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

OBJECTIVES: Although image-guided system (IGS) is considered useful in endoscopic sinus surgery (ESS), its impact on the clinical outcome remains further evaluation. This study aimed to compare the clinical outcomes in chronic rhinosinusitis patients undergoing IGS ESS with non-IGS ESS.

METHODS: PubMed, EMBASE, CNKI, WanFang, and VIP databases were searched from the inception up to November 3, 2023, using a search strategy for comparative clinical studies on clinical outcomes of IGS ESS and non-IGS ESS. The primary outcome was total complications. Secondary outcomes were recurrence, revision surgery, intraoperative blood loss, and surgical time. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. A meta-analysis was performed to calculate odds ratios (OR), weighted mean difference (WMD), and 95% confidence intervals (CI) using fixed-effects model.

RESULTS: A total of 627 studies fulfilled the search, of which 16 were included, with a total sample size of 2,845 patients. Meta-analysis indicated that compared with non-IGS, total complications were less common in the IGS group (OR = 0.59; 95% CI, 0.43 to 0.79; P < 0.001). What’s more, IGS could reduce intraoperative blood loss (WMD=-10.08; 95% CI, -19.80 to -0.35; P = 0.04) and surgical time (WMD=-4.28; 95% CI, -5.93 to -2.61; P < 0.001). However, there were no significant differences in the incidence of recurrence (OR=0.65; 95% CI, 0.42 to 1.01; P = 0.06) and revision surgery (OR=0.79; 95% CI, 0.53 to 1.18; P = 0.25) between the two groups.

CONCLUSIONS: In this meta-analysis, the use of IGS compared with non-IGS was associated with a lower risk of complications and with a reduction of intraoperative blood loss and surgical time. These findings do support the clinical use of IGS as an adjunct in ESS for chronic rhinosinusitis patients.