The use of image-guided surgery in endoscopic sinus surgery: an evidence-based review with recommendations


  • Potential conflict of interest: T.T.K. and R.R.O. have been consultants to Entellus Medical; V.R.R. has been a consultant to Arthrocare; R.R.O. and M.P.F. have been consultants for Medtronic ENT; and T.L.S. has been a consultant for Intersect ENT.

Correspondence to: Todd T. Kingdom, MD, Department of Otolaryngology–Head and Neck Surgery, University of Colorado, 12631 E. 17th Ave, B205, Aurora, CO 80045; e-mail:



The frequency of endoscopic sinus surgery (ESS) appears to be increasing, and the use of image-guided surgery (IGS) in these procedures is becoming more widespread. The use of IGS in ESS and anterior skull base surgery is predicated on the notion that its ability to aid in anatomic identification during surgery will lead to fewer complications and improved surgical outcomes. The purpose of this article is to provide an evidence-based examination of the benefits of IGS in ESS.


A systematic review of the literature was performed and recommendations were created based on the Clinical Practice Guideline Manual, Conference of Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instruments.


This review identified and evaluated literature regarding the effect of IGS on surgical complications and on postoperative outcomes in ESS. Currently, there is grade C evidence to support the use of IGS in ESS.


Based on the best available evidence in the literature, the use of IGS has not clearly been shown to decrease surgical complications or improve surgical outcomes. These evidence-based recommendations are based on limited literature with suboptimal research methodology. However, the importance, utility, and acceptance of IGS through expert opinion and consensus are supported by the available literature. Therefore, the use of IGS in ESS is an option and should be based on clinical judgment and applied on a case-by-case basis.