 36.7% in the non-CAS group; n=5, 16.7% in the CAS group], and intraoperative complications were fewer in the CAS group [two exposures of orbital fat in the non-CAS group; no complications in the CAS group]. Computer navigational systems appear to serve as a valuable adjunct in preoperative planning and safe intraoperative dissection