OBJECTIVES: Image-guided system (IGS) is a technique used to assist the physician during functional endoscopic sinus surgery (FESS), making FESS more accurate and reducing the complications associated with the procedure. The position and anatomical feature of sphenoid sinus make FESS surgery requiring sphenoid resection a challenge. The study seeks to compare the complications and cost of FESS with and without IGS among patients requiring sphenoid resection.

METHODS: Retrospective chart review took place at two tertiary care centers in Shenzhen, China. 84 patients with chronic rhinosinusitis and who underwent FESS involving sphenoid sinus were included from July 1, 2018 to December 31, 2019. The study group consisted of 38 patients who underwent FESS with IGS. The control group consisted of 46 patients who underwent FESS without IGS. The main outcomes for clinical safety were rehospitalization rate due to bleeding, reoperation rate due to bleeding and hospitalization cost.

RESULTS: There was no statistical difference in the baseline characteristic between the IGS and non-IGS groups (P>0.05). In the non-IGS group, there were two cases of rehospitalization due to bleeding; all two patients underwent hemostasis surgery with an incidence of 3.70% (P=0.215). The total hospitalization cost was ￥18,764.23 CNY in the IGS group and ￥19,624.92 CNY in the non-IGS group per patient, with no statistical difference between the two groups (P=0.076). In the case of no difference in the length of stay, although the procedure-related medical costs of IGS group were increased by ￥833.11 CNY compared with the non-IGS group, this was more than offset by drug costs and antibacterial drug costs.

CONCLUSIONS: IGS appears to serve as a valuable adjunct in safe intraoperative dissection. The use of an IGS for FESS involving sphenoid sinus may reduce the complications associated with the procedure and allow for a potentially cost-effectiveness operation.