Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Mar 18;10(2):e70106.
doi: 10.1002/lio2.70106. eCollection 2025 Apr.

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

Kangchen Lyu  1 , Baoying Tan  1 , Ziling Su  1 , Jianwei Xuan  1
Affiliations
Review

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

Kangchen Lyu et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objective: Although 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 sources: Two independent reviewers searched PubMed, EMBASE, Cochrane, CNKI, WanFang, and VIP to identify comparative clinical studies on clinical outcomes of ESS with or without IGS.

Methods: The 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).

Results: A 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).

Conclusion: Compared 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 evidence: 3.

Keywords: blood loss; chronic rhinosinusitis; complications; endoscopic sinus surgery; image‐guided system; meta‐analysis; recurrence; revision; surgery time; systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram for study selection.
FIGURE 2
FIGURE 2
Forest plot showing the odds ratio of complications in IGS group compared with non‐IGS group. Cl = confidence interval; IGS = image‐guided system; MH = Mantel–Haenszel.
FIGURE 3
FIGURE 3
Forest plot showing the odds ratio of recurrence in IGS group compared with non‐IGS group. Cl = confidence interval; IGS = image‐guided system; MH = Mantel–Haenszel.
FIGURE 4
FIGURE 4
Forest plot showing the odds ratio of revision surgery in IGS group compared with non‐IGS group. Cl = confidence interval; IGS = image‐guided system; MH = Mantel–Haenszel.
FIGURE 5
FIGURE 5
Forest plot showing the mean difference of blood loss in IGS group compared with non‐IGS group. Cl = confidence interval; IGS = image‐guided system; IV = inverse variance.
FIGURE 6
FIGURE 6
Forest plot showing the mean difference of surgical time in IGS group compared with non‐IGS group. Cl = confidence interval; DL = DerSimonian‐Laird; IGS = image‐guided system.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Zhang L., Zhang R., Pang K., Liao J., Liao C., and Tian L., “Prevalence and Risk Factors of Chronic Rhinosinusitis Among Chinese: A Systematic Review and Meta‐Analysis,” Frontiers in Public Health 10 (2022): 986026, 10.3389/fpubh.2022.986026. - DOI - PMC - PubMed
    1. Fokkens W. J., Lund V. J., Hopkins C., et al., “European Position Paper on Rhinosinusitis and Nasal Polyps 2020,” Rhinology 58, no. Suppl S29 (2020): 1–464, 10.4193/Rhin20.600. - DOI - PubMed
    1. Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery, Subspecialty Group of Rhinology, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association , “Chinese Guidelines for Diagnosis and Treatment of Chronic Rhinosinusitis (2018),” Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 54, no. 2 (2019): 81–100, 10.3760/cma.j.issn.1673-0860.2019.02.001. - DOI - PubMed
    1. Stankiewicz J. A., Lal D., Connor M., and Welch K., “Complications in Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A 25‐Year Experience,” Laryngoscope 121, no. 12 (2011): 2684–2701, 10.1002/lary.21446. - DOI - PubMed
    1. Ramakrishnan V. R., Kingdom T. T., Nayak J. V., Hwang P. H., and Orlandi R. R., “Nationwide Incidence of Major Complications in Endoscopic Sinus Surgery,” International Forum of Allergy and Rhinology 2, no. 1 (2012): 34–39, 10.1002/alr.20101. - DOI - PubMed

LinkOut - more resources