Image Guided Endoscopic Sinus Surgery: First Experience from Kashmir Valley

Image guidance is best suited to paranasal sinus surgeries as these demand a high degree of anatomical precision because of close proximity to orbit and cranial cavity which at times is challenging in patients with frequent anatomical variations. This study is aimed to describe our first experience of using image guided endoscopic sinus surgery in Kashmir valley in terms of real time correlation between the operative field and the preoperative imaging; to evaluate its utility in disease clearance and to evaluate patient reported outcome measures using (pre and post-op) VAS, SNOT-22, Lund Mackey endoscopic and radiological scores. This prospective observational study was conducted from September 2016 to August 2018. Patients with the specific inclusion and exclusion criteria were operated using image guidance system. Pre and post operative SNOT-22, VAS, Lund Mackey endoscopic and radiological scoring were compared. Operative time, Instrument accuracy and complications were noted. Out of twenty cases enrolled in this study majority (14) patients (70%) were cases of uncomplicated chronic rhinosinusitis with nasal polyposis. Mean number of sinuses operated were 7.8 +/- 2.14. Set up time for installing navigation system in first 10 cases was on an average 17 +/- 1.67 min and in second 10 cases it was 12 +/- 1.42 min. Mean operative time recorded was 112 +/- 17.32 min. Accuracy of our system was 1.25 +/- 0.73 mm (0.50-1.80) and average blood loss was 100 +/- 23.54 ml. There was statistically significant reduction in postoperative VAS score, SNOT-22 score, Lund Mackey endoscopic and radiological scoring. Revision FESS was done in 12 cases and most common intraoperative absent nasal landmark was middle turbinate in these cases. No orbital or intracranial complication was seen. Minor complications were seen. Image guided surgery is a valuable tool worth use in difficult and revision cases. It makes the surgeon comfortable and saves patient from any major complication.