The Clinical Outcome of Image-Guided System in Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis

ObjectiveAlthough image-guided system (IGS) is considered useful in endoscopic sinus surgery (ESS), its impact on clinical outcomes needs further evaluation. This study aimed to compare clinical outcomes in patients with chronic rhinosinusitis (CRS) undergoing ESS with or without IGS. Data SourcesTwo independent reviewers searched PubMed, EMBASE, Cochrane, CNKI, WanFang, and VIP to identify comparative clinical studies on clinical outcomes of ESS with or without IGS. MethodsThe primary outcome were total complications. Secondary outcomes were recurrence, revision surgery, blood loss, surgical time, and patient-reported outcomes. A meta-analysis was performed to calculate odds ratios (OR) and weighted mean difference (WMD). ResultsA total of 16 studies were included with a total sample size of 3014 patients. Compared with non-IGS, total complications were less common in IGS group (OR = 0.52, 95% CI, 0.37 to 0.74, p < 0.01), and recurrence rate and revision surgery rate in IGS group was also lower (recurrence rate: OR = 0.31, 95% CI, 0.18 to 0.52, p < 0.001; revision surgery rate: OR = 0.59, 95% CI, 0.36 to 0.98, p = 0.04). What is more, IGS could reduce intraoperative blood loss (WMD = -10.74 mL; 95% CI, -20.92 to -0.57; p = 0.04) and surgical time (WMD = -6.25 min; 95% CI, -9.59 to -2.90, p < 0.001). ConclusionCompared with non-IGS, IGS-assisted ESS was associated with a lower risk of total complications, recurrence, and revision surgery, and with a reduction of intraoperative blood loss and surgical time. These findings support the clinical use of IGS as an adjunct in ESS for CRS patients. Level of Evidence3